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National Health Insurance

Established in 1906, the National Insurance Company is the oldest general insurance company of India. The company was first recognised as a subsidiary of the Government of India but it soon delinked itself from its holding company- General Insurance Corporation of India and became an independent general insurance company in the year 2002. Ever since its separation from the GIC, the National insurance company has created a strong presence nationwide. It deals in a variety of insurance products including health insurance, personal accident, householders’ insurance, motor vehicle insurance and commercial insurance.

Highlights of National Insurance Company

Incurred Claim Ratio (2019-20)103.30%
Network Hospitals 2600+
No. of policies sold (2019-20)1,555,292
Policy renewabilityLifelong
Distinguished achievementFirst Company to introduce office on wheels in India.

National Health Insurance Plans

National insurance company offer a variety of health insurance plans to cater for the diversifying healthcare needs of the customers. Given below is a complete list of the health insurance plans provided by this company.

  1. National Mediclaim Policy

  2. National Mediclaim Plus Policy

  3. National Parivar Mediclaim Policy

  4. National Parivar Mediclaim Plus

  5. Overseas Mediclaim Business and Holiday

  6. Overseas Mediclaim Employment and Studies Plan

  7. National Critical Illness Policy

  8. National Senior Citizen Mediclaim Policy

  9. National Super Top Up Mediclaim Policy

  10. Arogya Sanjeevani Policy

  11. Vidyarthi Mediclaim Policy for Students

  12. Corona Kavach Policy

1. National Mediclaim Policy

This is a comprehensive health insurance policy that provides coverage to the insured as well their family members into a single mediclaim policy. The members that can be covered into this policy include spouse, dependent or adopted children, parents, parent-in-laws, brother and sister (up to 25 years, if a bona-fide student and not employed).

Features:

  • Sum Insured range This policy is available in a wide range of sum insured options ranging from Rs. 1 lakh to Rs. 10 lakhs.
  • Modern treatments Customers can get treatment for 12 Modern treatments including Robotic surgery, oral chemotherapies, immunotherapies and many more. The cover provided for these treatments equals to 25% of the sum insured amount.
  • Pre and Post Hospitalization This plan provides coverage for the medical expenses incurred before and after hospitalization in the form of pre and post hospitalization cover for a period of 45 days and 60 days respectively.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age18 years65 Years
Policy period1 year
Premium Payment TermAnnually, half yearly and quarterly

2. National Mediclaim Plus Policy

National mediclaim plus is an upgraded version of the National mediclaim policy and comes with some additional benefits along with higher sum insured options. There are three different plan options available for customers to select their sum insured range and slab conveniently.

Features:

  • Higher sum insured- This policy is available for high sum insured amounts ranging upto Rs 50 lakhs. There are three plan options available for selecting the sum insured amount-
    1. Plan A – 9 slabs, 2L to 10L in multiple of 1L
    2. Plan B – 3 slabs, 15L/ 20L/ 25L
    3. Plan C – 3 slabs, 30L/ 40L/ 50
  • Special discounts- There are special discounts provided on this policy when purchased online or for family, and youth discounts of 10%.
  • Optional covers- The plan also offers additional benefits in the form of optional cover for critical illness and outpatient treatment.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age18 years65 Years
Policy period1 year

3. National Parivar Mediclaim Policy

This is a family floater policy that is designed for customers who wish to cover their family members under a single policy and within a single sum insured amount.

Features:

  • Long Term Policy- The plan is available for longer policy terms ranging between 1 to 3 years and also offers attractive discounts to customers who opt for long term policy.
  • Maternity/Infertility Discount- Customers above the age group of 45 years can avail special maternity and infertility discounts with this plan.
  • Zone wise premium discount- There are special discounts available for customers depending upon the zone where they live and/or buy the policy.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age18 years65 Years
Policy period1, 2, and 3 years

4. National Parivar Mediclaim Plus

This plan is an advanced version of the National Parivar Mediclaim Plus plan. It offers higher sum insured amount ranging upto Rs.50 lakhs and the distribution of the sum insured is made into three plans which allow customers to select an amount that fits their budget conveniently.

Features:

  • Sum insured range- The plan is offered with higher sum insured options ranging between Rs. 6 lakhs to Rs. 50 lakhs. There are three plan options available for selecting the sum insured amount-
    • Plan A – 5 slabs, 6L to 10L in multiple of 1L
    • Plan B – 3 slabs, 15L/ 20L/ 25L
    • Plan C – 3 slabs, 30L/ 40L/ 50L
  • Pre-existing disease cover- This policy has a special provision which allows customers to cover pre-existing diseases such as diabetes and hypertension after paying an additional premium amount.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age18 years65 Years
Policy period1, 2, and 3 years

5. Overseas Mediclaim Business and Holiday

This is a comprehensive health insurance policy that provides coverage to the policyholders in case they face any travel emergencies while travelling abroad. The policy is provided to three categories of travellers:

  1. Business & Holiday

  2. Employment and Study

  3. Corporate Frequent Traveller

Features:

  • The coverage under this plan is provided within a variety of sections as defined below-

    1. Section A Medical expenses & repatriation

    2. Section B Personal accident

    3. Section C Delay of checked in baggage

    4. Section D Loss of checked in baggage

    5. Section E Loss of passport

    6. Section F Personal liability

  • All the above listed plan options can be bought online using credit, debit cards as well as net banking.

  • There is also a Plan K option available under this policy that provides cover to the insured while travelling in Asian countries excluding Japan for business and holiday limited to US$ 15,000.

6. Overseas Mediclaim Employment and Studies Plan

This mediclaim insurance is a comprehensive policy that provides coverage for travel emergencies that occur while the insured person is travelling abroad. It is available for three categories of travellers-

  1. Business & Holiday

  2. Employment and Study

  3. Corporate Frequent Traveller

Features:

  • The plan provides cover for medical expenses, evacuation, repatriation, medical emergency reunion and contingency insurance.

  • In addition to the above listed expenses, the policy also provides cover for loss and delay of checked in baggage.

7. National Critical Illness Policy

As the name suggests, National Critical Illness policy is a type of health insurance plan that provides financial coverage to the policyholder for the expenses incurred by him/her during the treatment of any of the listed critical illnesses. The cover is provided in the form of a lump sum payment when the insured is diagnosed with or undergoes a specified critical illness

Features:

  • Plan options: This policy is available within two different plan categories.
    • Plan A covers 11 Critical Illnesses
    • Plan B covers 37 Critical Illnesses (including that one covered in plan A)
  • Sum insured range: The plan provides wider coverage by offering a high sum insured amount ranging between Rs.1 lakhs to 75 lakhs.
  • Pre-existing disease cover: Customers can also cover their pre-existing diseases under this policy by paying an additional premium amount.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age18 years65 Years

8. National Senior Citizen Mediclaim Policy

This is an indemnity based health insurance policy that is specially designed for individuals above the age group of 60 years. The plan is available in the form of both an individual basis and floater basis.

Features:

  • Sum Insured options: This plan is available in a variety of sum insured options in the form of two plan options- Plan A and Plan B. In Plan A, there are 10 slabs which range between Rs 1 lakhs to Rs. 10 lakhs. Plan B also provides the same sum insured along with some additional features such as hospital cash, cover for funeral expenses, and many more.
  • Annual Increase in Sum Insured: This policy offers an annual increase in sum insured amount by 5% for each claim free year made by the policyholder. The maximum increase offered equals to 50% of the opted sum insured amount.
  • Optional covers- In addition to the basic benefits, the plan also offers additional protection in the form of optional cover such as OPD, critical illness, and personal accident cover.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age

Individual basis- 60 years

Floater basis- 18 years

Individual basis- 80 years

Floater basis- 65 years

9. National Super Top Up Mediclaim Policy

This is a top up health insurance plan that comes with a high threshold limit and can be purchased with or without a base policy. Customers can take this policy to cover their family members under a single sum insured on floater basis or each member on an individual sum insured basis. sum insured at reasonable cost.

Features:

  • Coverage for commonly excluded diseases: A distinguishing feature of this policy is that it covers a variety of diseases that are usually excluded from standard health insurance plans. These diseases include HIV/AIDS, obesity- bariatric surgery, mental illness and genetic disorders.
  • Special discounts: Customers can avail attractive discounts on this policy on a variety of conditions such as early entry, opting for family cover (in individual policies only) and online purchase.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age18 years65 Years
Policy period1 year

10. National Arogya Sanjeevani Policy

National Insurance Arogya Sanjeevani policy is a basic indemnity based health insurance plan that provides financial coverage to the policyholders for a maximum sum insured amount of Rs 10 lakhs. This plan is available in both types- individuals as well as floater type.

Features:

  • Sum insured options: This policy is available in a variety of sum insured options ranging between Rs. 50,000 to Rs. 10 Lakhs.
  • Premium instalment facility: To make premium payment convenient for the customers, this policy provides an instalment facility for paying the premium amount.
  • Online discounts: The plan offers special discounts if the policy is purchased online without any intermediary.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age18 years65 Years
Policy period1 year

11. Vidyarthi Mediclaim Policy for Students

This is a special category of health insurance policy that provides health and personal accident cover for students. The plan also offers financial cover to the insured student for allowing him/her to continue the education in case of death or permanent total disablement of the guardian.

Features:

  • The policy is available within three sections that provide different types of covers. Given below is a description of these sections-
    • Section I- This covers hospitalization expenses of students.
    • Section II- It provides cover in case of personal accidents of the parents.
    • Section III- This provides cover for personal accidents of insured students.
  • This policy can also be purchased by Educational Institutions in the form of a group policy to cover the students of their institute.
  • There is no pre-policy health check-up required for buying this policy.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age3 years25 Years
Policy period1 year

12. National Corona Kavach Policy

This is a newly launched standard insurance policy that is designed to address the basic health insurance needs of insured persons that arise when the person is diagnosed or being treated with COVID-19 disease.

Features:

  • Sum Insured range: This policy comes with a wide range of sum insured options starting from Rs. 50,000 to Rs. 5 lakhs.
  • Covid expenses cover: A variety of covid related expenses such as PPE Kit, gloves, mask, cost of pulse oximeter, oxygen cylinder, nebulizer are also covered in this plan.
  • Special discounts: The plan offers a special of 5% discount for health care workers and 10% discount on online purchase of the policy where no intermediary is involved.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age18 years65 Years
Policy period3 ½ months. 6 ½ months and 9 ½ months

Reasons To Choose National Health Insurance Plans

Network Hospitals

Whenever a customer purchases any health insurance policy, the first thing that he/she seeks for is cashless hospitalization. And a very important factor related to cashless hospitalization is network hospitals because customers can avail cashless treatment facility only in the network hospitals provided by their insurer. Fortunately, National Insurance company has partnerships with a large number of hospitals across various cities in India which helps its customers to avail cashless treatment easily during medical emergencies. At present, this company has more than 2600 network hospitals in its list.

Claim Settlement

There is no point in buying an insurance policy where the claim is not settled timely. That is why, while buying insurance, it becomes very important to make sure that the insurer settles the claim and provides the required financial assistance during a medical emergency. Claim settlement ratio is a useful parameter that can be used to determine the claim paying ability of the insurance company. In the case of National Insurance, this company has a good claim settlement history and has a satisfactory claim support ratio of 45.37%. This ratio reflects that out of all the claims registered by the company in 2019-20, 45.37% of them got settled within three months.

Solvency Ratio

Customers are always advised to buy insurance policies from a company that is financially sound and reputed in the market. This provides an assurance that the provider holds enough funds to settle all the future payments of the customers. And to check this, there’s a very useful parameter called ‘solvency ratio’ which measures the company’s ability to meet its long-term debt obligation. The solvency ratio of the National Insurance company is 0.37%.

Country-wide presence

National Insurance company has established a strong presence which includes several offices in India and a foreign office in Nepal. At present, the company has around 1730 offices and more than 13000 skilled employees along with 50,000 agents spread all over the nation.

Steps to Calculate the Premium of National Health Insurance Plans

Customers can now check the premium amounts for National health insurance plans online from the company’s website. To do this, they should follow the below stated steps:

  • Visit the official website of the National Insurance company.
  • From the top menu bar select ‘Products’ and click on the ‘Health’ tab.
  • Click on the ‘Get Quote/Buy Policy’ menu and select your desired plan.
  • Click on the ‘Download’ tab from the plan page.
  • From the download section, click on the link- ‘Rate chart with GST’.
  • A pdf will be downloaded that includes premium rates for different age groups and sum insured amounts.
  • Locate your age group, sum insured amount and check the premium rate accordingly.

For your convenience, we’ve created a table below that shows sample premium rates of National Mediclaim Policy. Please note that the amounts in this table are calculated for a healthy male person of age group between 18 to 25 years and includes GST charges as well.

Sum insured amount Premium rate
Rs. 50,000Rs. 1,455
Rs. 2,00,000Rs. 3,912
Rs. 4,00,000Rs. 6,406
Rs. 5,00,000Rs. 6,632
Rs. 6,00,000Rs. 7,174
Rs. 8,00,000Rs. 8,246
Rs. 10,00,000Rs. 9,256

Buying Process of National Health Insurance Plans

The buying process of National insurance plans is quite simple. The company sells some of its products online and the remaining few through the standard offline method. Given below is a detailed description of both the buying processes. Let’s take a look.

Offline Process

  1. Visit the nearest office of National Insurance Company either directly or through an authorised agent.

  2. Collect the proposal form and fill it.

  3. Submit the proposal form at the branch either directly or through an authorised agent.

  4. The company will provide premium estimates to the customer.

  5. The policy will be issued to the customer either directly on request or through registered post.

Online Process

  1. Visit the official website of the National Insurance company.

  2. From the top menu bar select ‘Products’ and click on the ‘Health’ tab.

  3. Click on the ‘Get Quote/Buy Policy’ menu.

  4. Pick your desired plan and submit the required details.

  5. Make an online payment of the premium amount.

After receiving the premium amount, the company will send a soft copy of the policy on your registered email ID.

Steps to renew your National health insurance policy

Health insurance plans by National Insurance company come with lifelong renewability. Customers can easily renew their policy online by visiting the official website of the company. Given below is a step by step guide for renewing health insurance policy online-

  1. Visit the official website of the company.

  2. Click on the ‘Quick Renewal’ tab from the menu bar.

  3. Fill in your ‘Policy Number’ and ‘Captcha’ to continue.

  4. Submit the required details and make the payment.

Once the payment is made, the company will provide you the renewal confirmation document on your registered email ID.

How to file claims for National health insurance plans?

National Insurance company adopts two methods for settling the claims- Cashless and Reimbursement method. Given below is a detailed description of filing a claim under both these methods. Let’s take a look-

Cashless Claim Facility

  1. In case of planned hospitalization, the customer should intimate the company 72 hours prior to the admission along with complete details of the insured, address of the hospital and condition requiring hospitalization.
  2. In case of an emergency hospitalisation, customers can send the intimation to the company within 24 hours of admission.
  3. After the patient is admitted, the hospital will send a pre-authorisation request form for cashless claim to the company. This form should be duly signed by the insured and Hospital Authorities and must include the details of admission, illness, proposed line of treatment and the estimated expenses.
  4. After checking the pre-authorisation form and all other documents, the company will settle the claim.
  5. Customer can claim pre and post hospitalisation expenses separately after taking the treatment.

Reimbursement Claim Facility

  1. In case of planned hospitalization, the customer has to provide intimation to the Company either in written form or through mail or fax 72 hours prior the hospitalisation.
  2. The intimation should be given within 72 hours of hospitalisation in the case of emergency hospitalisation.
  3. Customers should submit all the original documents and hospital bills to the company within 15 days from the date of discharge.\
  4. After verifying all the documents, the company will provide the claim amount to the policyholder.

Frequently Asked Questions

1. What documents should I submit while filing a claim?

Here’s a complete list of documents that should be submitted to the company while filing for a claim-

  • Duly filled Claim form.

  • Original hospital bills, payment receipts, medical history of the patient recorded, discharge certificate.

  • Original cash-memo from the hospital and chemist.

  • Original payment receipt, investigation test reports along with prescription report from attending doctor.

  • Doctor/Surgeon’s original certificate stating diagnosis and nature of operation performed along with bills and receipts.

  • Any other document as requested by the company.

2. What are the exclusions of National health insurance plans?

National Insurance health plans have a certain set of excluded conditions under which no coverage is provided to the insured person. Here is a list of those conditions-

  • Any type of disease or accidental injury arising due to drug/alcohol abuse.

  • Claims arising out of participation in military, naval, or air force operations.

  • All types of injury or illness that are caused by war, invasion, any terrorist act, or riot.

  • Expenses incurred on the treatment of sexually transmitted diseases such as HIV or AIDS.

3. How can I track my claim status?

Steps for checking the status of your claim are:

  • Visit the official website of the company.

  • Locate the menu bar given at the extreme right section of the page and click on ‘Track claim status’ option.

  • Enter the required details about your policy and click on ‘Submit’.

  • The next page will provide you with the details and status of your claim request.

4. Should I buy another policy to cover covid-19 treatment even if I’ve an existing health insurance policy from National Insurance?

If you have an existing health insurance cover from National Insurance, then you can avail of treatment cover for coronavirus-related ailments in your existing policy itself. The company has adopted a new policy wherein if the customer is hospitalized for a minimum period of 24 hours for treatment of Covid-19, then the company will provide cover for medical expenses in all standard health insurance policies.

5. Is it compulsory to perform a pre-policy check up before buying a health insurance policy from National Insurance?

Customers are required to perform a pre-policy check only if they satisfy any one of the below-mentioned conditions-

  • If age of the proper is 40 years or above,

  • While opting for Sum insured amount of Rs. 6 lakhs and above

  • While opting for Critical Illness optional cover, between the age of 18 and 65 years

6. Does the company reimburses the expenses incurred on pre policy checkup?

Yes, as per the norms of the company, customers will get 50% of their expenses incurred on pre-policy checkup reimbursed, but only when the proposal is accepted and the premium has been realized.

7. Which diseases are covered under the National Insurance critical illness policy?

The Critical illness policy from the National Insurance Company provides cover for a total of 37 critical illnesses. Given below is a list of those illnesses:

1. Cancer of Specified Severity

2. Myocardial Infarction (First Heart Attack of Specified Severity)

3. Open Chest Coronary Artery Bypass Graft Surgery (CABG)

4. Open Heart Replacement or Repair of Heart Valves

5. Coma of Specified Severity

6. Kidney Failure requiring Regular Dialysis

7. Stroke Resulting in Permanent Symptoms

8. Major Organ/Bone Marrow Transplant

9. Permanent Paralysis of Limbs

10. Motor Neurone Disease with Permanent Symptoms

11. Multiple Sclerosis with Persisting Symptoms

12. End Stage Liver Failure

13. Third Degree Burns

14. Goodpasture’s Syndrome

15. Apallic Syndrome

16. Aplastic Anaemia

17. Systemic Lupus Erythematosus with Lupus Nephritis

18. Bacterial Meningitis

19. Multiple System Atrophy

20. Progressive Scleroderma

21. Aorta Graft Surgery

22. Pneumonectomy

23. Primary (Idiopathic) Pulmonary Hypertension

24. Primary Parkinson’s Disease

25. Alzheimer’s Disease

26. Benign Brain Tumour

27. Cardiomyopathy

28. End Stage Lung Failure

29. Brain Surgery

30. Progressive Supranuclear Palsy

31. Creutzfeldt-Jakob Disease (CJD)

32. Major Head Trauma

33. Encephalitis

34. Blindness

35. Deafness

36. Loss of Speech

37. Loss of Limbs