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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.

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.

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.

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 facilityavailable if treatment availed in a network hospital
Reimbursement facilityavailable if treatment availed in a non-network hospital
Pre and post hospitalisationmedical expenses incurred during 30 days prior to hospitalisation and 60 days after discharge from hospital will be covered
Section I
Hospitalisation expensescovered
Room, Boarding expenses as provided by the Hospital/Nursing Homecovered 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 Expensescovered 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 & implantscovered upto maximum of 50% of Sum Insured per illness
Domiciliary treatmentcovered upto 20% of basic sum insured
Ambulance chargescovered upto Rs 1000 in a policy year
Cost of health check upreimburses the amount upto maximum of 2% of average sum insured once after a block of 3 continuous claim free years
Pre-existing Diabetes and Hypertensioncovered from inception of the policy
Section II
Critical Illnesses
Coronary Artery Surgerycovered
Cancercovered
Renal Failure i.e. Failure for both kidneyscovered
Strokecovered
Multiple Sclerosiscovered
Major Organ Transplants like kidney, Lung, Pancreas or Bone marrowcovered
Paralysis and blindness at extra premiumrequires additional premium equal to 15% in each case or 25% in case of both covers together
Exclusions and Waiting Period
Pre-existing illnessescovered after 1 policy year from inception of the policy
No claim period30 days for general cover and 90 days in case of Critical Illness from commencement of the policy
Waiting periodCertain disorders and surgeries such as cataract, hernia, Piles etc. will be covered after first policy year

Cost Details

Annual Premium
Sum Insured (in Rs)Age (in years)
60-65 years66-70 years71-75 years76-80 years
Mediclaim1 lakh4180519655686890
Critical Illness2 lakh2007213022002288
Total Premium6187732677689178
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.