- About Coverfox
National Insurance Varistha Mediclaim policy is from National Insurance Company, which is government backed and one of the oldest insurance companies in the country. The health insurance policy is a specially designed health insurance for senior citizens aged 60 and more. The policy is loaded with a lot of features and benefits like inpatient treatment at hospital, domiciliary hospitalisation care expenses, along with whopping 140 plus day care procedures. All the coverage is available with cashless facility or reimbursement basis.
Other Plans By National Health Insurance Company
This sum insured coverage is available for emergency or planned hospitalisation.
The health insurance cover can be renewed for life.
No health check-up is required if the applicant has been covered with any health insurance policy continuously for past 3 years.
The policy has a great feature of rewards like cumulative bonus and free health check-up for claim free years.
The policy has a provision for an optional benefit to cover critical illness like stroke, cancer, multiple sclerosis among others. The sum insured for critical illness is INR 2 lakhs and the claim is paid in a lump sum on diagnosis.
Pre hospitalisation cover of 30 days and post hospitalisation cover of 60 days is available in the plan.
Some pre-existing diseases are included in coverage after one year of claim-free renewal.
Pre-existing diseases like Hypertension and Diabetes can be included in coverage from the start of the policy on payment of extra premium.
The policy provides a free medical check-up for being enrolled in the policy for continuous 3 years. The medical check-up reimbursement amount is limited to 2% of the sum insured.
The policy offers a free look period of 15 days where if the policyholder is not satisfied, he/she can return the policy to the insurance company and get relevant refund amount.
The premiums for the plan can be claimed for tax deduction under Section 80D of the Income Tax Act, 1961. Please note the tax laws are subject to change from time to time and hence, it is recommended to consult a tax expert on the same.
Hospitalisation expenses are paid till 1% of Sum Insured up to the amount of 25% of sum insured.
Charges incurred for surgery such as fees of the surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists etc. are covered up to the amount of 25% of sum insured.
The expenses incurred for blood, oxygen, diagnostic charges, medicines, drugs, etc are covered up to the amount of 50% of Sum Insured.
Ambulance charges in case of emergency travel to the hospital are covered to the amount of INR 1000 for one policy year.
Cataract and Benign Prostatic Hyperplasia and Organ Transplant are also covered in the scope of the policy, but to a certain specified limit.
The policy comes with an initial waiting period of 30 days in which no coverage is given to the policyholder other than accidental injury.
There is a waiting period of 1 year for the following conditions
Vaccination or inoculation of any kind is not compensated by the company
Cost of eye glasses and dental treatment and surgery is also not included in the scope of the policy
Expense for diagnosis where there is no sign of the positive existence of any diseases
Expenses that are mainly cosmetic in nature
Any injury or disease which is an outcome of a war is treated as an exclusion
Medical care expenses for Self-inflicting injuries by the use of drugs or alcohol are not included in the policy
Diseases which are originated from HIV AIDS is not included
Any Vitamin and tonic intake is not included, unless it has been prescribed for the treatment by the Doctor
Treatment required due to pregnancy and childbirth
Injury or disease as a result of exposure to nuclear weapons/materials.
All the treatment needed to be conducted in India and any treatment done outside the boundaries of the nation are not included
Claim will not be paid if the policyholder/insured smokes more than 40 cigarettes a day or equivalent amount of tobacco.
|Coverage Sum Insured Amount (in INR.)||INR 1,00,000 is the sum insured for Hospitalization & Domiciliary Hospitalization Cover and INR 2,00,000 is the sum insured for Critical Illness cover (optional benefit)||-|
|Policy duration (in years)||1||1|
|Age of entry (in years)||60 years||80 years|
|Renewability Age||-||For Life|
Proof of Age: The applicant has to provide age proof of all the persons who will be getting covered with the health insurance policy. Below are the acceptable documents for this:
Identity Proof The applicant can provide any of the following identity proof:
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:
Passport Size Photos
The applicant might be required to medical tests to enrol in the plan
In the event of hospital treatment or domiciliary hospital treatment, the insured person or his/her relative or representatives required to inform the TPA. The notification can be done in writing by letter, email, or 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 facility||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 hospitalisation||TPA need to be informed within 24 of the insured person’s admission to the network hospital|
|Informing of claim for Reimbursement||Company/TPA must be informed|
|In the case of planned hospitalisation or domiciliary hospitalisation treatment||TPA 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 treatment||TPA 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|
To get the Cashless facility for treatment in network hospitals, the 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.
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.
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 for any reason, it will communicate the same to the policyholder in writing within 30 days of receipt of the claim.
Upon the 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. Required Documents to Claim National Insurance Varistha 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
National Insurance Varistha Mediclaim Policy is great health insurance option for senior citizens of India. The policy comes with very affordable premium and good coverage. The applicant can also take optional coverage option which covers many critical illnesses and offers a lump sum amount for treatment. The insurance policy offers renewability benefit for the entire lifetime of a person. The claim settlement process of the company is very easy and simple to understand. The National Insurance Company also has a tie-up with major hospitals across the country where the insured person can take benefit of cashless facility. Overall, this health insurance policy is a well customised for the senior citizens and is highly recommended for individuals over the age of 60 years to cover themselves financially against perils of rising medical care expenses.
I purchased this policy online and being not a very technically savvy person, the enrolment process was fairly easy. The policy information on the website is also very clear and easy to understand. Hence, I decided to go for this policy. - Duruchand Lalwani – Delhi
I was looking for a policy that would suit my father who is 65 years old. I looked at the features of this policy and it perfectly fit my requirement. The enrolment process was also easy and the customer service of the company is also good. - Kirti Ghosh - Kolkata
I wanted a health insurance policy for my mother who suffers from hypertension. I was looking for a policy where I don’t have to wait for the coverage for 4 years or have a long waiting period. When I saw that this policy offers coverage straight away with additional premium, my search ended. I am happy with the purchase and recommend the same to others. - Pravin Shinde – Maharashtra
I retired from work recently and my coverage of health insurance ended with me leaving the job. I wanted to secure myself with a good but affordable health insurance policy. One of my friends told me about National Insurance Varistha Mediclaim and I was happy with the coverage it offered. I took additional coverage of critical illness in the plan and I am at peace today that I am covered till a good health insurance policy which will allow me to renew it for life. - Gulshan Sharma – Madhya Pradesh