National Parivar Mediclaim Policy is a Customized Health Insurance Plan that provides all the Medical Insurance needs for an entire family in a single Policy & single Sum Insured, The Policy covers expenses in respect of inpatient treatment (allopathy, Ayurveda and homeopathy), domiciliary hospitalization, reasonably and usually incurred for treatment of a disease or an injury contracted/sustained during the policy period. The Policy also covers pre-hospitalization and post-hospitalization expenses, more than140 daycare procedures/surgeries, organ
donor’s medical expenses, hospital cash, ambulance charges, air ambulance charges, medical emergency reunion, doctor’s home visit, and nursing care during post-hospitalization, anti-rabies vaccination, maternity expenses, infertility expenses, vaccination for children and seconde -medical opinion. Pre-existing Diabetes and/or Hypertension, Outpatient Treatment, and other important Illness.
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Coverage Type- Floater insurance
covering the members of a family under one sum insured and shall cover a minimum of two relations.
Minimum Sum Insured – 1 Lakh
Maximum Sum Insured- 10Lakh
Minimum Entry Age– 18Years
Maximum Entry Age– 65 Years
Eligibility– Self, Spouse, dependent Children’s, Parents
Childrens coverage Age– Minimum 3 Months Maximum 18 years
Dependent Male Child if not employed or a bonafide student cover up to 25 Years
Female Child if not employed Cover till Marriage
Policy Term- 1 to 3 Years
Treatment Nature– Allopathy, Ayurveda, Homeopathy
Pre- Policy Medical Check Up – Policy check-up is required for all individual relations who are fifty years and above or between the age of eighteen years and sixty-five years, choosing Critical Illness?
The Company shall reimburse 50% of the expenses incurred for pre-Policy check -up if the proposal is accepted and therefore the premium has been realized.
Room Rent & Nursing Charges– 1% of Sum Insured
ICU CHARGES- 2% of Sum Insured
Domiciliary Treatment– cover for domiciliary Hospitalization expense
Day Care Procedure– Cover More than 140 daycare Procedures for example dialysis, chemotherapy, etc. Up to Sum Insured.
Donor Medical Expense- Full cover of the donor organ Medical Expense.
Hospital Cash Benefit-
The Company shall pay the insured a daily hospital cash allowance up to the limit as shown below for a maximum of five days, provided the hospitalization exceeds three days.
Illustration
In the case of hospitalization of 3 days – No Hospital Cash payable
In case of hospitalization of 5 days – Hospital Cash payable for 4th and 5th day only, i.e., 2 days
In case of hospitalization of 10 days – Hospital Cash payable for 4th to 8th day, i.e., 5 days
Hospitalization of fewer than 24 hours shall not be considered for the purpose of payment of Hospital Cash
Ambulance charges – Up to Rs- 1,000/- per illness & per insured person, and Rs 2,500/- (in a policy year)
Anti Rabies Vaccination– Cover For Anti Rabies Vaccination-
MaternityThe Company shall pay to the hospital or reimburse the insured the medical expenses, incurred as an in-patient, for delivery or termination up to the first two deliveries or terminations of pregnancy during the lifetime of the insured or his spouse, if covered by the Policy, provided the Policy has been continuously in force for twenty-four months from the inception of the Policy or from the date of inclusion of the insured person by the Policy, whichever is later. The benefits mentioned below are up to the limit asshown in the Table of Benefits.i. Medical expense for delivery (normal or cesarean).
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ii. Medical expense for lawful medical termination of pregnancy.iii. Hospitalization expenses, if medically necessary, up to a maximum of thirty days for pre-natal and sixty days for post-nataltreatment within the sub-limit for maternity. Baby from Birth Cover Medical expenses of the newborn baby/ newborn babies (in the event of multiple births in a delivery), including expenseswith respect to vaccination. Hospitalization is not required for vaccination. Infertility– Cover of infertility treatment of insured and spouse after three years of continuous coverageE- Medical Opinion– The second medical opinion for a serious illness can be arranged from a world-leading center.Adjustment of the premium for Travel Policy- Renewal Premium will be adjusted for the period policyholder is abroad and coverage under overseas medical Policy from the National Insurance. No Claim Bonus– 5% flat discount on base premium for each claim-free Policy Year (aggregated for each year and available on renewal) Aggregate amount of NCD allowed shall not exceed flat 5% of the entire base premium for the term of the policy.Long Term Policy Discount- 4% on the total premium of two years, 7.5% on the total Premium of 3 Years.Health CheckupWaiting period and exclusions – Health check-up Every 4 claim-free years., up to INR 5,000.
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Pre-existing illnesses Shall be covered after the Policy has been continuously effective for forty-eight months.Waiting period First thirty days from the inception of the Policy. Certain illnesses as Benign ENT disorders, Tonsillectomy, Adenoidectomy, Mastoidectomy, and Tympanoplasty are going to be covered after completion of the primary policy year; Cataract, Benign prostatic hypertrophy, etc. are going to be covered after completion of two years of policy; Treatment for joint replacement unless arising from accident Osteoarthritis and osteoporosis are going to be covered after completion of 4 years of the policyHIV, AIDS, STDAny condition directly or indirectly caused to or associated with HIV, AIDS, complications of AIDS, and other sexuallytransmitted diseases (STD).
General Debility, Congenital External Anomaly
General debility, run-down condition or rest cure, congenital external disease or defects or anomaly
Obesity
Treatment for obesity or a condition arising therefrom (including morbid obesity) and any other weight control and management
programme/services/supplies or treatment.
Treatment of genetic disorders.
Drug Alcohol abuse.
Spectacles, contact lens, hearing aid, cochlear implants.Psychiatric Disorder, Self Inflicted InjuryTreatment for all psychiatric and psychosomatic disorders/diseases, intentional self-inflicted injury, attempted suicide. Genetic Disorders, Stem Cell Surgery (except bone marrow transplant). Circumcision Circumcision, except as and to the extent provided
Vaccination or Inoculation
Vaccination or inoculation unless forming part of treatment and requires hospitalization, except as and to the extent provided
Optional Cover
- Pre-existing diabetes and/ or hypertension optional cover, covered from Inception up to the sum insured opted.
- Outpatient Treatment- Cover limit – Rs-2,000 to Rs 10,000, per family
- Critical Illness – Lump Sum Benefit Rs 2,00,000 to 10,00,000 on the diagnosis of a Critical Illness
Zone Region Discount (%)
II – capital Territory (NCT) Delhi and National Capital Region (# NCR), Chandigarh, Pune 4.44%
III – Chennai, Hyderabad, Bangalore, Kolkata 11.11%
IV — Rest of India 20%
Premium Rate excluding GST for senior-most members (with TPA) for each policy year for Zone I (Greater Mumbai Metropolitan area, the entire state of Gujarat)
| Sum Insured / Age in years |
18-25 |
26-35 |
36-45 |
46-55 |
56- 59 |
60-65 |
66-70 |
71-75 |
76-80 |
81-85 |
86+ |
| 1,00,000 |
3,652 |
4,004 |
4,967 |
7,319 |
9,328 |
10,404 |
11,983 |
13,983 |
14,716 |
16,053 |
20,504 |
| 2,00,000 |
4,905 |
5,052 |
6,928 |
11,148 |
14,156 |
16,576 |
20,243 |
23,118 |
25,230 |
27,846 |
29,421 |
| 3,00,000 |
5,942 |
6,120 |
8,542 |
12,746 |
16,695 |
19,111 |
22,550 |
31,279 |
35,175 |
39,219 |
41,838 |
| 4,00,000 |
6,671 |
7,158 |
9.935 |
15,123 |
18,138 |
22,261 |
26,744 |
38,879 |
44,506 |
50,133 |
54,001 |
| 5,00,000 |
7,325 |
8,007 |
11,253 |
16,943 |
19,208 |
24,812 |
30,241 |
46,660 |
53,313 |
60,652 |
65,864 |
| 6,00,000 |
7,926 |
8,862 |
12,607 |
18,513 |
20,504 |
27,842 |
33,335 |
53,414 |
61,612 |
70,753 |
77,402 |
| 7,00,000 |
8,551 |
9,746 |
13,613 |
20,911 |
23,173 |
29,854 |
35,771 |
58,469 |
68,889 |
79,875 |
88,043 |
| 8,00,000 |
9,153 |
10,681 |
14,685 |
22,269 |
23,767 |
31,244 |
37,787 |
61,768 |
75,998 |
93,136 |
1,02,696 |
| 9,00,000 |
9,662 |
11,685 |
15,595 |
23,491 |
25,288 |
35,357 |
40,619 |
64,512 |
82,735 |
1,07,390 |
1,18,446 |
| 10,00,000 |
10,148 |
12,292 |
17,173 |
24,806 |
27,180 |
37,709 |
43,673 |
66,723 |
89,262 |
122,733 |
1,34,143 |
| Premium Rate excluding GST for other family members (with TPA) for each policy year for Zone I (Greater Mumbai Metropolitan area, the entire state of Gujarat) |
|
|
Sum Insured ) / Age
(in months & years) |
3m-5 |
6-17 |
18-25 |
26-35 |
36-45 |
46-55 |
56-59 |
60-65 |
66-70 |
71-75 |
76-80 |
81-85 |
86+ |
|
1,00,000 |
469 |
531 |
594 |
678 |
1207 |
2551 |
3756 |
5202 |
6220 |
7507 |
8234 |
9325 |
13328 |
|
2,00,000 |
573 |
644 |
798 |
856 |
1684 |
3886 |
5701 |
8288 |
10508 |
12459 |
14116 |
16175 |
19124 |
|
3,00,000 |
656 |
734 |
967 |
1037 |
2076 |
4443 |
6723 |
9556 |
11706 |
16857 |
19680 |
22781 |
27195 |
|
4,00,000 |
701 |
782 |
1085 |
1213 |
2415 |
5272 |
7304 |
11131 |
13883 |
20953 |
24901 |
29121 |
35100 |
|
5,00,000 |
740 |
824 |
1192 |
1357 |
2735 |
5906 |
7735 |
12406 |
15698 |
25146 |
29829 |
35231 |
42812 |
|
6,00,000 |
775 |
861 |
1290 |
1501 |
3064 |
6453 |
8257 |
13921 |
17304 |
28786 |
34472 |
41098 |
50311 |
|
7,00,000 |
811 |
900 |
1391 |
1651 |
3308 |
7289 |
9332 |
14927 |
18568 |
31510 |
38543 |
46397 |
57228 |
|
8,00,000 |
846 |
937 |
1489 |
1810 |
3569 |
7763 |
9571 |
15622 |
19615 |
33288 |
42521 |
54100 |
66752 |
|
9,00,000 |
874 |
967 |
1572 |
1980 |
3790 |
8189 |
10183 |
17679 |
21085 |
34767 |
46291 |
62380 |
76990 |
|
10,00,000 |
900 |
994 |
1651 |
2083 |
4173 |
8647 |
10945 |
18855 |
22670 |
35958 |
49943 |
71292 |
87193 |
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