Health Insurance 1301 views December 16, 2020

National Insurance Company Limited has introduced different types of health insurance policies that serve customer needs. You can compare the National Health Insurance policy and choose the one which fits your needs the best. So if an accident happens or an illness is diagnosed, having a National Health Insurance policy can help you overcome any financial issues emerging out of such contingencies. The company will pay for the incurred expenses such as room rent, medicines, doctor fees, test expenses, etc. Let’s know the variants of National Health Insurance policies and their respective details on this page.

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Popular National Health Insurance Policies

From giving you the financial cover against novel Coronavirus to daycare procedures, National Health Insurance Policies gives you that protective gear you need in this uncertain world. Below is a list of its health policies that you can read.

CORONA KAVACH POLICY-NATIONAL (Sum Insured INR 50,000-5,00,000)

It’s a health insurance policy specially designed for the treatment of COVID-19 patients. You have coverage for Allopathy and AYUSH treatments, Pre-and Post-hospitalization, Ambulance fees, basic hospitalization, Home Care Treatment, PPE Kit, gloves, mask, cost of a Pulse oximeter, Oxygen cylinder, nebulizer and any other similar expenses, and Hospital Daily Cash allowance.

On your CORONA KAVACH POLICY-NATIONAL, a 15-day waiting period will apply to the COVID-19 related expenses starting from the first policy commencement date. Exclusions under this National Health Insurance are –

  1. Investigation & Evaluation
  2. Rest Cure, rehabilitation and respite care
  3. Dietary supplements and substances
  4. Unproven Treatments
  5. Covid-related claims where it is diagnosed before the commencement of the policy
  6. Day Care treatment and OPD treatment
  7. Diagnosis and Treatment outside India
  8. Tests at an Unauthorized Diagnostic Center

Note– All covers will cease if you travel to any country placed under travel restriction by the Government of India.

National Mediclaim Plus Policy (Individual Plan with a Sum Insured of INR 2,00,000-50,00,000)

This is a High Sum Insured policy that covers In-patient treatment expenses (for at least 24-hour hospitalization) and 140+ Daycare Procedures. National Mediclaim Plus Policy comes with three different plans –

  1. Plan A – 9 slabs with Sum Insured of INR 2-10 Lakh in multiples of INR 1,00,000
  2. Plan B – 3 slabs with Sum Insured of INR 15 lakh, INR 20 lakh and INR 25 lakh
  3. Plan C – 3 slabs with Sum Insured of INR 30 lakh, INR 40 lakh and INR  50 lakh

Under this policy, Self, Spouse, Dependent/legally adopted children and Parents will be covered against the following:-

  1. AllopathyAyurveda and Homeopathy treatments
  2. Room Rent/ICU charges
  3. Medical practitioners, surgeon, anesthetist, consultants, specialist’s fees
  4. Ambulance fee (including Air Ambulance)
  5. Organ Donor expenses
  6. Pre-and Post-hospitalization Expenses (up to 30/60 days)
  7. 12 modern treatments
  8. Morbid obesity treatment
  9. Correction of eyesight (if refractive errors > -7.5 D)
  10. Injury/Illness due to participation in hazardous or adventure sports
  11. Mental illness
  12. HIV/AIDS
  13. Genetic disorders
  14. Cataract surgery
  15. Doctor’s home visit and nursing expenses
  16. Maternity and Newborn Cover
  17. Vaccination
  18. Hospital cash benefits & Medical Emergency Reunion
  19. Add-on covers such as Critical Illness and Out-patient Treatment

The company will not pay for the following under this plan such as – Illness claim for the first 30 days, All pre-existing diseases (up to 36 months), Change-of-Gender Treatments, Cosmetic, Plastic Surgery, non-prescribed Vitamins, Tonics, Drug, Alcohol abuse, Self-Inflicted Injury, Dental treatment and OPD treatment.

National Mediclaim Policy (Individual Plan with Sum Insured INR 1,00,000-10,00,000)

Under the National Mediclaim Policy, the company will compensate for the In-patient treatment expenses (for at least 24-hour hospitalization) and 140+ Daycare Procedures. It can cover you, your spouse, your dependent children, parents, parents in-laws, brother up to the age of 25 years (if a bonafide student and unemployed), sister (if unemployed till marriage), and a newborn from the age of 3 months.

Under this policy, Self, Spouse, Dependent/legally adopted children and Parents will be covered against the following:-

  1. AllopathyAyurveda and Homeopathy treatments
  2. Room Rent/ICU charges
  3. Medical practitioners, surgeon, anesthetist, consultants, specialist’s fees
  4. Ambulance fee
  5. Organ Donor expenses
  6. Pre-and Post-hospitalization (up to 45/60 days)
  7. 12 modern treatments
  8. Morbid obesity treatment
  9. Correction of eyesight (if refractive errors > -7.5 D)
  10. Injury/Illness due to participation in hazardous or adventure sports
  11. Mental illness
  12. HIV/AIDS
  13. Genetic disorders

Overseas Mediclaim Business and Holiday

It’s an Overseas Mediclaim Policy that covers emergency travels when the insured person is traveling abroad. It is available in three categories-

  1. Business & Holiday
  2. Employment & Study
  3. And a Corporate Frequent Traveller

This policy covers Illness, medical evacuation, repatriation, Personal Accident & Disability, Loss of Checked Baggage, Delay of Checked Baggage, Loss of Passport, Third Party bodily Injury & Property damage.

Under this policy, exclusions will apply to-

  1. Pre-existing diseases/illnesses
  2. Traveling against Medical advice
  3. Travel for Medical treatment
  4. Participation in Military, Naval, or Air Force
  5. Suicide/Intentional self-injury
  6. Mental disorder
  7. Alcoholism
  8. Drug abuse
  9. HIV related illness including AIDS
  10. Participation in winter sports, mountaineering, adventure sports, etc.

Note- Policy premiums can be paid in Indian National Rupees whereas the claim will be in US$.

Overseas Mediclaim Employment and Studies

National Health Insurance Overseas Employment and Studies policy will cover expenses for illness, Medical evacuation, Repatriation, Medical Emergency reunion, Contingency Insurance (for sponsored students only), Loss of checked-in baggage and Delay of Checked-in Baggage (in the US $ 100). And the exclusions of Overseas Mediclaim Business and Holiday will apply here too.

National Health Insurance City-wise list of Preferred Provider Network (PPN) Hospitals

CityTotal Number of PPN HospitalsPopular PPN Hospitals
Ahmedabad158Aarna Superspeciality Hospital, Anand Surgical Hospital Ltd, Apollo Hospitals International Ltd, Baps Yogiji Maharaj Hospital and Bavishi Eye Hospital.
Bengaluru267Abhaya Hospital, Bangalore Hospital, Healthcare Global Enterprises (HGE), Chaitanya Hospital and Citi Hospital.
Chandigarh207Healing Touch Super Speciality
Hospital, Alchemist Hospital (Panchkula), Indus Hospital Super Speciality (Mohali SAS Nagar) and IVY Hospital
Chennai235Apollo Spectra Hospitals (A Unit Of Apollo
Specialty Hospitals Pvt Ltd), Fortis Malar Hospitals Ltd and Frontier Lifeline Pvt Ltd
Coimbatore110Kovai Medical Centre - Erode, The Eye Foundation and Kmch Speciality Hospital
Delhi347Dharamshila Cancer Hospital And Research
Centre, Max Smart Super Speciality Hospital and Fortis Hospital
Hyderabad344Yashoda Super Speciality Hospital, Hyderabad Multispeciality Hospital and MediCover Hospitals (A Unit of Sahrudaya Health
Care Pvt. Ltd.)
Indore42Apollo Hospitals, Shalby Hospital and Retina Specialty Hospital.
Jaipur82Fortis Health Management North Ltd, Rungta Hospital and Mahatma Gandhi Hospital
Kolkata139Ruby General Hospital, Calcutta Heart Clinic & Hospital, A.M.R.I.Hospitals Ltd and Calcutta Lions Netra Niketan
Mumbai556Jaslok Hospital And Research Centre, Fortis Hiranandani Hospital and Mgm New Bombay Hospital
Pune136Columbia Asia Hospital, Global Hospital and Noble Hospital

National Health Insurance Claim Process

You can either get a Cashless Facility or reimbursement – the choice is yours-

Cashless Facility – Available only for policies serviced by a Third Party Administrator (TPA). First, check the list of PPN hospitals. And if it is a planned hospitalization, intimate the TPA/Company 72 hours in advance with details like Name and address of the hospital and your condition for which you are going to get hospitalized. In the case of emergency hospitalization, the claim intimation can be sent to the TPA/Company within 24 hours of admission.

Note- A Pre-Authorization Request for the cashless claim will be sent to the TPA by the hospital.

Reimbursement – Send a written intimation/mail/fax about your hospitalization to the TPA/Company within 72 hours of hospitalization (for an emergency hospitalization) and 72 hours before hospitalization (for a planned admission). And before you leave the hospital, collect the Discharge Summary, investigation report, and other relevant documents. After that, submit these documents in original form to the TPA/Office within 15 days from the date of discharge.

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