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National Group Mediclaim Policy

National Group Mediclaim Policy is a group indemnity health insurance product designed specifically to address the basic health insurance need of both employer-employee and non-employer–employee groups. The Policy covers Hospitalization Expenses for In-Patient Care, or Day Care Treatment Reasonably and Customarily incurred for treatment of an Illness contracted/Injury sustained during the Policy Period. This is an ideal group policy that can cater to the needs of the different groups. To know more about this policy, have a look at the following mentions.

Eligibility Criteria

Age at entry

For adults – 18 years and above

For children –

Children between the age of 3 months and 18 years may be covered, provided parent(s) is/are covered at the same time.

Who can avail of the policy?
  • Self
  • Spouse
  • Dependent legitimate or legally adopted children
  1. Dependent child up to 18 years of age
  2. Dependent male child above 18 years and up to 25 years of age, if a bonafide student and not employed
  3. Dependent female child if not employed, till marriage
  • Dependent parents
Mid-term inclusion of the family members
  • Newborns between the age of 3 months and 6 months
  • Spouse within 60 days of marriage
  • Family members other than above may be included only at renewal
Policy period1 year
Sum insured

Minimum – Rs. 50,000

Maximum- Rs. 10 lakhs

Minimum group size7 members
Policy typeIndividual basis

Coverage Details

The following table gives a glimpse of the coverage of the policy. Have a look.

ParametersSub-limits
Room chargesMaximum amount admissible – 25% of the sum insured
Medical practitioner’s fees25% of the sum insured
Other expenses50% of the sum insured
Modern treatment expensesMaximum up to 25% of the sum insured. It can be extended up to 50%.
Expenses related to non-professionals in hazardous or adventure sports25% of the sum insured
Pre-hospitalization expenses30 days
Post-hospitalization expenses60 days

Key Highlights of National Group Mediclaim Policy

This plan has come up with a bucket full of benefits and facilities. The important mentions are as follows.

Hospitalization Expenses:

All the expenses related to hospitalization, such as anesthesia, blood, oxygen, operation theatre charges and surgical appliances, medicines and drugs, diagnostic procedures, prosthetics, and other devices or equipment, if implanted internally during a surgical procedure, are covered under this plan.

AYUSH Treatment:

The Company will indemnify the Hospital or the Insured Person for the Medical Expenses (including Pre and Post Hospitalisation Expenses) incurred for Ayurveda and Homeopathy treatment, provided the treatment is undergone in an Ayush Hospital.

Day Care Treatment:

In case of any surgeries/procedures which would have otherwise required a Hospitalization of more than twenty-four hours, but due to advancement of medical science require Hospitalisation for less than twenty-four hours, will be covered subject to prior approval of the Company/TPA.

Mental Illness Cover:

The policy will cover the Medical Expenses (including Pre and Post Hospitalisation Expenses) related to Mental Illnesses, provided the treatment will be undertaken at a hospital with a specific department for Mental Illness under a Medical Practitioner qualified as a Psychiatrist or a professional.

Organ Donor Expenses:

The Company will indemnify the Hospital or the Insured Person, the Medical Expenses (excluding Pre and Post Hospitalisation Expenses) incurred for the organ donor’s treatment during the course of organ transplant to any Insured Person. Terms and conditions are applicable.

Ambulance Charges:

The Company will reimburse the Insured Person the expenses incurred for emergency ambulance charges, up to 1% of the Sum Insured subject to a maximum of Rs. 1,000/- in a Policy Period for each Insured Person, for transportation to the Hospital or from the Hospital to another Hospital or from the Hospital to diagnostic center and return during the same Hospitalisation. Ambulance Charges will be admissible provided a Hospitalisation claim has been admitted under the Policy.

Maternity Benefit (Optional):

The policy will pay Maternity Expenses up to Rs. 50,000/- for up to the first two deliveries or terminations of pregnancy of the Insured Person, as described below, and pre-natal and post-natal hospitalization expenses per delivery.

General Exclusions of National Group Mediclaim Policy

Before buying an insurance plan, it is very important to know and understand the exclusions of the policy for which it does not offer any coverage to avoid any future problems. So, to avoid future complexities and claim denial, here are the general exclusions of the National Group Mediclaim Policy.

  • Any self-inflicted injury, suicide, or suicide attempt falls under the category of exclusions.
  • Diagnosis expenses not related to the current diagnosis and treatment are not covered by the plan.
  • If you are having bed rest and do not have any medical treatment for the disease, it is not covered by the policy.
  • Any treatment cost related to obesity control will not be compensated by the policy.
  • Any unrecognized or unauthorized medical procedure is to be excluded and the doctor, surgeon, or medical practitioner has to be licensed and registered.
  • Any treatment or surgery related to gender treatment will not be reimbursed by the company.
  • Cosmetic surgery and plastic surgery are not covered by the plan.
  • If you take part in any kind of hazardous activities or adventurous sports like sky diving, para-gliding, scuba diving, etc., and gain injury from that, that is not covered by the plan unless it is not taken as an optional cover.
  • Injury incurred due to the participation in any unlawful act or due to war, war-like situation, riots, public unrest, etc, will not be covered by the policy.
  • Treatments for the consumption of alcohol, drug, or any intoxicating substance are excluded.
  • Gestational Surrogacy and reversal of sterilization are excluded.

Buying Process of the National Group Mediclaim Policy

One can easily buy this policy by following the below steps.

  • Go to the official website of the National Health Insurance Company.
  • Click on the Products tab available on the homepage and select the health option.
  • Then, click on the Know More option.
  • Scroll down a bit, and find the National Group Mediclaim Policy. Click on that.
  • Scroll down the landing page. There you will find the Buy Policy Online Option. Click on that.
  • Put your customer id and password to log in to the online customer account.
  • Put the necessary details, such as personal details and policy-related details.
  • On the basis of the given details, the premium amount will be displayed.
  • Check all the details twice, and if satisfied, pay the premium amount online safely.
  • Download the policy document.

Claim Process of National Group Mediclaim Policy

The following steps have to be followed to avail of a successful claim experience.

  • After the occurrence of the incident, intimation is to be given to the policy issuing office immediately.
  • Above step will be preceded by lodging an FIR at the nearest Police Station if necessary.
  • Collect relevant claim forms.
  • Fill up the claim form correctly after reading it thoroughly.
  • Submit the claim form to the policy issuing office either directly or by an authorized Agent along with documents required/asked for, such as Police Reports, Doctors’ Prescriptions, Reports of Pathological tests, Cash Memos from the Chemists Shop for the medicine purchased, Admission and Discharge Certificates, Receipts from Surgeon, Doctors, etc. as the case may be.
  • The policy issuing office may appoint Surveyor/ Loss Assessor or may refer the case to panel doctors if necessary.
  • The claim is finally settled and payment is made to the Policyholder as a full and final settlement of the claim.
  • Please note in some cases, provisional payment is also made to the Policyholder pending the final processing of the claim, depending on the merits of the case.

Frequently Asked Questions

Target Group can be all combinations viz, Employer-Employees, Non-Employer-Employee covering all Social Sectors, Corporates / Non-Corporates.

The following modern treatments are covered:

  • Uterine Artery Embolization and HIFU (High intensity-focused ultrasound)
  • Balloon Sinuplasty
  • Deep Brain stimulation
  • Oral chemotherapy
  • Immunotherapy- Monoclonal Antibody to be given as an injection
  • Intra vitreal injections
  • Robotic surgeries
  • Stereotactic radio surgeries
  • Bronchial Thermoplasty
  • Vaporization of the prostrate (Green laser treatment or holmium laser treatment)
  • IONM – (Intra Operative Neuro Monitoring)
  • Stem cell therapy: Hematopoietic stem cells for bone marrow transplant for hematological conditions to be covered

No change (increase or decrease) of the sum insured is to be allowed during the policy period. Enhancement of SI is allowed at renewal.

The following group discounts are available.

Number of primary membersGroup discount
Up to 500NIL
501-20005%
2001-500010%
5001 and above15%

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