National Insurance Varishtha Mediclaim for Senior Citizens
Objective
This is a special policy that aims to cover senior citizens against hospitalisation and critical illness expenses.
Suited for
Any senior citizen, upto 80 years of age, can buy this policy and renew it up to 90 years of age.
What does it do?
A senior citizen policy which will cover hospitalisation expenses, but with sub-limits. It offers additional coverage for critical illness only if policyholder opts for it. Most people in this age group suffer from diabetes or hypertension. This policy offers to cover pre-existing diabetes and hypertension for extra premium. No claim would be paid if the insured member smokes 40 or more cigarettes/ cigars or has an equivalent tobacco intake each day.
Pros
It offers critical illness cover and pre-existing diabetes and hypertension for an extra premium.
This policy can also covers paralysis and blindness for an extra premium.
Premium paid is eligible for tax benefit under section 80D of the Income Tax Act.
Cons
There are sub-limits on the policy benefits.
Policyholder has to bear a pre-specified percentage of admissible claim each time medical services are availed.
Our View
Every senior citizen policy has co-payment clause attached to it. A policyholder cannot escape the co-payment condition while buying insurance at this age. Another useful feature is Critical illness cover which can be added onto this policy as the chances of contracting such illnesses are high at this age.
Eligibility
| Entry Age (years) | |
| Minimum | 60 |
| Maximum | 80 |
| Maximum Policy Renewal Age (years) | 90 |
| Coverage Type | Individual |
| Sum Insured (Rs) | 100000 and Rs 200000 for critical illness |
| Policy Term (years) | 1 |
| No Claim Bonus | Insured person can either opt for a premium discount of 5% for each claim free year till it reaches 50% or select to increase the sum insured by the amount of cumulative bonus at the time of renewal |
| Pre Policy Medical Check Up | Not required if insured was covered under any health insurance for preceding three years. Required for others |
| Co Payment Clause | Insured has to compulsorily bear 10% of all admissible claims. Insured may also opt for 2% co-payment which will entitle him for a premium discount of 10%. An additional co-payment of 10% of admissible claim would be required in case claim arises out of a pre-existing disease |
| Customer Service | |
| Address | Head Office: National Insurance Company Limited 3 Middleton Street Kolkata West Bengal Pincode : 700071 |
| Mail to | [email protected] |
| Call to | 1800 419 4033 |
Additions to the Plan
| Scope Of Cover | |
| Cashless facility | available if treatment availed in a network hospital |
| Reimbursement facility | available if treatment availed in a non-network hospital |
| Pre and post hospitalisation | medical expenses incurred during 30 days prior to hospitalisation and 60 days after discharge from hospital will be covered |
| Section I | |
| Hospitalisation expenses | covered |
| Room, Boarding expenses as provided by the Hospital/Nursing Home | covered upto 1% of Sum Insured per day. Cover increases to 2% if admitted to ICU. Overall limit is 25% of Sum Insured per illness |
| Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses | covered upto maximum of 25% of Sum Insured per illness |
| Anesthesia, Blood, Oxygen, OT charges, Surgical appliances (any disposable surgical consumables subject to upper limit of 7% of Sum Insured), Medicines, drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of pacemaker, artificial limbs, Cost of stent & implants | covered upto maximum of 50% of Sum Insured per illness |
| Domiciliary treatment | covered upto 20% of basic sum insured |
| Ambulance charges | covered upto Rs 1000 in a policy year |
| Cost of health check up | reimburses the amount upto maximum of 2% of average sum insured once after a block of 3 continuous claim free years |
| Pre-existing Diabetes and Hypertension | covered from inception of the policy |
| Section II | |
| Critical Illnesses | |
| Coronary Artery Surgery | covered |
| Cancer | covered |
| Renal Failure i.e. Failure for both kidneys | covered |
| Stroke | covered |
| Multiple Sclerosis | covered |
| Major Organ Transplants like kidney, Lung, Pancreas or Bone marrow | covered |
| Paralysis and blindness at extra premium | requires additional premium equal to 15% in each case or 25% in case of both covers together |
| Exclusions and Waiting Period | |
| Pre-existing illnesses | covered after 1 policy year from inception of the policy |
| No claim period | 30 days for general cover and 90 days in case of Critical Illness from commencement of the policy |
| Waiting period | Certain disorders and surgeries such as cataract, hernia, Piles etc. will be covered after first policy year |
| Annual Premium | ||||||
| Sum Insured (in Rs) | Age (in years) | |||||
| 60-65 years | 66-70 years | 71-75 years | 76-80 years | |||
| Mediclaim | 1 lakh | 4180 | 5196 | 5568 | 6890 | |
| Critical Illness | 2 lakh | 2007 | 2130 | 2200 | 2288 | |
| Total Premium | 6187 | 7326 | 7768 | 9178 | ||
| For fresh entrants to National Insurance, above premium will be increased by 10%. | ||||||
| If insurer wants to cover pre-existing diabetes and /or Hypertension, an additional premium of 10% for each condition has to be paid for the first policy year. | ||||||
