National Parivar Mediclaim Policy: Coverage, Claim & Renewal

Updated: 04-09-2023 09:30:24 AM

The Family is the foundation of life and love. In order to protect them and ensure that that they do not face any financial insecurity, it is recommended to invest in a good Family Health Insurance Policy. National Insurance has Parivar Mediclaim Policy which is a health insurance policy which helps to provide financial coverage to the policyholder as well as to his or her family against the financial burden of hospitalisation expenses.

What Is National Parivar Mediclaim Policy?

National Insurance Parivar Mediclaim policy is a family floater insurance policy which will reimburse 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.

Types Of National Parivar Mediclaim Policy

National Insurance Parivar Mediclaim Policy is a family floater policy wherein the entire family including self, spouse and two dependent children will be covered under a single sum insured.

Eligibility Criteria

Particulars	Min-Max
Entry Age	Adult: 18-65 Yrs Child: 3 months-25 yrs
Sum Insured	Rs 2 lakh-Rs 5 lakh in multiples of 50,000
Policy Term	One Year

 

What National Insurance Parivar Mediclaim Policy Covers?

This health insurance policy provides coverage for the following:

• Room rent, boarding, nursing
• Consultant, specialists fees
• Pre/ Post Hospitalisation Expenses
• Day Care Treatment
• Organ Donor Expenses
• Expenses incurred for any one illness which is limited to 50% of sum Insured

Diabetes and hypertension can be covered from inception by paying extra premium

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:

• First consultation letter from the doctor
• 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 Policy

• The insurance company is not liable to pay if the claim arises due to the following cases:
• Certain disease are excluded up to first 2 years of the policy
• 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
• Pregnancy
• Non-allopathic 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 Policy

This policy can be renewed annually throughout the lifetime of the insured person. However, beyond 65 years, 25% loading charges will be applicable in the premium. 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 Parivar Mediclaim Policy

• It reimburses hospitalisation expenses which helps to take the financial burden off from the insured
• Cashless facility can be availed through TPA
• 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

Features
Claim Type (In-House or TPA)	Cashless and TPA
Pre-Hospitalization	Expenses incurred 15 days prior to admission in the hospital
Network Hospital Count
Post-Hospitalization	30 days after the discharge from hospital
Room Eligibility	1% of sum insured per day (Normal) and 2% of sum insured per day (ICU)
Share Claim Payments	10-25% if the claim arises out of diabetes and/or hypertension covered under pre-existing disease
Restoration of Cover	NA
No Claim Bonus	NA
Ambulance Charges	NA
Worldwide Coverage	NA
Maternity Cover	NA
Hospitalization at Home
Day Care Treatment	Covered, 140+ day care procedures are covered
Non-Allopathic Treatment Coverage	NA
Emergency Ambulance	NA
Health Check up	NA

 

FAQ’s

Q1- Is Pre-existing disease covered under this policy?

Pre-existing disease, injuries and related conditions mentioned at the time of inception of the policy will be covered after 4 years of continuous coverage claim free policy years.

Q2- 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 or S/he can visit directly to the office and agents to purchase this policy.

Q3- Is there any waiting period with this policy?

Yes, pre-existing disease will be covered after a waiting period of 48 months and there are some specified diseases which are covered after a waiting period of 2 years.