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  • National Health Insurance

    National Health Insurance
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    Cashless Treatment

    Customer Service

    Medical Coverage

    Claim Experience

    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 Health Insurance at a Glance

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    Coverage for your most loved ones

    Total members covered

    Coverage for a maximum of 6 family members*

    You get a choice of coverage tenure

    Pre and Post Hospitalization cover

    Medical expenses covered for 30 days before your hospitalization and 60 days for post hospitalization for related medical expenses

    The next best thing to having a doc in the family

    Health Check-ups

    Health check up expenses will be reimbursed once at the end of a block of 4 continuous claim free policy years, upto a maximum of 1% of the average sum insured of the block.

    * For a family health cover product.

    Critical Factors of the Plan

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    Not a paisa goes from your own pocket!

    Co-Pay

    No-copay, Insured may also opt for 2% co-payment which will entitle him for a premium discount of 10%.

    You?re covered for any future medical expenses

    Life long renewable

    Plans are lifelong renewable and covers you for your entire lifetime.

    Get essential cover for existing ailments

    Pre-existing Diseases

    Any pre-existing condition will be covered after a waiting period of 4 year

    Hospital room rent determines your treatment bill

    Room Rent

    Room, boarding & nursing expenses upto 1% of the sum insured per day& 2% of sum insured per day for ICU. subject to an overall limit of 25% of the sum insured

    *These Features may be included as part of different products and are subject to the insurer's terms & conditions.

    Additional Features of National Health Insurance

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    Good health offers multiple rewards

    Discount of 10% will be allowed on the total premium if policy is bought for family comprising the insured

    The world is your healthcare oyster

    Cashless facility available in over 6000+ hospitals across India.

    So you have time to focus on more important stuff

    Cumulative bonus @5% of sum insured for each claim free policy year

    *These add-ons may be included as part of different products and are subject to the insurer's terms & conditions.

    Overview

    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 affordable healthcare.


    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 Mediclaim Policy
    2. National Mediclaim Plus Policy
    3. Parivar Mediclaim
    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 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 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

    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)
    Exclusions
    • 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

    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

    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

    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 FAQs

    1. Can this policy by National Insurance cover the whole family?
    2. Yes. Family members can be covered for up to a maximum of the sum assured to policy owner.


    3. How much insurance does an individual need?
    4. 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.


    5. What is meant by portability?
    6. Portability refers to transfer of policy from one insurance provider to another along with credit gained and family cover, if applicable.


    7. What is a waiver?
    8. The time period for furnishing claim related proof may be waived in case the insurance company deems necessary.


    9. Is there a free-look period for these health insurance policies by National Insurance?
    10. 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.


    11. What is cashless facility?
    12. 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.


    13. Can a person already suffering from some disease avail this scheme?
    14. 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.


    15. How is Health Insurance different from Life Insurance?
    16. 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.


    17. Do I need Health Insurance if I am young and Healthy?
    18. 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.


    19. I have a Health Insurance scheme from my Employer, do I still need a personal Health Insurance policy?
    20. 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.


    21. Is there tax benefit on Health Insurance schemes?
    22. Yes. Tax exemption is available under section 80D of the Income Tax Act.


    23. What is the maximum and minimum policy duration?
    24. Most policies come for a whole year after which they are to be renewed. However, certain policies also offer two years renewal period.


    25. Are diagnostic charges covered in Health Insurance?
    26. Yes. Diagnostic tests like MRI, CT-Scan etc. are covered under the medical insurance schemes.


    27. Are homeopathy and naturopathy covered in National Health Insurance?
    28. No. These treatments are not covered under a standard policy.


    Examples of Network Hospitals in Major Cities

    CITY NAME OF HOSPITAL
    Mumbai Lilavati Hospital
    New Delhi Apollo Hospital
    KOLKATA Fortis Hospital
    BANGALORE Ramakrishna Hospital
    CHENNAI Deepam Eye Hospital

    *Disclaimer - This is not an exhaustive list but an indicative representation of hospitals that form a part of the company's wider network.


    News About National Health Insurance

    • 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.

      31st May 2016

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