New Delhi: National Insurance Company (NIC) offers motor, health, personal accident policy, rural insurance, Pradhan Mantri Suraksha Bima Yojana (PMSBY), Pradhan Mantri Fasal Bima Yojana (PMFBY) insurance among others. Under its health insurance portfolio, it has a host of products like National Mediclaim Plus Policy (Individual Plan), National Mediclaim Policy (Individual Plan), Overseas Mediclaim Business and Holiday, Overseas Mediclaim Employment and Studies and Parivar Mediclaim.
The National Mediclaim Policy covers in-patient treatment expenses incurred during the treatment of illness or injury. It also covers more than 140-day care procedures on cashless or reimbursement basis during the policy period.
Highlights, benefits, exclusions of National Mediclaim Policy-
1. Any individual between the age of 18 and 65 years can apply for this policy. Children between the age from three months to 18 years, spouse, dependent parents can be covered under this.
2. Under this scheme, the sum insured ranges from Rs 50,000 to Rs 5 lakh.
3. Room Rent or ICU charges, medical practitioners, surgeon, anesthetist, consultants, specialist’s fees and other charges would be as per the limits mentioned in the policy.
4. The ambulance charges and organ donor’s expenses are covered up to sub-limit mentioned.
5. The cashless facility is available at the network hospitals only through a third-party administrator (TPA).
6. It offers an annual increase in sum insured by five per cent for each claim free year up to a maximum of 50 per cent of sum insured opted.
7. It offers benefits like tax rebate under Section 80D of Income-Tax Act 1961 for the premium paid.
8. HIV, AIDS, STD, Sterility, infertility, assisted conception, refractive error surgery, obesity, psychiatric disorder, intentional self-inflicted injury, cosmetic, plastic surgery, dental treatment (unless arising out of accident and requiring hospitalization) and outpatient department treatment (OPD) are not covered under the National Mediclaim Policy.
9. The documents required during the claim includes duly filled claim form issued by insurer (Part A & Part B), discharge summary of hospital, doctor's certificates and prescriptions, final hospital bills and receipts, laboratory and other investigation reports or plates or films and bills, pharmacy bills and receipts, and any other document as may be required on case to case basis.
10. For the planned hospitalization, intimation must be sent to the TPA or company in advance (72 hours prior) with details of name and address of the hospital and condition requiring hospitalization. In case of emergency hospitalization, intimation should be sent within 24 hours of admission.
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