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National Mediclaim Policy

The National Mediclaim Policy is an indemnity health insurance policy specifically designed to offer comprehensive coverage to the policyholders. The plan was launched by the National Insurance Company with the primary aim of providing financial assistance to the insured in case of unexpected medical emergencies.

Once purchased, the health insurance plan gives benefits like access to both allopathic and homeopathic therapies. Moreover, it can be renewed for as long as the policyholder lives. To get an insight into how the National Mediclaim Policy can benefit you and your family, you need to understand the features, benefits, and various other details of the policy. This post will discuss all the important aspects of the plan so that you can make a wise decision.

Eligibility Criteria Of National Mediclaim Policy

Minimum Entry AgeFor Adults: 18 Years, For Children: 3 Months
Maximum Entry AgeFor Adults: 65 Years, For Children: 18 Years
Sum InsuredRs. 1 Lakh To Rs. 10 Lakhs
Policy Period1 Year
Policy TypeIndividual
RenewabilityLifelong

Coverage Details of National Mediclaim Policy

Every plan has a unique set of features. Similarly, the National Mediclaim Policy comes with a range of features that allows the policyholders to trust the plan. Let’s check them out in the table given below!

CoveragesStatus
Pre-Hospitalization Expenses45 Days
Post-Hospitalization Expenses60 Days
Modern Treatments12 Treatments
Medical Practitioner’s Fees25% Of SI
Room Charges25% Of SI
Daycare ProceduresCovered
Ayurveda & HomeopathyCovered
HIV/AIDSCovered
Mental IllnessCovered
Organ Donor ExpensesCovered
Ambulance CoverUp To Rs. 2000 In A Policy Period
Morbid Obesity TreatmentCovered
Correction Of Refractive ErrorCovered

Upsides Of National Mediclaim Policy

National Mediclaim Policy offers a wide range of benefits to the policyholder. Some of them are as discussed below:

  • Reinstatement Of Basic Sum Insured: If the available sum insured is exhausted at any time during the policy period due to a hospitalization claim and if your basic sum insured is Rs. 6 lakhs and above, the plan will reinstate the basic sum insured (i.e., excluding any CB) to be used in any subsequent hospitalization. 
  • Cumulative Bonus: Each insured person is qualified to receive a Cumulative Bonus (CB) at a rate of 5% of the basic sum insured for each claim-free policy period on the condition that the policy is continuously renewed with the company without a break in policy.
  • Preventive Health Check-Up: At a maximum cost of 1% of the average sum insured, the plan will additionally pay for a health examination once at the conclusion of a block of four claim-free policy periods.
  • Enhancement Of Basic Sum Insured: The plan offers the option to enhance the basic sum insured at the time of renewal. The coverage for enhanced basic sum insured will be available after the completion of the waiting periods. 
  • Discount Benefits: A discount on the overall premium is given if the proposer/insured chooses to make an optional co-payment under the policy. The insured may choose between the following two options:
    • For 20% Co-Payment: 50% Discount
    • For 15% Co-Payment: 10% Discount

Moreover, a 10% reduction will be given on the total premium for both the first policy and any subsequent renewals if the policy is purchased online, in person, or directly from the consumer (without the use of an intermediary).

  • Pre-Policy Health Check-Up: People over the age of 50 who are purchasing the National Mediclaim insurance from the company for the first time must have a pre-policy checkup. If the proposal is approved, the company will pay back 50% of the costs associated with the pre-policy examination.
  • Tax Benefits: Under Section 80 D of the Income Tax Act, 1961, the proposer or insured can avail tax benefits for the premium amount paid for the plan. This enables the policyholder to save a significant amount of money, which he/she can use for other important purposes.

What’s Ruled Out Under National Mediclaim Policy?

The plan does not cover the following expenses:

  • Change of gender treatments
  • Cosmetic or plastic surgery
  • Drugs or alcohol abuse
  • Self-inflicted injury
  • Home visit charges
  • Non-prescription drugs
  • Dental treatment (unless arising due to an accident and needing hospitalization)
  • OPD treatment

Premium Illustration Of National Mediclaim Policy

It is very important to understand the premium of the National Mediclaim Policy because the amount defines the benefits and coverages you will enjoy during the policy tenure. Therefore, we have calculated premiums amounts while keeping in mind various parameters, such as age, gender, and sum insured. The same is illustrated in the table below so that you can have a better understanding of the plan’s premium amount.

NameAgeGenderSum InsuredPremium Amount
Vicky Singh30 YearsMaleRs. 1 LakhRs. 2,718
Sharmila Kumari47 YearsFemaleRs. 5 LakhsRs. 7,422
Pankaj Gupta56 YearsMaleRs. 7 LakhsRs. 27,293
Vaishnavi Uppal63 YearsFemaleRs. 10 LakhsRs. 44,698

Frequently Asked Questions

The plan covers the following members of the family:

  • Self
  • Spouse
  • Dependent natural or legally adopted children, 
  • Parents
  • Parent-in-laws
  • Brother till marriage
  • Sister if not employed, till marriage
  • Newborn from 3 months age

In the pre-policy check-up of the plan, the following reports are required:

  • Blood sugar test
  • Physical examination
  • Lipid profile
  • Serum creatinine
  • Urine routine and microscopic examination
  • ECG
  • Eye checkup (including retinoscopy)
  • Any other investigation required by the company

Yes. As per the IRDAI guidelines, the insured is allowed to port the policy with a similar product.

Yes. The policy 15-day free-look period, within which you can cancel the policy if you are dissatisfied with the terms and conditions.

Yes. The midterm inclusion of family members is allowed only in the case of new-born between the age of 3 and 6 months and spouses within 60 days of marriage.

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