National Insurance Young India Mediclaim Policy
National Young India Mediclaim Policy is an Indemnity Health Insurance Policy and can be issued on an Individual or Floater basis. The policy covers expenses incurred due to Hospitalisation for In-Patient Care or Day Care Treatment Reasonably and Customarily incurred for treatment of an Illness contracted/Injury sustained during the Policy Period. All pre-existing diseases are included after the first 3 years (36 months) of the policy. Additionally, Optional Covers are also available with this policy. To know more about this plan, have a look at the following mentions.
|Age at entry|
|Minimum member on a floater basis||2 members|
|Policy period||1 year and 3 years|
|Basic sum insured options||Rs. 3 lakhs, Rs. 5 lakhs, and Rs. 10 lakhs.|
The following table gives an idea about the policy and its sub-limits.
|Cumulative Bonus||From 5% to 50%, for claim-free years.|
|Daycare procedures||Up to the sum insured|
|Modern treatment||25% of the sum insured|
|Death (personal accident cover)||100% of the sum insured|
|Permanent total disablement||100% of the sum insured|
Key Benefits of the National Young India Mediclaim Policy
This policy has come up with a bucket full of benefits and facilities. Some of the important mentions are as follows.
AYUSH Treatment Expenses:
The Company will indemnify the Medical Expenses pre and post-hospitalization expenses up to the Sum Insured, incurred for Ayurveda and Homeopathy treatment up to the Sum Insured, provided the treatment is undergone in an AYUSH Hospital.
The policy will cover the expenses incurred for transportation to the Hospital or from the Hospital to another Hospital or from the Hospital to the diagnostic center and return to the Hospital during the same Hospitalisation.
The policy will cover the Medical Expenses incurred for all Hospitalization(s) covered under the Policy:
- Room Rent and Intensive Care Unit Charges (including diet charges, nursing care by a qualified nurse, RMO charges, and administration charges for IV fluids/blood transfusion/injection)
- Medical Practitioner(s) fees
- Anesthesia, blood, oxygen, operation theatre charges, surgical appliances
- Medicines and drugs
- Diagnostic procedures
- Prosthetics and other devices or equipment if implanted internally during a surgical procedure.
- Dental Treatment was necessitated due to an injury
- Plastic surgery necessitated due to disease or injury
- Hormone replacement therapy, if medically necessary
- Vitamins and tonics, forming part of treatment for disease/injury as certified by the attending medical practitioner
- Circumcision, necessitated for treatment of a disease or injury
It offers coverage for Maternity Expenses of the Insured or Spouse only, and also Pre-Natal and Post-Natal Hospitalisation expenses per delivery. The New Born Baby shall be automatically covered under the available Maternity Benefit limit from birth for up to 3 months, including expenses for vaccination. Hospitalization is not required for vaccination.
Reinstatement of Basic Sum Insured:
For Policies with Basic Sum Insured of Rs. 5 lacs and above, in the event of the available Sum Insured being exhausted anytime during the Policy Year on account of Hospitalization claim(s), the Company shall reinstate the exhausted Basic Sum Insured (i.e., excluding any CB) to be utilized in any subsequent Hospitalisation(s) during the same Policy Year.
For each claim-free Policy Year, the Cumulative Bonus allowed shall be an amount equal to 5% of the Basic Sum Insured (excluding CB) of the expiring Policy Year. If a claim is made in any particular Policy Year, the CB accrued shall be reduced at the same rate at which it has accrued. However, Basic Sum Insured will be maintained and will not be reduced. CB shall be accumulated and available on renewal. Maximum CB shall not exceed 50% of the Basic Sum Insured of the renewed Policy.
General exclusions of the National Young India Mediclaim Policy
While talking about the benefits and inclusions of the plan, one also needs to know about the exclusions of the plan to get a comprehensive idea of the policy and avoid future complications. Here are the mentions.
- If one files a claim within the waiting period, the claim will be rejected.
- Self-inflicted injury, suicide, or suicide attempt will not be covered by the policy.
- Any injury incurred due to war, an act of war, hostility, violent act by foreign enemies, or martial law is not covered by the policy.
- If any injury derives from any kind of criminal activity involving the insured person, he/she will not be compensated for that by the policy.
- The expenses of all non-medical items, such as food, extra room tariffs, and so on, are not covered by this policy.
- Any treatment or surgery related to gender treatment will not be reimbursed by the company.
- Any unrecognized or unauthorized medical procedure is to be excluded and the doctor, surgeon, or medical practitioner has to be licensed and registered.
- Diagnosis expenses not related to the current diagnosis and treatment are not covered by the plan.
Buying Process of the National Young India Mediclaim Policy
One can easily buy this policy online by following the below easy steps.
- Visit the official website of the National Health Insurance Company.
- Click on the Product tab and then on the Health option.
- After that, select the Know More option.
- Scroll down a bit, and find out the National Young India Mediclaim Policy.
- Click on that. At the bottom of the landing page, there will be the Buy Policy Online option. Click on that.
- Log in to the online customer portal of the company.
- Provide personal details and policy-related details.
- On the basis of the given data, the premium amount will be displayed on the screen. Check the details twice.
- If satisfied, pay the premium amount online safely.
- Download the policy document for better convenience.
Claim Process of National Young India Mediclaim Policy
National Health Insurance Policy offers both cashless and reimbursement claim processes. For a better understanding, both procedures have been discussed below.
- For planned hospitalization, intimate the insurer 72 hours prior to the Insured Person’s admission to Network Provider. For emergency hospitalization, inform the company within 24 hours of the hospitalization.
- The cashless request form available with the Network Provider and TPA will be completed and sent to the TPA for authorization.
- The TPA, upon getting the cashless request form and related medical information from the Insured Person/ Network Provider, will issue a pre-authorization letter to the Hospital after verification.
- At the time of discharge, the Insured Person has to verify and sign the discharge papers and pay for non-medical and inadmissible expenses.
- The TPA reserves the right to deny pre-authorization in case the Insured Person/Network Provider is unable to provide any required details related to the pre-authorization request.
- In case of denial of Cashless Facility, the Insured Person may obtain the treatment as per the treating Medical Practitioner’s advice and submit the necessary documents for reimbursement of the claim.
- For this type of claim, one can opt for a hospital of his/her choice.
- Receive the treatment and get discharged from the hospital.
- Keep all the documents in hand in their original format.
- Submit the duly signed and filled claim form along with all the relevant documents.
- The company may appoint a surveyor to assess the situation and the documents.
- If no discrepancy is found, the claim amount will be settled within the stipulated time.
- Completed claim form
- Medical practitioner’s prescription advising admission for inpatient treatment.
- Cash memo from the hospital (s)/chemist (s) supported by proper prescription from attending medical practitioner for Pre-Hospitalization, Hospitalisation, and Post Hospitalisation.
- Payment receipt, investigation test reports, and associated plates/CDs in original, supported by the prescription from the attending medical practitioner for Pre-Hospitalization, Hospitalization, and Post Hospitalisation.
- Attending medical practitioner’s certificate regarding Diagnosis along with the date of Diagnosis and bill, receipts, etc.
- Surgeon’s certificate regarding Diagnosis and nature of operation performed along with bills, receipts, etc.
- Bills, receipt, sticker of the Implants.
- Bills, payment receipts, medical history of the patient record, discharge certificate/ summary, break up of final bill from the hospital, etc.
- Any other document required by Company/TPA.
Frequently Asked Questions
Midterm inclusion of family members at pro-rata premium is allowed only in case of
- newborns between the age of 3 months and 6 months
- spouse within 60 days of marriage
Members other than the above may be included only at renewal. On inclusion of a new member.
The following discounts are available.
Discount for Girl Child – A discount of 1.5% is allowed on the total premium of families having a covered girl child aged up to 18 years.
Discount for Direct Sale – If the Policy is bought online or by walk-in/ direct customer, a discount of 10% shall be allowed on the total premium for both new policy and subsequent renewals.
Wellness Discount – A discount of 1% on renewal premium is allowed for opting for evidence-based wellness activities in expiring policy (e.g., gym membership for 1 year, participation in marathon, swimathon, walkathon, etc.).
Long-Term Discount – A discount of 4.25% is allowed on the total premium if opting for a long-term policy.
Covid-19 Vaccination Discount – A discount of 10% is allowed on individual premiums if the Insured Person has received 2 doses of COVID-19 vaccine. Children (Insured Persons less than 18 years) may be allowed a discount provided both parents are vaccinated.
The Proposer can avail tax benefits for the premium paid, subject to Section 80D of the Income Tax Act 1961.
The insured person will have the option to migrate the policy to other health insurance products/plans offered by the company by applying for migration of the policy at least 30 days before the policy renewal date as per IRDAI guidelines on Migration. If such a person is presently covered and has been continuously covered without any lapses under any health insurance product/plan offered by the company, the insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on migration.
The insured person will have the option to port the policy to other insurers by applying to such insurer to port the entire policy along with all the members of the family, if any, at least 45 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to portability.