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Health Insurance June 1, 2021
National Parivar Mediclaim Plus Policy provides you and your family financial protection against medical expenses. This policy is available to persons aged between 18-65 years. Under this policy, you can cover your spouse, children and parents. To know more about the coverage of the National Parivar Mediclaim Plus Policy, read this page below.
Table of Contents
National Parivar Mediclaim Plus Policy Coverage Option
The insurer offers you three different plans under National Parivar Mediclaim Plus Policy –
| Plan A | Plan B | Plan C |
|---|---|---|
| Sum Insured (SI) option of INR 6, 7, 8, 9, 10 Lakh | SI option of INR 15, 20, 25 Lakh | SI option of INR 30, 40, 50 Lakh |
| Room rent limit up to 1% of SI per day and up to 2% of SI per day for ICU | No room rent limit | No room rent limit |
| Cataract surgery covered up to 15% of SI or INR 60,000, whichever is lower | No limit on cataract surgery | No limit on cataract surgery |
| Domiciliary Hospitalization expenses are covered up to INR 1 Lakh | Domiciliary Hospitalization expenses are covered up to INR 2 Lakh | Domiciliary Hospitalization expenses are covered up to INR 2 Lakh |
| Hospital cash benefit of INR 500 per day per insured member, payable up to 5 days | Hospital cash benefit of INR 1,000 per day per insured member, payable up to 5 days | Hospital cash benefit of INR 2,000 per day per insured member, payable up to 5 days |
| Ambulance charges are covered up to INR 2,500 per hospitalization in a policy year | Ambulance charges are covered up to INR 4,000 per hospitalization in a policy year | Ambulance charges are covered up to INR 5,000 per hospitalization in a policy year |
| Vaccination for children covered up to INR 1,000 | Air ambulance charges are covered up to 5% of the sum insured per insured per policy year | Air ambulance charges are covered up to 5% of the sum insured per insured per policy year |
| Maternity expenses shall be covered after a waiting period of 2 years for normal delivery, up to INR 30,000, and for cesarean section, the coverage is limited to INR 50,000 | Doctor’s Home Visit and Nursing Care expenses are covered up to INR 1,000 per day, payable up to 10 days | Doctor’s Home Visit and Nursing Care expenses are covered up to INR 1,000 per day, payable up to 10 days |
| Infertility treatment shall be covered after a waiting period of 2 years, subject to a maximum of INR 50,000 | No limitation on vaccination for children | No limitation on vaccination for children |
| Free health Check-up available after every 2 policy years, up to INR 5,000 irrespective of claims | Medical emergency reunion cover with no sub-limit | Medical emergency reunion cover with no sub-limit |
| No sub-limit on maternity expenses | No sub-limit on maternity expenses | |
| Infertility treatment shall be covered after a waiting period of 2 years, subject to a maximum of INR 1 Lakh | Infertility treatment shall be covered after a waiting period of 2 years, subject to a maximum of INR 1 Lakh | |
| Free health Check-up available after every 2 policy years, up to INR 7,500 irrespective of claims | Free health Check-up available after every 2 policy years, up to INR 10,000 irrespective of claims |
National Parivar Mediclaim Plus Policy Base Cover
You’ll get coverage against the following medical expenses under this policy if you are admitted to the hospital due to an illness/injury during the policy term –
- Room, rent, ICU charges including diet charges, nursing charges, RMO charges, administration charges for IV fluids/blood transfusion/injection
- Medical practitioner’s fee
- Cost of anesthesia, blood, oxygen, operation theatre charges, surgical appliances
- Cost of medicines and drugs prescribed by the doctor
- Diagnostic procedures related to the illness/injury
- Cost of prosthetics and other devices or equipment if implanted internally during a surgical procedure
- Dental treatment expenses if are necessitated due to an injury
- Plastic surgery cost if it is necessitated due to disease or injury
- Hormone replacement therapy if it is medically necessary
- Cost of vitamins and tonics if they are part of the treatment
- Circumcision if necessitated for the treatment of a disease or injury
Other medical expenses covered under this policy are as follows –
- Pre and post hospitalization up to 30 and 60 days, respectively
- Domiciliary hospitalization expenses
- Day Care Procedures
- Ayurveda and Homeopathy treatment
- Organ donor’s medical expenses for in-patient hospitalization, pre, and post-hospitalization
- Doctor’s home visit and nursing care expenses during post-hospitalization if prescribed by the doctor
- Anti Rabies Vaccination covered up to INR 5,000 per insured
- Vaccination for newborn baby covered under maternity expenses
- Modern Treatments are covered up to 25% of SI for each treatment
- Treatment occurs due to participation in hazardous or adventure sports (non-professionals) are covered up to 25% of SI
- Morbid Obesity covered after a waiting period of 4 years
- Refractive error (min 7.5D) treatment shall be covered after a waiting period of 2 years
- Medical Second Opinion (MSO) is available for 160 major illnesses and a maximum of two MSO is available per family for each new diagnosis of any of the major illnesses in a policy year
Note: In case the sum insured is exhausted due to claims arising out of a road traffic accident injury during a policy year, the insurer shall reinstate the sum insured as mentioned in the policy schedule. Reinstatement is allowed only once during the policy year.
National Parivar Mediclaim Plus Policy Optional Covers
You can add any of the optional covers under this policy by paying an additional premium for it –
Pre-existing Diabetes/Hypertension: The insurer will cover the medical expenses of diabetes/hypertension if it is pre-existing. The insurer’s liability under this cover is as follows:
- For the first policy year: up to 25% of SI
- For the second policy year: up to 50% of SI
- For the third policy year: up to 75% of SI
Out-patient Treatment: By choosing this cover, you can get coverage for out-patient consultations, diagnostic tests, medicines/drugs, dental treatment. Limit under this optional cover per family is as follows – INR 2,000, 3,000, 4,000, 5,000,10,000, 15,000, 20,000, 25,000 in addition to the SI.
Critical Illness: You’ll get coverage against the following critical illnesses – stroke resulting in permanent symptoms, cancer of specified severity, kidney failure requiring regular dialysis, major organ/ bone marrow transplant, multiple sclerosis with persisting symptoms, an open chest CABG (Coronary Artery Bypass Graft), permanent paralysis of limbs and blindness. The benefit amount is restricted to 50% of the sum insured. Benefit amounts available per individual are as follows: INR 2,00,000, 3,00,00, 5,00,000, 10,00,000, 15,00,000, 20,00,000, 25,00,000.