National Health Insurance

Below is a table summarizing various National health insurance plans: 

National Mediclaim Policy (Individual)

National Mediclaim Policy (Individual) is a comprehensive health insurance plan tailored to offer extensive coverage for medical expenses incurred by the insured individual. The policy provides a sum insured ranging from Rs.1 lakh to Rs.10 lakh, ensuring financial security during times of medical emergencies. 

Features and Benefits: 

1. Hospitalization Expenses Coverage: The policy covers hospitalization expenses, including room charges, doctor's fees, and other related costs, ensuring that you receive the necessary medical care without worrying about financial burdens. 
2. Chemotherapy and Radiotherapy Coverage: Treatment expenses for chemotherapy and radiotherapy are included in the policy, providing support for critical illnesses like cancer. 

1. Coverage for Specific Illnesses: The National Mediclaim Policy also covers treatment expenses for specific ailments like HIV/AIDS, morbid obesity, and refractive error, offering a broader scope of coverage. 
2. Coverage for Mental Illness and Hazardous Sports: The policy extends coverage for mental illness treatment and even includes benefits for individuals involved in hazardous sports, ensuring their well-being. 
3. Ambulance Charges and AYUSH Treatment: The policy covers ambulance charges for transportation to the hospital and funeral expenses, easing the financial burden on the family during difficult times.
4. Preventive Health Check-up: After every 4 claim-free years, the insured can avail of preventive health check-up facilities, allowing early detection of potential health issues. 
5. Cumulative Bonus: The policy offers a cumulative bonus of 5% for each claim-free year, with a potential bonus of up to 50%, rewarding policyholders for maintaining a healthy lifestyle. 

1. Sum Insured Reinstatement: Plans with a sum insured of Rs.6 lakh and above offer the benefit of sum insured reinstatement, which ensures that you can make multiple claims without exhausting your coverage. 

National Parivar Mediclaim Plan

The National Parivar Mediclaim policy is specifically designed to provide comprehensive coverage for the medical expenses of the entire family on a floater sum insured basis. With a sum insured ranging from Rs.1 lakh to Rs.10 lakh, this policy ensures that your family's health needs are well taken care of. 

Features and Benefits: 

1. In-patient Hospitalization Coverage: The policy covers the expenses incurred during in-patient hospitalization, including room charges, doctor's fees, and other related costs. 
2. Domiciliary Hospitalization Coverage: If any family member requires treatment at home, the policy covers domiciliary hospitalization expenses, ensuring continuous medical care. 

1. AYUSH Treatments Coverage: The policy extends coverage for alternative therapies under Ayurveda, Yoga, Unani, Siddha, and Homeopathy (AYUSH), promoting holistic healthcare. 
2. Maternity and Infertility Cover: The National Parivar Mediclaim policy includes maternity cover, covering expenses related to childbirth, and also offers infertility cover, providing support for fertility treatments. 
3. Coverage for Anti-Rabies Vaccination and Medical Second Opinion: The policy covers the costs of anti-rabies vaccination and also provides coverage for seeking medical second opinions, ensuring well-informed healthcare decisions. 
4. Coverage for Specific Illnesses: Treatment expenses for morbid obesity, hazardous sports injuries, and refractive error are covered under this policy, offering a wider scope of coverage. 
5. Health Check-up Facilities: Policyholders can avail health check-up facilities once every 4 years, facilitating regular health monitoring and early detection of health issues. 

1. Optional Covers: The National Parivar Mediclaim policy also offers optional covers like OPD (Out-Patient Department) cover, critical illness cover, and PED (Pre-existing Diseases) diabetes/hypertension cover, providing customized coverage to suit individual health requirements.

National Senior Citizen Mediclaim Policy

The National Senior Citizen Mediclaim policy is a specialized health insurance plan tailored to meet the medical needs of senior citizens aged 60 years and above. This policy offers a sum insured option ranging from Rs.1 lakh to Rs.10 lakh, ensuring adequate coverage for the healthcare requirements of elderly individuals. 

Features and Benefits: 

1. Hospitalization Expenses Coverage: The policy covers hospitalization expenses incurred during in-patient care, including room charges, doctor's fees, and other related medical costs. 
2. Day Care Procedures Coverage: The policy extends coverage for day care procedures, ensuring necessary medical treatments are covered even if they do not require overnight hospitalization. 

1. Domiciliary Hospitalization Coverage: In case the insured requires medical treatment at home, the policy covers domiciliary hospitalization expenses, ensuring uninterrupted healthcare. 
2. Coverage for Specific Illnesses: The National Senior Citizen Mediclaim policy provides coverage for morbid obesity, refractive error treatment, and injuries sustained during adventure sports, offering comprehensive protection. 
3. Ambulance Charges and Funeral Expenses Coverage: The policy covers ambulance charges for transportation to the hospital and also provides coverage for funeral expenses, easing the financial burden on the family during difficult times. 
4. Reinstatement of Sum Insured for Road Traffic Accidents: In case of a road traffic accident, the sum insured is reinstated, ensuring the insured has adequate coverage for subsequent medical expenses. 
5. Cumulative Bonus: For every claim-free year, the policy offers a cumulative bonus of 5%, enhancing the sum insured over time as a reward for maintaining good health. 

1. Preventive Health Check-up Benefits: The National Senior Citizen Mediclaim policy includes preventive health check-up benefits, encouraging regular health screenings and early detection of health issues. 
2. Optional Covers: Policyholders have the option to avail an additional coverage for PED diabetes/hypertension, OPD treatments, personal accidents, and critical illnesses, tailoring the policy to suit their individual healthcare needs.

National Super Top Up Mediclaim Policy

The National Super Top Up Mediclaim policy is specifically designed to offer additional coverage to the insured individuals beyond their base health insurance policy, providing extra financial protection in case the sum insured of the base policy gets exhausted. With a sum insured range of Rs.3 lakh to Rs.20 lakh and a deductible amount ranging from Rs.2 lakh to Rs.10 lakh, this policy ensures enhanced coverage for unforeseen medical expenses. 

Features and Benefits: 

1. Coverage for Hospitalization and Modern Treatments: The policy provides coverage for hospitalization expenses, daycare procedures, and modern medical treatments, ensuring comprehensive protection for the insured's healthcare needs. 

1. Coverage for Specific Illnesses: The National Super Top Up Mediclaim policy covers treatments for AIDS, refractive errors, and injuries sustained during adventure sports, offering specialized protection. 
2. Coverage for Maternity Expenses and Morbid Obesity: The policy extends coverage for maternity-related expenses and treatments for morbid obesity, catering to the unique healthcare requirements of individuals. 
3. Post-Hospitalization Home Care: The policy covers doctor, nurse, and attendant's visit at home following hospitalization, ensuring continuity of care and a smooth recovery process. 
4. Cumulative Bonus: For every claim-free year, the policy provides a cumulative bonus of 5%, enhancing the sum insured over time as a reward for maintaining good health. 
5. Daily Hospital Cash Benefit: In case of hospitalization exceeding three days, the policy offers daily hospital cash benefits of up to Rs.2000, helping the insured manage additional expenses during their hospital stay.

National Mediclaim Plus Policy

The National Mediclaim Plus policy is a comprehensive and all-encompassing health insurance plan tailored to provide extensive coverage for individuals against a wide array of diseases and medical conditions. With a sum insured range of Rs.2 lakh to Rs.50 lakh, this policy ensures that individuals are adequately protected and financially secure in the face of unforeseen medical expenses. 

Features and Benefits: 

1. Comprehensive Coverage: The National Mediclaim Plus policy offers coverage for various medical expenses, including hospitalization costs, ambulance charges, and modern medical treatments, ensuring a holistic approach to healthcare coverage. 
2. Maternity Cover and Children's Vaccination: The policy provides coverage for maternity-related expenses and children's vaccination, addressing the specific healthcare needs of individuals and their families. 
3. Coverage for Hazardous Sports, Morbid Obesity, and Refractive Error: The policy extends coverage for treatments related to hazardous sports injuries, morbid obesity, and refractive errors, offering specialized protection for unique healthcare requirements. 

1. Medical Emergency Reunions and Second Opinion: The policy covers expenses for medical emergency reunions, allowing individuals to be reunited with their loved ones during medical emergencies. Additionally, it provides coverage for medical second opinions, ensuring informed decisions regarding healthcare treatments. 
2. Health Check-up Facilities: The National Mediclaim Plus policy offers health check-up facilities after every two years, promoting preventive care and early detection of health issues. 
3. Cumulative Bonus: The policy provides a cumulative bonus of 5% for every claim-free year, increasing the sum insured up to 50% as a reward for maintaining good health. 
4. Optional Covers: The policy offers the flexibility to add optional covers such as OPD cover and critical illness cover, enabling individuals to customize their insurance plan as per their specific healthcare needs. 

National Parivar Mediclaim Policy

The National Parivar Mediclaim Plus policy is a comprehensive and inclusive health insurance plan that offers coverage for the entire family on a floater sum insured basis. With a sum insured ranging from Rs.6 lakh to Rs.50 lakh, this policy ensures that the family members are well-protected and financially secure in the face of medical contingencies. 

Features and Benefits: 

1. Comprehensive Coverage: The National Parivar Mediclaim Plus policy provides coverage for hospitalization expenses, ensuring that the family has access to quality healthcare when needed the most. It also offers coverage for medical emergency reunions, allowing insured members to be reunited with their loved ones during critical health situations. 
2. Maternity Expenses and Newborn Baby Coverage: The policy includes coverage for maternity expenses, newborn baby expenses, and infertility treatments, catering to the specific healthcare needs of expecting mothers and newborns. 
3. Medical Second Opinion and Sum Insured Reinstatement: The policy offers the benefit of a medical second opinion, allowing insured members to seek expert advice for making informed decisions about their healthcare. Additionally, it provides sum insured reinstatement in case of road traffic accidents, ensuring that the family's coverage remains intact during challenging times. 
4. Coverage for Adventure Sports Injuries, Refractive Error, and Morbid Obesity: The National Parivar Mediclaim Plus policy extends coverage for treatments related to adventure sports injuries, refractive errors, and morbid obesity, addressing unique healthcare requirements that may arise. 

1. Health Check-Up Benefits: The policy covers the costs of health check-ups after every two years, promoting preventive care and early detection of health issues for the entire family. 
2. Optional Covers: The policy offers the flexibility to add optional covers such as critical illness cover, OPD cover, and PED diabetes/hypertension, empowering the insured members to customize their insurance plan according to their specific healthcare needs. 

National Vidyarthi Mediclaim Policy

The National Vidyarthi Mediclaim policy for students is specifically tailored to cater to the healthcare needs of students, providing health insurance and personal accident coverage. With a sum insured amount ranging from Rs.50,000 to Rs.2 lakh, this policy ensures that students have access to comprehensive coverage during their academic journey. 

Features and Benefits: 

1. In-Patient Hospitalization, Pre-Hospitalization & Post-Hospitalization Expenses: The policy covers the expenses incurred during in-patient hospitalization, as well as the pre-hospitalization and post-hospitalization expenses, ensuring that students receive comprehensive coverage for their medical treatments. 

1. Coverage for HIV/AIDS and Refractive Error: The Vidyarthi Mediclaim policy extends coverage for treatments related to HIV/AIDS and refractive errors, addressing specific health concerns that students may face. 
2. Treatment for Mental Illnesses and Morbid Obesity: The policy covers the treatment expenses for mental illnesses and morbid obesity, promoting holistic healthcare for students' overall well-being. 
3. Personal Accident Cover and Repatriation Expenses: The policy provides personal accident coverage, safeguarding students from financial hardships in case of accidents. Additionally, it covers repatriation expenses for both students and their guardians, ensuring they receive proper care and support during emergencies. 
4. 5% Cumulative Bonus: For every claim-free year, the policy grants a cumulative bonus of up to 50%, rewarding students for maintaining good health and not making claims. 
5. No Pre-Policy Medical Check-Up: The Vidyarthi Mediclaim policy eliminates the need for a pre-policy medical check-up, making it convenient and accessible for students to purchase the policy without any hassle. 

National Critical Illness Policy

The National Critical Illness policy offers extensive financial coverage for a wide range of critical illnesses, ensuring that policyholders receive the necessary support and financial assistance during challenging times. With a sum insured ranging from Rs.1 lakh to Rs.75 lakh, this policy provides substantial coverage to address the financial burden associated with critical illnesses. 

Features and Benefits: 

1. Lump Sum Payment on First Diagnosis: In the event of a first diagnosis of any of the covered critical illnesses, the policy offers a lump sum payment to the insured. This helps policyholders to manage the immediate financial expenses related to the illness and access necessary medical treatments. 
2. 5% Early Entry Discount: Policyholders who are under 42 years of age at the time of purchasing the policy are eligible for a 5% early entry discount. This discount provides cost savings and benefits young individuals planning for critical illness coverage. 
3. No Pre-Policy Medical Check-Up Up to Age 45: For individuals up to 45 years of age, no pre-policy medical check-up is required. This streamlines the policy purchase process, making it more convenient and accessible for potential policyholders. 

1. Survival Period: The policy specifies a survival period, which is the duration that the insured must survive after the critical illness diagnosis to be eligible for the lump sum payment. The survival period varies from 30 days to 90 days, depending on the terms of the policy. 

How to Buy National Health Insurance Online?

To purchase a National Health Insurance policy online, follow these steps: 

1. Step 1: Visit the official website of National Health Insurance. 
2. Step 2: Click on the 'Health Insurance' icon on the webpage. 

1. Step 3: Select the individuals you want to insure and provide their respective ages. 
2. Step 4: Enter the city of residence and your contact details for communication. 
3. Step 5: Indicate if you have any medical history or pre-existing diseases. 
4. Step 6: Browse and choose the specific National Health Insurance plan that best suits your requirements. 
5. Step 7: Review all the policy details, coverage, and health insurance premium amount before proceeding. 

1. Step 8: Make the payment for the chosen policy to complete the purchase process. 
2. Step 9: After successful payment, the insurance company will issue you the policy document. 

How to Renew National Health Insurance Online?

To renew your National Health Insurance policy online, follow these steps: 

1. Step 1: Visit the official website of National Health Insurance. 

1. Step 2: From the dropdown menu, select 'Health Renewal.' 
2. Step 3: Enter your registered mobile number and the One-Time Password (OTP) received on your mobile. 
3. Step 4: For new customers, click on the health insurance icon on the homepage and provide the requested details such as age, city, phone number, etc. 
4. Step 5: Select the specific National Health Insurance policy you want to renew. 
5. Step 6: Pay the renewal premium amount using the available online payment options. 

1. Step 7: After successful payment, your policy will be renewed, and you will receive confirmation of the renewal. 

Documents Required for National Health Insurance

When you are raising a reimbursement claim under National Health Insurance, it is essential to ensure that you have all the necessary documents ready to facilitate a smooth and successful claim process: 

1. A fully completed claim form: This form is provided by the insurance company and contains essential details about the insured person, the nature of the medical treatment, and the expenses incurred. 
2. Cash memo from the hospital or chemist with prescriptions: The cash memo serves as proof of the medicines or medical supplies purchased along with the prescriptions from the treating doctor.  

1. Hospital bills and payment receipts: These documents serve as evidence of the medical expenses incurred during the hospitalization or treatment. They should clearly mention the services availed and the amount paid.  
2. Discharge certificate or summary from the hospital: The discharge certificate provides details about the duration of hospitalization, the treatment received, and the overall condition of the patient upon discharge. 
3. Investigation test reports along with their payment receipts and prescriptions: Any medical tests or investigations conducted as part of the treatment should be supported by their respective reports, payment receipts, and prescriptions. 
4. Doctor's certificate stating the diagnosis date: This certificate from the treating doctor confirms the diagnosis date and helps determine the eligibility for the claim. 
5. The patient's medical history: Providing the patient's medical history helps the insurance company assess the nature of the illness or injury and verify the need for medical treatment.  

1. Surgeon's certificate providing details of the operation and payment receipts: If any surgical procedure was performed, the surgeon's certificate must contain details about the surgery, and the payment receipts for the surgery expenses should be included. 
2. Any additional documents as requested by the insurance company: Depending on the specific circumstances of the claim, the insurance company may request additional documents to verify the authenticity of the claim. 

How to File a Health Insurance Claim with National Insurance?

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

1. 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.
2. 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.

Online Payment Options for 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.

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