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National Medical Insurance

This policy provides for cashless hospitalization in India for the treatment of any illness or disease or accidental injury (not specifically excluded) suffered during the policy period. The payment of claim is made through Third Party Administrators who have been empanelled by the Company to provide hassle free admission and discharge from the Network hospital without making any payment. The reimbursement of domiciliary hospitalization claims will also be made through the TPA.fff

For obtaining Mediclaim Policy the proposer has to fill up the proposal form and Insured Person details form and submit two latest stamp sized coloured photograph of each family member to be insured.

A family package cover can be taken covering proposer, spouse, dependent parents and two dependent children with a 10% discount in premium.

Group policies can be issued to specified groups and group discount can be availed provided group size is more than 100 members. Premium upto Rs.10,000/- paid by cheque for this policy is entitled for tax rebate under section 80D of the Income Tax Act.

This policy becomes operative when treatment is taken as an in-patient in a hospital / nursing home in India which satisfies the following criteria:
It should be an institution established for indoor care and treatment of sickness and injury and which either
1. Has been registered as a Hospital/Nursing Home with the local authorities and is under the supervision of a registered and qualified Medical Practitioner
2. Should comply with minimum criteria as under:
1. It should have at least 15 in-patient beds (10 beds in class‘C’ city)
2. Fully equipped operation theatre of its own wherever surgical operations are carried out
3. Fully qualified Nursing Staff under its employment round the clock
4. Fully qualified Doctor should be in charge round the clock

The policy also reimburses through TPA relevant medical expenses incurred upto 30 days prior to and 60 days after hospitalisation subject to the overall sum insured.

The policy provides for Domiciliary Hospitalisation expenses when medical treatment is taken for a period exceeding 3 days for an illness/disease/injury (not specifically excluded) which normally would require treatment as an in-patient in a hospital/nursing home but is actually taken whilst confined at home in India under the following circumstances:

Either the condition of the patient is such that he/she cannot be removed to the hospital/nursing home OR the patient cannot be removed to the hospital/nursing home for lack of the accommodation therein.

The policy does not cover any disease / injury which the insured is suffering from, at the time of taking the first policy. Certain specified illnesses are also excluded during the first year of insurance.

In individual mediclaim policy only, there is a provision for reimbursement of expenses incurred for a medical check-up, subject to certain limits, once every 4yrs, provided the policy is renewed without break and no claim has been preferred during this period. This payment can be claimed from TPA after submission of bills.

Add on covers
The policy can be extended to cover treatment taken in Nepal and /or Bhutan with prior permission from the insurance company.

The group mediclaim policy can be extended, on payment of additional premium, to cover maternity benefit i.e. expenses incurred in delivery, provided the extension is taken for all the members covered in the group.

Who can take the policy
The policy can be taken by any person residing in India who is between 5 and 80 yrs of age. Children between the age of 3months and 5yrs can be covered provided one or both parents are covered concurrently.

How to select the sum insured
Various options are available ranging from Rs.15,000/- sum insured to Rs.5lacs sum insured. Since the annual premium is based on the age of the person covered and the sum insured selected, the selection of sum insured would depend upon the premium one could afford to pay. The sum insured represents the maximum amount that would be reimbursed for medical treatment for all illnesses suffered during the policy period of one year.

In individual mediclaim policy, a cumulative bonus of 5% is given on every claim free renewal whereby the sum insured is increased by 5% on renewal provided there has been no claim in the previous policy period. Maximum cumulative bonus permissible is 50% which would be given after 10 years claim free renewal. In the event of a claim, the increased percentage will be reduced by 10% subject to minimum of the basic sum insured selected.

How to claim
In case of a claim under the policy, the Insured person should contact the Third Party Administrator whose name and address has been mentioned in the policy. The reimbursement for treatment taken in Non-Network hospital is also made through TPA.

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