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National Critical Illness Policy

The National Insurance Critical Illness Policy is a special benefit plan that pays expenses if the policyholder contracts one of the critical illnesses on the list. If the insured experiences a specified procedure or treatment, the policy will pay out a fixed lump sum amount to the insured. When this lump sum is distributed, the disease’s insurance coverage ends and the policy expires.

For those who have a family history of these serious illnesses, this health insurance policy is advantageous so that, in the event, the insured contracts one of them, the associated medical costs won’t be a financial burden. It is best to anticipate the worst and be ready for it. The policy can be renewed till the insured is 65 years of age. Furthermore, this plan is available under two plans; Plan A and Plan B.

Read on to know more about the National Critical Illness policy in detail!

Eligibility Criteria

Here are the eligibility criteria for the National Critical Illness Policy.

ParametersDetails
Age

Minimum- 18 Years

Maximum- 65 Years

Children between the age of five (5) years and eighteen (18) years may be covered, provided parent(s) is/are covered concurrently

Members Covered
  • Spouse
  •  Dependent legitimate or legally adopted children, up to twenty-five (25) years of age
  •  Parents
Sum Insured (SI)The SI is available per insured person is INR 1/ 2/ 3/ 4/ 5/ 6/ 7/ 8/ 9/ 10/ 15/ 20/ 25/ 30/ 35/ 40/ 45/ 50/ 55/ 60/ 65/ 70/ 75 Lakh.
CoveragePlan A – Covering 11 Critical Illnesses Plan B – Covering 37 Critical Illnesses (including Plan A)
Policy Period1 Year

Coverage Details

Here are the coverage details for the National Critical Illness Policy.

ParametersDetails
Family DiscountA discount of 10% (ten percent) is allowed in the premium.
Staff DiscountA discount of 15% shall be allowed on the total premium
Online, Direct, and POS Machine Discount

A discount of 10% shall be allowed on the total premium for policies bought online, by walk-in customers (direct sales), and from

Point of Sale (POS) Machines, where no intermediary is involved.

Criteria for deciding SI in case of earning Proposer
  • Proposer/ Insured: Up to 5 times of annual income
  • Spouse, if earning: Up to 5 times of annual income
  • Spouse, if non-earning: INR 1L to 10L, not exceeding 50% of the SI of the Proposer
  • Dependent children up to the age of 25 years: INR 1L to 5L not exceeding 25% of the SI of the Proposer.
  • Dependent Parents: INR 1L to 5L, not exceeding 50% of the SI of the Proposer
1 Early Entry Discount (EED)An EED of 5% on individual premiums will be allowed starting from the fourth policy period

Key Features and Benefits of Considering National Critical Illness Policy

The following are the important features and benefits of choosing the National Critical Illness insurance Policy.

  • Early Entry Discount – The major benefit of choosing a Critical Illness insurance policy from National Insurance is that an individual may receive a 5% discount on their premium if they purchased a National Critical Illness Policy before the age of 42 (completed years) and renewed it for a continuous period of three years. This will start with the fourth policy period and continue through all subsequent renewals for the duration of the policy.
  • Family Discount – If the policy is purchased for a family, a 10% premium discount is available for eligible family members.
  • Employee Discount – Employees of National Insurance Company who purchase policies to protect themselves and their families will receive a 15% discount on the total premium.
  • Online, Direct, and POS Machine Discount – For policies purchased i) online, ii) by walk-in customers (direct sales), and iii) from Point of Sale (POS) Machines, a 10% discount is permitted on the total premium.
  • Lifelong Renewability: The National Critical Illness Policy has a feature that allows for perpetual renewal. On the insurance provider’s website or by going to one of the company’s locations, people can renew their coverage. To make a payment using the online mode, a person must first enter their policy number on the insurance provider’s website.
  • AYUSH Treatments: The National Insurance Critcalillness Plan includes non-allopathic treatments such as Ayurveda, Unani, Siddha, and homeopathy (AYUSH). These AYUSH procedures are only partially covered, though.
  • Free Look period: The Free Look period will be restricted to new individual health coverage policies; it shall not apply to renewals, porting, or moving of policies. The insured has a period of 15 days from the date of receipt of the policy document to go through the terms and conditions and send back the document if they are unsatisfactory.
  • Portability Benefit: If an insured person wishes to switch to or from a Critical Illness benefit policy offered by any insurer, the insured person must apply with information about the current policy and any claims to the new insurer at least 45 (forty-five) days before the policy expires.

What are the Exclusions Under the National Critical Illness Policy?

The following are the things not included under the National Critical Illness Policy.

  • Waiting Period – the first three months
  • Any Critical Illness PRE-EXISTING before the inception of the Policy.

Non-Payable Conditions, Any Critical Illness resulting out of the following:

  • Congenital, Genetic Disorders, Sterility, Infertility, Assisted Conception
  • Pregnancy
  • Non-Prescribed Drug & Drug Addiction
  • Self-Inflicted Injury
  • AIDS, HIV
  • Cosmetic Treatment, Plastic Surgery, Sex Change, Hormone Replacement Therapy
  • Catheter-based techniques including but not limited to, balloon valvotomy/ valvuloplasty are excluded.
  • Localised scleroderma (linear scleroderma or morphea);
  • Eosinophilic fasciitis;
  • CREST syndrome
  • Removal of a lobe of the lungs (lobectomy)
  • Lung resection or incision
  • Lung disease, chronic hypoventilation, pulmonary thromboembolic disease, drugs, toxins, illnesses of the left side of the heart, congenital heart disease, and any secondary cause are expressly excluded from the definition of pulmonary hypertension.
  • Non-organic diseases such as neurosis and psychiatric illnesses; and
  • Alcohol-related brain damage.
  • Any other type of irreversible organic disorder/dementia.
  • Cysts, Granulomas, malformations in the arteries or veins of the brain, hematomas, abscesses, pituitary tumors, tumors of skull bones, and tumors of the spinal cord.

How to Buy a National Critical Illness Insurance Policy?

It’s encouraging to hear that you’ve chosen to safeguard yourself against potentially fatal medical conditions. You must now purchase the National Critical Illness Health Insurance Plan. However, you cannot purchase the plan on the National Insurance website. There is no need to worry, though. Probus Insurance is still where you can make your purchase.

A dedicated insurance broker, Probus Insurance Broker Private Limited, operates all over India and provides a wide selection of insurance plans (including life and non-life) to meet the exploding demands of the populace.

Listed below are the steps to consider buying the National Critical Illness health plan via Probus Insurance.

  • The “We Are Here” chatbot is located on the right side of this page.
  • You must select your department before entering your full name, email address, and phone number and clicking the “Start Chat” button.
  • You can initiate communication with any of the company’s support agents by clicking it. Ask any questions you may have after that, and they will help you buy the National Critical Illness Policy.

You’re still having trouble making a purchase, right? Not to worry if so! Simply contact a customer service representative at Probus Insurance to purchase a National Critical Illness policy right away. The contact information is provided below.

ParametersDetails
Call+91 7304332968
WhatsAppSay “Hi” to 7304332968
Mailcare@probusinsurance.com

How To File a Claim for Your National Critical Illness Policy?

There are two ways to claim for cashless treatment:

Cashless Procedure for Planned Admission:

  • From the network of hospitals listed in the insurance document, pick one.
  • Three days before admission, notify the third-party administrator (TPA) and supply a membership number.
  • Obtain a hospital cashless request form.
  • Send the application and the medical records to TPA.
  • TPA will examine each document.
  • Once approved, the insurance provider will pay the hospital bills only, not including phone, food, or attendant fees.
  • In the event of rejection, one may request reimbursement.

Cashless procedure for Emergency Admission:

  • Inform the third-party administrator (TPA) and provide your membership number in the event of an emergency admission.
  • Fill out the cashless form in the hospital with a doctor’s certification.
  • Send TPA the form and your medical records.
  • If a cashless facility is approved, medical bills will be paid in full right away.
  • If something is rejected, ask for a refund.

Reimbursement Claim Process:

You must first pay for the treatment before submitting a claim for reimbursement in a reimbursement claim. When you submit a claim, you must present the hospital and medical expense receipts as well as other supporting documentation. The insurance provider, i.e. National Insurance, will credit the money to your bank account after checking the invoices.

You can apply for reimbursement if your cashless claim request is denied or if you or a member of your family needs medical attention at a non-network hospital. Recall to begin the reimbursement procedure seven days after the patient has been released. The steps to start are as follows:

Reimbursement procedure for a claim:

  • Use the toll-free number to contact National Insurance Company and give your membership number.
  • Pay off all hospital bills.
  • When you ask for reimbursement, be sure to include all necessary documents, including bills, prescriptions, discharge summaries, and more.
  • The reimbursement form is available for download and completion on the insurance website.
  • Send the insurance company the form and the medical records.
  • Once the claim is accepted, a check will be issued. The process typically takes 20 days to complete from the date that all documents are received.

Documents Required

An insured will need to provide the following documentation to support the insurance claim:

  • A doctor’s certification attesting to the critical illness’s correct diagnosis
  • A summary of the initial discharge, if any
  • Reports from pathological, radiological, and other diagnostic tests that support the critical illness’s diagnosis.
  • Any other records that the business needs to support the claim.

How To Renew Your National Critical Illness Policy?

All health insurance benefits will be forfeited if a policyholder fails to renew their coverage. The policy expires if it is not renewed and the premium is not paid promptly. This obviates any doubt that any claim made after the policy’s expiration would be denied. Thus, renewing your National Critical illness policy is of utmost importance.

Listed below are the steps to renew your National Critical Illness policy.

  • Go to the official website of National Insurance.
  • On the top, you will see “Quick Renewal”. Click on it.
  • The moment you click on it, you will see a page wherein you will need to enter your Policy Number and then enter the “Captcha” code. After entering all the details, click on “Renew Policy”.
  • After that, you must pay the renewal premium for your insurance. You can then renew your policy using a credit or debit card at that point.
  • Your registered email address and phone number will receive a message with information about your policy after you make the payment.

Frequently Asked Questions

Yes. The option for the policyholders is to add two additional critical illnesses: total and permanent blindness and permanent limb paralysis.

Yes. Under Section 80D of the Income Tax Act of 1961, you may be eligible for tax benefits on the premium you paid for the critical illness plan provided by National Insurance.

Critical illness plans offered by National Insurance protect you from the following illnesses:

  • Coma of Specified Severity,
  • Coronary Artery Bypass Graft Surgery (CABG),
  • Kidney Failure Requiring Regular Dialysis,
  • Open Heart Replacement,
  • Cancer of Specified Severity, etc.

You can alter the sum insured under your family health insurance policy from National Insurance at the time of renewal. Please be aware that National Insurance, regardless of the policy type, amount insured, or premium, does not permit any changes to the sum insured during the term of the policy.

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