National Insurance Parivar Mediclaim

About National Insurance Company

National Insurance Company Ltd. was started in the year 1906 in Kolkata (earlier Calcutta) which makes it one of the oldest general insurance companies operating in India. National Insurance Company has collaborated with 11 Indian and 21 foreign companies. It is one of the four subsidiaries of the government-owned General Insurance Company.

National Insurance is India’s 2nd largest non-life insurers in the collection of Gross Direct Written Premium.

Being the oldest general insurance company, it has several pilot introductions of product customizations, both for corporate and rural sectors to its credit. It is also one of India’s first insurance companies to enter into an alliance with corporate giants. It also leads the way of introducing Bancassurance in India by collaborating with some of the largest banks.

It boasts a strong workforce of 13000 employees and 1730 offices, covering a wide network of operation in India and Nepal. National Insurance Company enjoys strong financial strength and issuer credit rating reflecting good performance and stronghold in India’s insurance market.

All About National Insurance Parivar Mediclaim

National Parivar Mediclaim Policy offers health insurance coverage which is designed to provide financial protection against health-related emergencies for the entire family. It is a family floater policy; the entire family gets coverage under a single policy. The applicable sum insured amount can be utilised by any member of the family against various injuries and illnesses. As per the policy terms and conditions, a family is limited to spouse, self and two dependent children. The primary objective of the policy is to mitigate the financial loss of a family during an unexpected hospitalisation due to illness or accidental injury to a family member.

Features of National Insurance Parivar Mediclaim

Some of the key features of National Parivar Mediclaim Policy can be listed as follows.

Coverage

The coverage Sum insured offered in the policy ranges from INR 2 lakhs to INR 5 lakhs in multiples of INR 50,000. Cashless treatment and Reimbursement

The policy offers cashless treatment facility at network hospitals and also reimbursement of hospitalisation expenses as per the terms and conditions of the policy.

Renewal

The tenure of the policy is for 1 year and it has to be renewed by the policy holder.

Pre and post hospitalisation

Pre hospitalisation is covered for a period of 15 days and post hospitalisation is covered for a period 30 days.

Ambulance charges

Ambulance charges are limited to INR 1000 per illness and total of INR 2500 in a policy year.

No Claim Bonus

No claim bonus is given if no claims are made in a policy year. On renewal, the policyholder will be entitled to 5% of discount on base premium as No Claims Bonus.

Medical Check- Up

The policy provides a free medical check-up for being enrolled in the policy continuously for 4 years. The medical check-up reimbursement amount is limited to INR 5,000.

Tax Benefits

The premium paid towards the policy plan is eligible for tax benefits as per the provisions mentioned under Section 80D of the Income Tax Act, 1961.

Co-Payment

If the policyholder opts for a pre-existing disease like diabetes and hyper tension, then co-payment of 10% will be applicable to the claims for treatment of those disease.

Pre-existing diseases

Pre-existing diseases can be covered in the scope of the policy after 48 months of continuous policy coverage.

Benefits of National Insurance Parivar Mediclaim

Hospital Room Rent Up to 1% of the sum insured cover per day
ICU ChargesUp to 2% of the sum insured cover per day
Hospital CoverFees given to surgeon, anaesthetist, medical practitioners, and consultants
Medical Expenses Blood, anaesthesia, oxygen, operation theatre charges, surgical appliances, drugs, medicines, chemotherapy, x-rays, cost of pacemaker, cost of artificial limbs, etc.
Organ Donor Charges/ExpensesCoverage provided for surgery costs when the insured person is donating an organ to another person
Limit For Total Charges/ExpensesTotal charge/expenses for one particular illness are limited to 50% of the sum insured coverage

Flexibility

The policy is available for anyone from the age of 18 years to 60 years and dependent children from the ages of 3 months to 25 years, provided parents are also part of the policy cover.

Sum Insured

The policy offers a choice of the sum insured from INR 2 lakhs to INR 5 lakhs for the different coverage needs to customers.

Coverage

The policy offers comprehensive coverage for hospitalisation due to illnesses and accidental injuries. Pre-existing diseases can also be covered in the policy.

Premium Charges

The premium charges of this family floater plan are based on the age of the eldest member of the family.

Day care procedures covered

The policy covers up to 140+ day care procedures/surgeries up to the limit of the sum insured.

Organ Donor Benefits

The organ donor expenses are covered up to the sum insured by the company.

Plan Option

There are no plan options in the policy. It is one plan family floater policy offered by the company.

Avail AYUSH benefits

The policy provides coverage in respect to allopathy, Ayurveda and homeopathy treatments up to sum insured in the scope of the plan.

Waiting Period

The policy has an initial waiting period for 30 days for all kinds of diseases. After that, it has a waiting period for one year, two years and four years for a list of different diseases as mentioned in the policy document.

What is Covered in National Insurance Parivar Mediclaim?

  • Reimbursement of hospitalisation expenses necessarily incurred, under the following heads:

    • Room, boarding and nursing expenses as provided by the hospital/nursing home – 1% of sum insured per day for normal room and 2% of sum insured per day for ICU room.

    • Fees for Surgeon, Anaesthetist, medical practitioner, consultant, specialist’s fees, nursing expenses.

  • Charges incurred on account of blood donation, oxygen, anaesthesia, operation theatre , surgical appliances, X-ray, dialysis, medicines and drugs, diagnostic material, chemotherapy, radiotherapy, cost of organs, cost of pacemaker, artificial limbs and other similar expenses.
  • It is possible to cover diabetes and hypertension from inception by paying extra premium.
  • Pre and post hospitalisation charges covered for 15 and 30 days respectively.
  • Cashless facility can be processed through TPA for network hospitals.

What is Not Covered in National Insurance Parivar Mediclaim?

One of the important exclusion is regarding the pre-existing illness. Pre-existing diseases can be covered after 4 years of continuous coverage under this policy. All diseases and injuries related conditions which are pre-existing at the time of the start of the policy, will be covered after only 4 continuous claim free policy years.

  • No claim, other than accidental injuries, is payable by the insurance company within the first 30 days of the start of the policy.
  • Exclusion of certain named diseases up to the first 2 years of the policy.
  • Congenital diseases, sterility, venereal disease, intentional self-injury, use of drugs, alcohol, rest cure etc.
  • AIDS and other HIV related treatment.
  • Expenses incurred primarily for diagnostic, laboratory examinations not related to or consistent with the diagnosis for which insured is hospitalised.
  • Dental treatment, other than caused by accidental injury and requires hospitalisation.
  • Treatment required due to pregnancy and childbirth.
  • All treatment covered other than an allopathic stream of treatment.
  • War, invasion and nuclear perils.

Add-ons For National Insurance Parivar Mediclaim

Pre-existing diseases like diabetes, hypertension, Outpatient treatment and critical illness are optional add-ons covers available in the plan.

Additional Discounts for National Parivar Mediclaim

Long Term Discount

If the policy is issued for a period of 2 years, then a discount of 4% will be allowed on the total premium. If the policy is issued for 3 years, then a discount of 7.5% will be applicable.

Online Discount

If the policy is purchased online, then a discount of 5% on the premium will be applicable. Similarly, if the policy is renewed online, then a discount of 2.5% will be applicable.

Tax Benefits in National Parivar Mediclaim

The premium paid for the National Parivar Mediclaim can be used for tax deduction up to a limit of INR 1,00,000 as per the provisions mentioned in Section 80D of the Income Tax Act,1961. It is to be noted that tax laws are revised from time to time. The applicant should consult the financial advisor to know the current income tax deductions and benefits at the time of buying the health insurance policy.

List of National Insurance Health Insurance Plans

National Mediclaim Plus Policy

National Mediclaim Plus Policy is a high sum insured health insurance policy for In-patient hospitalisation expenses for more than 24 hours, and 140 plus Day Care Procedures and surgeries on cashless or reimbursement basis during the active policy period. This policy also has many additional features and benefits.

National Insurance Parivar Mediclaim Policy Plus

National Insurance Parivar Mediclaim Policy Plus is a premium product which covers all family members under a single Sum Insured, for In-patient hospitalisation expenses for more than 24 hours and 140 plus Day Care Procedures and surgeries on cashless or reimbursement basis during the active policy period. This policy provides exclusive features which cover most of the health concerns for the insured.

Varistha Mediclaim Policy for Senior Citizens

Varistha Mediclaim Policy for Senior Citizens, by name, is an exclusive policy for senior citizens above 60 years of age. It comprehensively covers for In-patient hospitalisation and domiciliary hospitalisation expenses along with 140 plus Day Care Procedures and surgeries on cashless or reimbursement basis during the active policy period.

National Insurance Critical Illness Policy

National Insurance Critical Illness Policy is a special benefit policy which covers the insured against the expenses in the event of any of the listed critical illnesses. A fixed lump sum discount will be given to the insured on diagnoses of specified illness to cover the post-op procedure or treatment to cure it. Once the lump sum is paid to the insured, the policy coverage ceases.

Eligibility Criteria to Apply National Insurance Parivar Mediclaim

  • Policy shall cover at least two family members, as defined below.
  • Proposer should be between 18 years and 65 years.
  • Maximum entry age of any family member is 65 years.
  • Children between the age of 3 months and 25 years may be covered, provided parents are also covered in the same policy.
  • Family members include Policyholder, spouse, parents, dependent children (legitimate or legally adopted)
  • Dependent child up to the age of 18 years
  • Dependent male child above 18 years and up to 25 years, if he/she is a student and unemployed
  • Dependent female child, if she is not employed or married
  • Midterm inclusion of family members at pro-rata premium is allowed only in case of
  • new-born between the age of 3 months and 6 months
  • Spouse within 60 days of marriage
  • On inclusion of a new family member, applicable waiting period shall apply
  • Dependent children have the option to port to similar health insurance product of the company or any other insurer on completion of the specified exit age as mentioned.
  • If during the policy period, the number of members covered reduces to a single member, then on expiry of the policy period, the insured person shall be moved to similar health insurance product available with the company or of any other insurer.

Documents Required To Buy National Insurance Parivar Mediclaim

  • Proof of Age: The applicant has to provide the age proof of all the persons who will be getting covered with the health insurance policy. Below are the acceptable documents for this:

    • Birth certificate
    • 10th or 12th mark sheet
    • Passport
    • Aadhaar card
    • Voting ID
    • Driving license
    • PAN card etc.
  • Identity Proof: The applicant can provide any of the following identity proof:

    • Aadhaar card
    • Passport
    • Voting ID
    • Driving license
    • PAN card
  • Address Proof: The applicant will be required to submit your permanent proof of address. You can submit any of the following documents for the same:

    • Electricity bill
    • Telephone bill
    • Ration card
    • Passport
    • Aadhaar card
    • Driving license
    • Voters ID
  • Passport Size Photos

  • The applicant might be required to medical tests to enrol in the plan

What Is Claim Procedure for National Insurance Parivar Mediclaim

Notification of Claim

In the event of hospital treatment or domiciliary hospital treatment, the insured person or his/her relative or representative is required to inform the TPA. The notification can be done in writing by letter, email, fax providing all necessary information like policy number, treatment details etc. The contact details can be found on the official website of the company.

Informing Of Claim For Cashless FacilityTime To Inform The TPA
In case of planned hospitalisation TPA should be informed at least 72 hours prior to the insured person’s admission to the network hospital
In case of emergency hospitalisationTPA needs to be informed within 24 of the insured person’s admission to the network hospital
Informing of claim for ReimbursementCompany/TPA must be informed:
In the case of planned hospitalisation or domiciliary hospitalisation treatmentTPA should be informed at least 72 hours prior to the insured person’s admission to the network hospital
In the case of emergency hospitalisation or domiciliary hospitalisation treatmentTPA need to be informed within 24 of the insured person’s admission to the network hospital
  • Informing of claim for vaccination: In the case of Anti Rabies Vaccination
  • Company/TPA must be informed: At least 24 hours prior to getting the vaccination

Procedure for Cashless Claims

  • To get the Cashless facility for treatment in network hospitals, TPA needs to be informed. For this, the insured has to fill a cashless request form and send it for authorisation to TPA.
  • After taking authorisation from TPA for the treatment at the network hospital (list of network hospital can be seen in the booklet provided or from the official website of the company).
  • TPA, after checking and verifying the request form, will issue a pre-authorisation letter to the hospital.
  • The insured person, after the treatment, will need to verify and sign the discharge papers and pay for non-medical expenses.
  • The TPA reserves the right to reject the pre-authorisation request in case the policyholder is not able to provide the relevant medical details.
  • In case of rejection of cashless treatment, the policyholder may still get the required treatment as per treating doctor’s advice and submit the claim papers to the TPA for processing.

Procedure for Reimbursement of Claims

  • For reimbursement of claims, the policyholder is required to submit the necessary documents to TPA within the given time limit. Procedure for Reimbursement of Claim under Domiciliary Hospitalisation
  • For reimbursement of claims under domiciliary hospitalisation, the policyholder is required to submit the necessary documents to TPA within the given time limit.

Claim Settlement

  • Once the TPA/insurance Company has received the required final document and investigation report if required in the case, the claim needs to be settled within a time frame of 30 days by the Insurance Company.
  • If the claim is rejected by the insurance company or any reason it will communicate the same to the policyholder in writing within 30 days of receipt of the claim.
  • Upon acceptance of an offer of settlement by the policyholder, the payment of the claim amount will be made within 7 days from the date of acceptance of the offer by the Health Insurance Company.
  • If there is a delay in payment, the company is liable to the claimant an interest at the rate of 2% above the prevailing bank rate.

Documents Required To Claim National Insurance Parivar Mediclaim

To successfully submit and get the claim approved, the claimant needs to submit the following documents in original within the given time limit.

  • Completed filled claim form
  • Original Bills, receipts for payment, medical history of the patient recorded, discharge certificate or summary from the hospital etc.
  • Cash-memo from the hospital /medical store/chemist verified by proper prescription
  • Attending medical consultant’s certificate regarding diagnosis along with date and day mentioned clearly with necessary bills and receipts etc.
  • Certificate from the surgeon confirming the diagnosis and nature of operation and bills/receipts etc.
  • Any other document required by Company/TPA as depending from case to case basis

Conclusion

National Parivar Mediclaim is an affordable Health Insurance Plan for the entire family. It offers the flexibility of sum insured as per the needs of different customers. The plan offers a lot of features and benefits to the insured and his whole family. The plan offers rewards for not making claims on renewal of the policy. It also offers an additional discount on online purchase and renewal. The terms and conditions of the plan are very simple to understand and the claim procedure is also very easy to understand and follow. The company gives quick authorisation for cashless treatments and the claims are also reimbursed to the policyholder in a timely manner. National Insurance Company is one of the oldest Indian insurance companies and it has put all its expertise to ensure the plan offers peace of mind against any health emergencies in the family. It is one of the most simple and comprehensive health insurance plans in the market today.

Reviews of National Insurance Parivar Mediclaim

I was looking for an affordable but comprehensive health insurance plan. I searched online and the National Parivar Mediclaim was best suited for my needs. I also got a discount of 5% on premium for purchasing the plan online. I am satisfied with the purchase of this health insurance plan. (Rahul Bhatt – Kanpur)

I purchased this plan for my family and had to make a claim for my father’s illness. The claim procedure was easy and customer service was also efficient in helping me during the claim process. Happy with the purchase! (Neha More – Mumbai)

This is my first insurance policy with National Insurance Company. I purchased National Parivar Mediclaim and found the enrolment process hassle free. The premium amount is also pocket- friendly. I will recommend this health insurance plan to my friends and family. (Thirumalai Konar – Chennai)

This is my 4th year in this health insurance policy. I have been rewarded with no claim bonus on multiple occasions and my premium on renewal has been all the more affordable. The website provides with comprehensive and accurate information which has enhanced my knowledge on health insurance and its benefits. (Kunal Gupta – Uttar Pradesh)

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