Health Insurance 533 views May 31, 2021

National Mediclaim Plus Policy

National Mediclaim Plus Policy covers medical expenses for inpatient treatment, pre and post-hospitalization, 140+ day care procedures/surgeries, Ayurveda and homeopathy treatment, organ donor expenses, maternity expenses, etc. This policy is available to persons aged between 18-65 years. Under this policy, you can cover your spouse, parents and dependent children (3 months – 18 years). Read this page further and know about the coverage of the National Mediclaim Plus Policy

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National Mediclaim Plus Policy Base Cover

You’ll get coverage against the following expenses under this policy –

In-patient Treatment: The insurer will cover the following expenses –

  1. Room rent and ICU charges including diet charges, nursing care charges, RMO charges, administration charges for IV fluids/blood transfusion/injection during your hospitalization
  2. Medical practitioner fees
  3. Cost of anesthesia, blood, oxygen, operation theatre charges, surgical appliances and other devices.

Pre and Post-hospitalization: The company shall reimburse the medical expenses incurred up to 30 days before the date of hospitalization and up to 60 days after the date of discharge from the hospital, provided the medical expenses are related to the same condition for which you are admitted.

Daycare Procedure: You’ll get coverage for medical expenses and pre and post-hospitalization expenses for daycare procedures where the hospitalization is of 24 hours and the treatment is taken in a hospital/daycare center.

Ayurveda and Homeopathy: If you are admitted to a government hospital or in an institute recognized by the government and receive, the insurer will cover the medical expenses for Ayurveda and Homeopathy treatment up to the sum insured.

Organ Donor’s Medical Expenses: Hospitalisation expenses of the organ donor will be covered under this policy

Maternity: The company shall cover the medical expenses incurred in respect of delivery or termination of pregnancy. Up to two deliveries or terminations, medical expenses are covered under this policy.

Hospital Cash: You’ll receive a daily hospital cash allowance based upon your chosen plan for up to 5 days, provided you are hospitalized for at least 3 days.

Road Ambulance: The company shall reimburse the expenses incurred for transportation to the hospital.

Air Ambulance: The company shall reimburse the expenses incurred for medical evacuation, subject to a maximum of 5% of the sum insured per policy period.

Medical Emergency Reunion: In case you are hospitalized for more than 5 continuous days in ICU for any life-threatening condition, the insurer shall reimburse the expenses of a round trip economy class air ticket or first-class railway ticket, up to INR 20,000 per policy period.

Doctor’s Home Visit & Nursing Care (post-hospitalization): The company shall reimburse the medical expenses incurred for doctor’s home visits and nursing care.

Vaccination: You’ll get coverage for medical expenses incurred for vaccinations of children. This cover applies to children aged up to 12 years.

Medical Second Opinion: You’ll get the benefit of Medical Second Opinion from a panel of World Leading Medical Centers (WLMC) for one of the major illnesses contracted to you during the policy period.

National Mediclaim Plus Policy Optional Cover

You can add any of the following optional covers under this policy as per your choice –

Critical Illness Benefit: The company shall pay the benefit amount under this optional cover if you are diagnosed with any of the following critical illnesses during the policy period and survives for at least 30 days from the date of diagnosis –

  1. Stroke resulting in permanent symptoms
  2. Cancer of specified severity
  3. Kidney failure requiring regular dialysis
  4. Major organ/ bone marrow transplant
  5. Multiple sclerosis with persisting symptoms
  6. Open chest CABG
  7. Permanent paralysis of limbs
  8. Blindness

Note: The diagnosis of a critical illness must be supported by clinical, radiological, histological and laboratory evidence.

Outpatient Treatment: The company shall pay for your out-patient consultations, diagnostic tests, medicines/drugs prescribed by a medical practitioner and out-patient dental treatment if you opt for this cover.

Terms & Conditions Applicable to National Mediclaim Plus Policy

  1. A co-payment of 20% applies on all the admissible claims except for vaccination if treatment is taken in a non-network hospital.
  2. At the time of renewal, a cumulative bonus equal to 5% of the sum insured will be provided to you if no claims were reported under this policy. The maximum cumulative bonus is subject to 50% of the sum insured.
  3. Expenses of health check-ups shall be covered by the insurer at the end of every block of two continuous policy periods, provided the policy is continuously renewed without any break.
  4. Under this policy, you’ll get both cashless facility and reimbursement of hospitalization expenses
  5. The coverage amount will be based upon the plan chosen by you.
    Plan APlan BPlan C
    Sum insured option - INR 2, 3, 4, 5, 6, 7, 8, 9, 10 LakhSum insured option - INR 15, 20, 25 LakhSum insured option - INR 30, 40, 50 Lakh

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