National Parivar Mediclaim Plus Policy: Coverage, Claim & Renewal

Updated: 04-09-2023 10:01:32 AM

What Is National Parivar Mediclaim Plus Policy?

National Insurance Parivar Mediclaim Plus policy is a family floater insurance policy which will reimburse in patient treatment, domiciliary hospitalisation expenses if the insured or his/her family is admitted in the hospital for the treatment due to illness/disease/accidental injury during the policy period. It offers financial coverage as high as Rs 50 lakh

Types Of National Parivar Mediclaim Plus Policy

National Insurance Parivar Mediclaim Plus Policy is a family floater policy wherein the entire family including self, spouse, children, parents/Parents-in-law will be covered under a single sum insured.

Eligibility Criteria

Particulars	Min-Max
Entry Age	Adult: 18-65 Yrs Child: 3 months-25yrs
Sum Insured	Plan A: Rs 6 lakh-Rs 10 lakh in multiples of Rs 1 lakh Plan B: Rs 15 lakh/Rs 20 lakh/Rs 25 lakh Plan C: Rs 30 lakh/Rs 40 lakh/Rs 50 lakh
Policy Term	1/2/3

What National Parivar Mediclaim Plus Policy Covers?

This health insurance policy provides coverage for the following:

• Hospitalisation expenses : Room rent, boarding, nursing
• Allopathy, Ayurveda, Homeopathy
• Pre/ Post Hospitalisation Expenses
• Day Care Treatment
• Domiciliary treatment
• Room rent, boarding, nursing
• Organ Donor Expenses
• Maternity Expenses
• Air, Ambulance charges
• Doctor’s home vist
• Nursing care during post hospitalisation
• Anti-rabies vaccination
• Maternity Expenses
• Infertility expenses
• Vaccination for children

 

Coverage	Plan A	Plan B	Plan C
Domiciliary Treatment	Up to Rs 1 lakh	Up to Rs 2 lakh	Up to Rs 2 lakh
Maternity Expenses	Up to Rs 30,000 for normal delivery and Rs 50,000 for caesarean section	Actual	Actual
Infertility Treatment Cover	Up to 50,000	Up to Rs 1 lakh	Up to Rs 1 lakh
Anti-rabies cover	Up to Rs 5,000
Ambulance Expenses	Up to Rs 2500	Up to Rs 4000	Rs 5,000
Air Ambulance expenses	Not Covered	Up to 5% of Sum Insured	Up to 5% of SI
Medical Emergency Reunion	Not Covered	No Sublimit	No Sublimit
Post hospitalisation expenses for Doctor’s home visit & nursing care	Not Covered	Rs 1000/ day maximum of 10 days	Rs 2000/ day maximum of 10 days
In Patient Treatment	Up to Sum Insured	Up to Sum Insured	Up to Sum Insured

Also Read: National Parivar Mediclaim Policy

Claim Process

For cashless and reimbursement Process, following steps should be followed:

• Inform the TPA about in advance to get the pre-authorisation within 24/72 hours of admission for emergency treatment/planned hospitalisation at one of the network hospitals
• The insured or someone from his behalf needs to fill Cashless request form which will be sent to TPA for authorisation
• Show the pre-authorisation letter, health card issued by the company, ID proof, policy to the network hospital to avail the cashless treatment facility
• If the process is followed properly and the documents are in order, the company will settle the claim
• In case of reimbursement process, fill out the claim form and send it to the TPA along with other documents required for the process within 15 days of discharge from the hospital
• The company will verify the documents received and approve the claim if everything is in order.

 

Document Required To Claim

Here are the documents required to submit to the insurance company:

• Duly signed claim and NEFT form
• Original hospital discharge card
• Original hospital bill
• Original money receipt duly signed with a revenue stamp
• Claim settlement letter from any other insurer (if any) in case of partial settlement
• Aadhaar card and PAN card copies
• Any other document required by company/TPA 

Cases Where You Can’t Claim National Parivar Mediclaim Plus Policy

The insurance company is not liable to pay if the claim arises due to the following cases:

• Intentional self-injury
• Suicide
• Insured under the influence of drugs, alcohol
• AIDS and other HIV related treatment
• Vitamins and tonics unless forming a part of the main treatment
• Dental treatment
• Claim due to war, invasion and nuclear perils

How Long Does It Take To Pay Out A Claim?

The claims need to be intimated within the duration of 24 hours [under hospitalization]. Upon getting all the required documents, the insurance company will assess and evaluate them and accordingly settle the claim within 30 days.

Renewal Process Of National Parivar Mediclaim Plus Policy

This policy can be renewed annually throughout the lifetime of the insured person. If the insured wish to increase the sum insured, S/he can do it at the time of renewal. The policyholder will get 30 days as a grace period from the date of expiry to renew his policy. It is recommended for an insured to pay timely premium before his policy gets lapsed.

Advantages Of Buying National Insurance Parivar Mediclaim Plus Policy

• Usually non-allopathic treatments such as Allopathy, Ayurveda, Homeopathy are not covered in the basic health insurance policy but under this, it is covered up to full sum insured
• The policy holder can seek medical second opinion for 160 major illnesses
• This policy provides the benefit of daily cash benefit
• Policyholder can avail tax benefits for the premium paid under section 80D of the Income Tax act 1961
• Free look period is available where the policyholder gets 15 days to review the terms and conditions of the policy and return the same if not found suitable

Critical Aspects

• No tax benefit is allowed on the premium paid under Critical Illness cover, if it is opted by the policyholder
• Amount available under Critical Illness cover is limited to the 50% of the sum insured
• Expenses of Pre-existing disease such as diabetes/ or hypertension will be covered after continuous 36 months of insurance

 

Features
Claim Type (In-House or TPA)	Cashless and TPA
Pre-Hospitalization	Expenses incurred 30 days prior to admission in the hospital
Network Hospital Count
Post-Hospitalization	60 days after the discharge from hospital
Room Eligibility	Covered, Up to 1% of Sum Insured per day
Share Claim Payments	10% if the treatment is taken in a non network hospital under Plan A
Restoration of Cover	Restored due to road traffic accident
No Claim Bonus	5% discount on the base premium every year
Ambulance Charges	Covered, Rs 2500-Rs 5000
Worldwide Coverage	NA
Maternity Cover	Covered
Hospitalization at Home	Covered, Rs 1 lakh-Rs 2 lakh
Day Care Treatment	Covered, 140+ day care procedures are covered
Non-Allopathic Treatment Coverage	Covered
Emergency Ambulance	NA
Health Check up	Covered after two continuous policy years

FAQ’s

Q1-Does this policy provide hospital cash benefit?

Yes, it does as per the table below per insured, per day:

Plan A – Rs 500 maximum of 5 days

Plan B- Rs 1000 maximum of 5 days

Plan C- Rs 2000 maximum of 5 days

Q2- What are the optional covers one can opt for under this policy?

National Insurance Parivar Mediclaim Plus provides comprehensive coverage to the insured, however, one can increase the coverage by opting for the optional covers such as Pre-existing diabetes, hypertension, outpatient treatment and critical illness.

Q3 Are there any discounts associated with National Insurance Parivar Mediclaim Plus Policy?

Yes, there are certain discounts which the insured can avail in the following segment:

Long term discount – If the policy is issued for two/three policy years, the insured will be eligible to get 4%/7.5% respectively on the premium.

If this policy is bought online, one can avail 5% discount in the premium and 2.5% discount if it is renewed online as well.

Discount in Lieu of no Maternity/ Infertility cover for individuals above forty five years Discount of 3%, shall be allowed on individual premium, for Insured and his spouse above forty five years of age. Discounts as per 2.4.2 and 2.4.3 shall not apply to optional covers and to mid term inclusion of family members.

Q4- How can one purchase this policy?

It is very easy to purchase this policy, either the policy seeker can directly go to the official website of National Insurance and buy this policy from the following channels

• Operating offices
• Agents
• Self service kiosks
• Office on wheels (Mobile van)

Q5- Is pre policy checks mandatory under this policy?

If the individual member is aged 40 years and above, opting for plan B and C irrespective of age, individual opting for the critical illness between the age of 18-65 are required to go through pre-policy check-up. If the proposal is accepted by the insurance company, it will reimburse 50% of the expenses.