National Health Insurance

National Health Insurance offers health plans that can be renewed throughout one’s lifetime. The plans come with access to a wide hospital network, add-on covers, cashless claims, and a number of exclusive features and benefits.

National Insurance Company Limited (NICL) is a fully central government owned general insurance company based in India. The company headquartered at Kolkata was established in 1906 and nationalised in 1972. NIC's gross direct premium income has steadily grown to about INR9000 crores rupees in the financial year 2012-13.

National Insurance Company Limited (NICL) is one of the oldest general insurance companies in India, offering customised health insurance plans and comprehensive health covers. From individual health insurance policies and family floater plans to senior citizen plans and group mediclaim policies, NICL offers a wide range of health insurance products to satisfy the varying needs of the customers.

The insurance cover can be enhanced by attaching an add-on like critical illness cover. The premium paid towards a National Health Insurance plan is eligible for tax deduction under Section 80D of the Income Tax Act, 1961.

National Insurance Company Highlights Updated on 28 Oct 2021

Features Specifications
Network Hospitals 6000+
Waiting Period for Pre-existing Disease 4 years
Incurred Claims Ratio 114.24%
Number of Policies Issued 1807861
Grievances Solved 97.07%
Renewability Lifetime

*For Year 2017-2018

Overview of National Health Insurance:

National Health Insurance Plans

National Insurance Company (NIC) is the oldest domestic general insurance provider in India. Formed 107 years ago in 1906, this company has established a stronghold in the northern and eastern parts of India through several pioneering efforts.

NIC was responsible for creating flexible general insurance products, tailoring them to meet customers’ personalised requirements. Although it is commonplace today for insurers to reach out to customers through bancassurance relationships and tie-ups with auto dealers and other major players, NIC was the first to explore this idea of maximising penetration through partnerships of strategic importance.

NIC has about 1,340 offices all over India with operations in Nepal as well. It reaches new territories through its growing business network of 373 centres. Its clientele includes both retail as well large industrial customers.

The company has made social and economic inclusion one of its priorities. It strives to extend the reach of the general insurance industry to areas that are not greatly exposed to insurance as a product or form of financial discipline. It accomplishes this through the use of technology which helps it cross physical boundaries and reach people in need of

As part of its product bouquet, National Insurance Company offers health insurance solutions to fulfill the financial protection needs of both individuals and their families. On offer in this category are the following policies:

  1. National Insurance Mediclaim Policy
  2. National Insurance Mediclaim Plus Policy
  3. National Insurance Parivar Mediclaim Policy
  4. Varistha Mediclaim Policy for Senior Citizens
  5. National Insurance Critical Illness Policy
  6. National Insurance Individual Personal Accident Policy
  7. National Insurance Janata Personal Accident Policy

The various facets of each of these health insurance plans are elucidated below:

National Insurance Mediclaim Policy:

Eligibility Entry age 18 years to 65 years. Children between 3 months and 18 years (at least one parent has to be covered under this plan). (sons above 18 years are considered dependents till the age of 25, if still a student; daughters are considered dependents until marriage).
Eligibility Max. Renewability Age No Limits
Eligibility Medical Screening Not required for persons up to 50 years. Required for persons over 50 years (not applicable to those switching over from another general/health insurer). Reimbursement of screening costs - 50% when proposer qualifies as a client.
Cover Sum Assured Rs.50,000 to Rs.5 lakhs (in increments of Rs.25,000).
Cover Basis Individual or Family Floater. (Family includes the proposer, his/her spouse and dependent children and dependent parents)
Cover Events
  • Inpatient hospitalisation (minimum 24 hours).
  • Up to 25% of sum assured for room expenses, which includes nursing charges - Up to 25% of sum assured for doctor’s fees.
  • Up to 50% of sum assured for anaesthesia, blood, oxygen, OT charges, surgical equipment, medicines, drugs, diagnostic equipment, pacemaker, prosthesis, implants, stents, dialysis, chemo/radiotherapy, donor hospitalisation expenses
  • Up to 1% of sum assured or Rs.2,000, whichever is lower for ambulance costs - Up to 20% of sum assured for Ayurvedic and Homeopathic treatment.
  • Over 140 day care procedures.
  • Up to 30 days of pre-hospitalisation expenses.
  • Up to 60 days of post-hospitalisation expenses.
  • Pre-existing diseases (waiting period - 4 years).
  • Accidental injuries (no waiting period).
Costs Premiums Family Premium Discount Rs.856 to Rs.40,124 (depends on age and chosen sum assured). 10% for covering an additional family member.
Benefits No-Claim Bonus Claims Claim updates Health Checks Emergency Assistance Hospital Network Tax Deduction 5% increment in sum assured for every claim-free year upon successive renewals (up to 50%). Cashless and Reimbursement facilities. SMS alerts. After every 4 successive claim-free years, up to 1% of the basic sum assured. 24 hours TPA customer support. 6,000 plus, in over 1,500 areas. As per provisions U/S 80D of the Income Tax Act.
Terms Portability Free Look Period Tax Allowed. 15 days from policy receipt for cancellation with premium refund (adjusted). Service tax and TPA charges apply.
Exclusions Ailments/Procedures/Treat-ments STDs including HIV and related diseases, General enervation, Maternity, Obesity, Psychiatric and related ailments, Genetic disorders, Unnecessary vaccinations, Cosmetic/sex change surgeries, Lipid Profiling, Blood Sugar, Serum Creatinine, Urine Tests, Microscopic Exams, ECGs, Eye checkups and retinoscopy, Treatment by unqualified doctors.

National Insurance Mediclaim Plus Policy:

Eligibility Entry age 18 years to 65 years. Children between 3 months and 18 years.
Eligibility Max. Renewability Age No Limits
Cover Sum Assured Plan A - Rs.2 to 10 lakhs (increments of Rs.1 lakh); Plan B - Rs.15 to 20 lakhs (increments of Rs.5 lakhs); Plan C - Rs.30 to 50 lakhs (increments of Rs.10 lakhs)
Cover Events
  • Inpatient hospitalisation.
  • Room charges: Up to 1% of sum assured (Plan A), Up to Rs.15,000 (plan B) and Up to Rs.20,000 (Plan C).
  • ICU charges: Lower of 2% of sum assured or Rs.15,000 (Plan A), Up to Rs.15,000 (Plan B), Up to Rs.20,000 (Plan C).
  • Cataract Surgery: Lower of 15% of sum assured or Rs.60,000 (Plan A), Up to Rs.80,000 (Plan B), Up to Rs.1 lakh (Plan C).
  • Maternity Delivery Expenses: Up to Rs.30,000/Rs.50,000 normal/c-sec (Plan A), Up to Rs.60,000/Rs.70,000 normal/c-sec (Plan B), Up to Rs.80,000/Rs.1 lakh normal/c-sec (Plan C).
  • Maternity hospitalisation costs including pre and post-natal expenses: Up to 2 deliveries/terminations for life time of insured member/spouse subject to waiting period of 2 years.
  • Newborn Expenses.
  • Cash Allowance for up to 5 days of hospitalisation: Rs.500 (Plan A), Rs.800 (Plan B), Rs.1,000 (Plan C).
  • Donor hospitalisation expenses.
  • Ambulance costs: Up to Rs.2,500 (Plan A), Up to Rs.4,000 (Plan B), Up to Rs.5,000 (Plan C).
  • Air Ambulance charges covered under Plans B and C up to 5% of sum assured.
  • Medical emergency reunion covered under Plans B and C up to Rs.20,000 - Post- hospitalisation allowance up to 10 days (includes doctor visits and nursing charges): Up to Rs.750 (Plan B) and Up to Rs.1,000 (Plan C)
  • Vaccinations for children under 12 years: Up to Rs.1,000.
  • One Second Medical Opinion for each illness.
  • Up to 100% of sum assured for Ayurvedic and Homeopathic treatment.
  • Over 140 day care procedures.
  • Up to 30 days of pre-hospitalisation expenses.
  • Up to 60 days of post-hospitalisation expenses.
  • Pre-existing diseases (waiting period - 3 years).
  • Add-on covers: Critical Illness sum assured from Rs.2 to 25 lakhs and Outpatient Treatment sum assured from Rs.2,000 to 10,000.
Benefits No-Claim Bonus Co-payments Health Checks 5% increment in sum assured for every claim-free year, upon successive renewals (limited to 50%). SMS alerts. 20% of admissible claim (non-network hospital). Every 2 years: Up to Rs.1,000 (Plan A), Up to Rs.2,000 (Plan B), Up to Rs.3,000 (Plan C).
Exclusions Ailments/Procedures/Treat-ments STDs including HIV and related diseases, General enervation, Obesity, Genetic disorders, Cosmetic/sex change surgeries, Naturopathy, Unscientific Treatment, Abuse of intoxicants, Spectacles, Contact Lens, Hearing Aids, Cochlear Implants

National Insurance Parivar Mediclaim Policy:

Floater Basis for protection of the proposer’s entire family against hospitalisation costs on account of ailments/accidental injuries
Eligibility Entry age 18 years to 60 years. Children between 3 months and 25 years
Eligibility Max. Renewability Age 65 years.
Cover Sum Assured Rs.2 lakhs to Rs.5 lakhs (in increments of Rs.50,000). Payout for each illness is subject to a limit of 50% of the chosen sum assured.
Cover Basis Family Floater. (Family includes the proposer, his/her spouse and dependent children).
Cover Events
  • Inpatient hospitalisation (minimum 24 hours).
  • Up to 1% of sum assured per day for room expenses including nursing and RMO charges.
  • Up to 2% of sum assured per day for ICU costs.
  • Costs pertaining to Surgeons, Anaesthetists, Doctor’s, Consultants, Specialists, Nurses, Anaesthesia, Blood, Oxygen, OT, Surgical Equipment, Medicines, Drugs, Diagnostic Equipment, X-Ray, Dialysis, Chemo/Radiotherapy, Pacemaker, Prosthesis, Organs and related costs.
  • Diabetes: Waiver of waiting period on payment of additional premium.
  • Up to 15 days of Pre-hospitalisation expenses.
  • Up to 30 days of post-hospitalisation expenses.
Exclusions Ailments/Procedures/Treat-ments
  • Waiting period for pre-existing conditions: 4 years from start of policy, if the condition was covered under a prior policy; 4 claim-free years from start of policy, if the condition was not covered under a prior policy.
  • Policy is effective only 30 days after inception i.e. no claims will be admitted during this period.
  • Waiting period for specific diseases: 2 years.
  • Congential ailments, STDs including HIV and related ailments, Self-inflicted injuries, Abuse of intoxicants, Convalescence, Dental treatment, Complications/ailments resulting from pregnancy/delivery.
  • Unnecessary diagnostic, lab exams.
  • Non-allopathic treatment.
  • Terrorism, War and related acts.

Varistha Mediclaim Policy for Senior Citizens:

Eligibility Entry age 60 yrs. to 80 yrs.
Eligibility Max. Renewability Age 90 yrs. (premium loading applies)
Eligibility Medical screening Not required for those previously covered by a health insurance plan in the 3 yrs. preceding application
Cover Sum Assured Hospitalisation Cover - Rs.1 lakh; Critical Illness Cover - Rs.2 lakhs
Cover Basis Fixed sum assured per individual covered
Cover Events Inpatient hospitalisation expenses:
  • Room costs: Up to 1% of the chosen sum assured and ICU costs: Up to 2% of the chosen sum assured; both limited to 25% of the chosen sum assured per hospitalisation (sub-limits not applicable for certain procedures at preferred provider network hospitals; Domiciliary hospitalisation up to 20% of the chosen sum assured)
  • Fees payable to surgeons, anaesthetists, doctors.,consultants or specialists: Up to 25% of the chosen sum assured per hospitalisation
  • Anaesthesia, oxygen, medicines, blood, disposable surgical equipment, consumables, prosthesis (pacemakers, artificial limbs, stents etc.), costs pertaining to use of operation theatres/X-rays, cost of treatments like chemotherapy, dialysis, radiation: Up to 50% of the chosen sum assured per hospitalisation
  • Ambulance costs: Rs.1,000 per hospitalisation per policy period
  • Diabetes/Hypertension: On payment of additional premium
Critical Illness Cover (Optional):
  • Coronary Artery Surgery, Cancer, Kidney Failure, Stroke, MS, Organ Transplant (major organs), Paralysis (additional premium payable), Blindness (additional premium payable)
  • Waiting period of 1 year for pre-existing diseases - Dental treatment - Cosmetic treatment - Pregnancy, childbirth - General debility - Congenital defects - Self-injury - Injuries of war, nuclear activity etc. - Vaccinations

National Insurance Critical Illness Policy:

Sum assured is paid-out in a lumpsum upon diagnosis of specified critical illnesses
Eligibility Entry age 20 yrs. to 60 yrs.
Eligibility Max. Renewability Age 65 yrs.
Cover Sum Assured Rs.5 lakhs, Rs.10 lakhs, Rs.20 lakhs, Rs.25 lakhs
Cover Events Sum assured payable on diagnosis of the following specified illnesses, subject to survival for 30 days post-diagnosis:
  • Coronary Artery Surgery: Capped at 20% of the chosen sum assured
  • Cancer, Kidney Failure, Stroke, MS, Major Organ Transplant
Exclusions 90 day waiting period

National Insurance Individual Personal Accident Policy:

Covers accidental death and Disability
Eligibility Entry age 5 yrs. to 70 yrs.
Eligibility Medical Screening Not required
Cover Sum Assured Cumulative Bonus for every claim-free year under Comprehensive Cover: 5% increase in sum assured, limited to 50%
Cover Premium Discounts 10% discount for Family Package cover Discounts on Group Policies
Cover Events
  • Accidental Death, Permanent Total Disablement, Permanent Partial Disablement and Temporary Total Disablement: Choice of only death cover or comprehensive coverage
  • Accidental Hospitalisation Expenses and Daily Allowance for Accidental Hospitalisation (optional)
  • Global coverage
Exclusions Self - injury, suicide, insanity, injury as a result of intoxication or criminal activity

National Insurance Janata Personal Accident Policy:

Covers accidental death and Disability
Eligibility Entry age 5 yrs. to 70 yrs.
Eligibility Medical Screening Not required
Cover Policy Term Up to 5 yrs.
Cover Sum Assured Rs.25,000 to Rs.1 lakh (in increments of Rs.25,000), per person, p.a.
Cover Premium Rs.15 per Rs.25,000
Cover Premium Discounts Discounts on Group Policies, based on group size
Cover Events
  • Death, Loss of sight or loss of two limbs or loss of sight in one eye and loss of one limb, Permanent Total Disablement: 100% of the chosen sum assured
  • Loss of one limb or loss of of sight in one eye: 50% of the chosen sum assured
Exclusions Self - injury, suicide, insanity, injury as a result of intoxication or criminal activity

National Health Insurance Customer Care:

National Insurance Company Limited (NICL) is among India’s leading and also one of the oldest state owned general insurance companies which was established in the pre-independence ear of 1906. Headquartered in Kolkata, the insurer was nationalized in 1972 and now offers a number of wide variety of general insurance products which include accident insurance, medical insurance, property insurance, auto insurance, and more. The insurer has a large customer base across India which includes various sectors of society. In terms of overseas presence, the insurer also operates and offers its products in Nepal. Under its health insurance segment, National Insurance offers a number of well-appointed policies such as the Overseas Mediclaim Business & Holiday, National Parivar Mediclaim, National Mediclaim Plus Policy, Parivar Mediclaim Plus, among a few others.

An essential part of the retail business is after sales service, and that is something which National Insurance lays great emphasis on. The insurer has set up a dedicated customer service division which is responsible for handling all queries, complaints, issues, and grievances faced by customers regarding their health insurance policy. Customers can get in touch with the support team via call or by writing in to them. There is a dedicated toll free number on which customers can call to speak to a support staff person, or even send across their issues and complaints via email on the customer care email address. In addition to the online channels, customers can also have their queries registered and resolved by walking in to any National Insurance branch office. These branch offices are located in several metro cities across India such as Bangalore, Chennai, Hyderabad, Mumbai, and Delhi.

How to File a Health Insurance Claim with National Insurance?

Policyholders can file 2 types of claims with National Insurance Company Limited:

  • Cashless Claim: In the case of planned hospitalisation, intimate the insurer at least 72 hours prior to admission and in the case of emergency hospitalisation, intimate the insurer within 24 hours of admission at a network hospital of National Insurance. A pre-authorisation request has to be approved by the TPA in order to avail cashless facility at a network hospital. The TPA reserves the right to approve or deny the request.
  • Reimbursement Claim: In the case of planned hospitalisation, intimate the insurer at least 72 hours prior to admission and in the case of emergency hospitalisation, intimate the insurer within 72 hours of admission. Within 15 days from of discharge from the hospital, the insured member has to submit a duly-filled claim form along with the original medical documents to the TPA or the insurer in order to make a reimbursement claim. The claim will be approved or rejected as per the policy terms and conditions.

Incurred Claims Ratio of National Health Insurance for the Year 2017-18

Net Earned Premium (in Crore) Net Claims Paid (in Crore) Incurred Claims Ratio (in %)
Rs.4047.41 crore Rs.4676.88 crore 115.55%

How to Take a National Health Insurance Policy?

Contact the nearest branch office of NICL, collect the relevant proposal form from an authorised agent, fill the form and submit it to the agent. In some case, a surveyor will be appointed by the company to estimate the risk factor of your health condition. Premium estimate of your chosen policy can be calculated using the online premium calculator or checking in with your agent. Policy documents will be issued directly or through registered post.

National Health Insurance Mediclaim Premium Calculator:

The insurer's website will have an online premium calculator where you can get an instant quote on your chosen insurance policy for free. All you have to do is choose a policy from the drop-down box, enter your personal details such as date of birth, city, email ID, and phone number, then enter the sum insured, and click on 'Calculate Premium'. The gross premium amount including tax will be displayed on the screen.

National Health Insurance Mediclaim Policy Renewal:

To renew National Health Insurance Mediclaim Policy, visit the company website, enter your policy number and email ID, click on 'Proceed', enter your policy details, contact details, and confirm the provided details. Your renewal notice will be displayed on the screen with the renewal premium amount to be paid.

Online Payment National Health Insurance Mediclaim Policy:

National health insurance policies are available on the company website for purchase. The insurance cover can be between Rs.1 lakh to Rs.5 lakhs. Individual and Parivar Mediclaim policies are available online. The individual mediclaim policy is available for people up to 50 years of age and a sum insured of up to Rs.5 lakh. Online premium payment can be made via the NICL portal using net banking, credit card or debit card.

National Health Insurance FAQs:

  1. Can this policy by National Insurance cover the whole family?

    Yes. Family members can be covered for up to a maximum of the sum assured to policy owner.

  2. How much insurance does an individual need?

    It depends on a number of factors like age, income, lifestyle etc. This insurance from National Health is for a maximum of Rs.5 lakhs.

  3. What is meant by portability?

    Portability refers to transfer of policy from one insurance provider to another along with credit gained and family cover, if applicable.

  4. What is a waiver?

    The time period for furnishing claim related proof may be waived in case the insurance company deems necessary.

  5. Is there a free-look period for these health insurance policies by National Insurance?

    Yes. A free-look period of 15 days from the date of availing the policy is provided to customers. Within this period the customers are expected to go through each and every clause and return the policy in case they do not accept one or more of the clauses. A refund is then generated for the insured person.

  6. What is cashless facility?

    Once you are insured, you will be given a “Health Card” that would help you avail services of a partner hospital, without having to give any cash. This is known as cashless facility.

  7. Can a person already suffering from some disease avail this scheme?

    Yes. In this case, you will need to submit relevant documents indicating the current disease. Any medical expense made towards this disease will be exempt from insurance coverage.

  8. How is Health Insurance different from Life Insurance?

    Life Insurance protects your loved ones in case of your untimely death and the pay-out is made only when the policy holder dies. Health Insurance is required to make payments related to health issues and sicknesses that you may face. There is no payment to be made at maturity and Health Insurance generally, needs to be renewed every year.

  9. Do I need Health Insurance if I am young and Healthy?

    Yes. No one knows when a medical urgency may arise. Health Insurance keeps you protected in case of sudden injury due to accident as well as against a host of serious sicknesses. Also, Health Insurance takes care of hefty expenses that are made in case a sudden serious medical emergency strikes.

  10. I have a Health Insurance scheme from my Employer, do I still need a personal Health Insurance policy?

    A private policy in addition to the one offered by your employer is advisable since policies offered by employers are generally group insurance schemes which are non-transferrable and hence may create an issue in case you wish to switch your job. An individual health insurance policy is thus, always recommended.

  11. Is there tax benefit on Health Insurance schemes?

    Yes. Tax exemption is available under section 80D of the Income Tax Act.

  12. What is the maximum and minimum policy duration?

    Most policies come for a whole year after which they are to be renewed. However, certain policies also offer two years renewal period.

  13. Are diagnostic charges covered in Health Insurance?

    Yes. Diagnostic tests like MRI, CT-Scan etc. are covered under the medical insurance schemes.

  14. Are homeopathy and naturopathy covered in National Health Insurance?

    No. These treatments are not covered under a standard policy.

  15. How does National Health Insurance work?

    Individual health insurance plans are for people between 18 to 70 years of age. Family floater plans cover self, spouse, children, and dependent parents. You can opt for cashless treatments at the network hospital of NICL across the country. Maternity expenses are covered after a 1-year waiting period for the first 2 children. Pre-policy medical tests are not required for National Insurance Mediclaim policies. There is a 2-year waiting period for pre-existing disease cover. Co-pay is applicable only after reaching 60 years of age.

  16. How much is National Health Insurance?

    The cost of a health insurance policy offered by NICL is based on the premium amount. The insurance premium is calculated depending on the insured member’s age, health condition, place of residence, lifestyle habits, chosen sum insured, etc. The premium can be higher or lower based on whether you opt for co-pay and deductibles.

  17. How to pay a premium? What are the modes of payment available?

    Health insurance premium can be paid via online payment using netbanking, debit or credit card and cash payment at the nearest branch office. For online payment, visit the company website.

  18. How can I check policy status for National Health Insurance?

    In order to check the status of your National Health Insurance policy, log in to the company website with valid credentials and enter the policy number.

  19. What is the policy renewal process for National Health Insurance?

    Pay the renewal premium of your health insurance policy online through the company website. Register or log in to the website with your policy number and date of birth, select your prefered payment option (netbanking, debit card or credit card), and save the premium payment receipt.

  20. What is the company’s process to settle claim for National Health Insurance?

    Download the claim form from the company website, fill it, attach supporting documents of your claim, and submit it at the nearest branch office for approval.

  21. What is the policy cancellation process for National Health Insurance?

    During the free-look period, if you object to the terms and conditions of your health insurance policy, you can return it to the insurer. Premium refund will be done with certain deductions like stamp duty charges. During the policy period, you can submit a duly-filled surrender form along with your policy documents at the nearest branch office to cancel your health insurance policy.

Examples of Network Hospitals in Major Cities:

Mumbai Lilavati Hospital
New Delhi Apollo Hospital
KOLKATA Fortis Hospital
BANGALORE Ramakrishna Hospital
CHENNAI Deepam Eye Hospital

News About National Health Insurance

  • Rs.11,000 crore needed each year to fund the National Health Protection Scheme

    The National Health Protection Scheme announced in this year’s budget promises to insure the health of over 10 crore households, providing a cover of Rs.5 lakh per beneficiary. To fulfill this, the government would require a funding of at least Rs.11,000 crore per year, considering an average of 5 individuals per household. The budget was tabled and unveiled by the Finance Minister Arun Jaitley on the 2nd of February.

    8 February 2018

  • National Insurance Company to offer shares

    With an eye on strategic diversification, National Insurance Company (NIC) is likely to go public soon, with the government formulating policies for the same. Lack of capital is the main reason for NIC, which is currently owned by the government to consider this move. Shares will be sold either through an Initial Public Offer or divestment, with the process expected to be completed in the current financial year.

    The performance of NIC has come under the scanner, with losses reported by the company, primarily in the health and motor segments. Profits of the company were limited to investments of premiums, with this new move likely to provide it a much needed impetus.

    31 May 2016

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

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