National Mediclaim Plus Policy
Will be updated soon.
Eligibility
| Entry Age (years) | |
| Minimum | 18 |
| Maximum | 65 |
| Maximum Policy Renewal Age (years) | The policy can be renewed annually throughout the lifetime of the insured person by mutual consent before the expiry of the policy. |
| Coverage Type | Policy can be issued to individuals on individual sum insured basis. The Policy offers three plans with varying covers Plan A:INR 2 lac to INR 10 lac in multiples of 1lac Plan B:INR 15 lac, INR 20lac,INR 25 lac Plan C: INR 30 lac, INR 40 lac ,INR 50 lac |
| Sum Insured (Rs) | |
| Maximum | 50 Lakh |
| Minimum | 2 Lakh |
| Cumulative Bonus | Increase in SI by 5% of SI (excluding CB) per year up to 50% of SI (excluding CB) |
| Policy Term (years) | 1 |
| Pre Policy Medical Check Up | Pre policy checkup is required for individual 40 (forty) years and above or opting for SI INR 6,00,000 and above, irrespective of age of the individual or opting for Critical Illness optional cover, between the age of 18 (eighteen) years and 65 (sixty five) years. The company shall reimburse 50% (fifty percent) of the expenses incurred for pre policy checkup, if the proposal is accepted and the premium has been realised. |
| Policy Termination | The company may cancel the policy (on grounds of fraud, moral hazard, misrepresentation or noncooperation) by sending the insured person 30 (thirty) days notice by registered letter at insured person’s last known address and in such event the company shall not allow any refund. The insured person may at any time cancel the policy and in such an event the company shall allow refund of premium after charging premium at company’s short period rate as applicable |
Additions to the Plan
| PLAN A | PLAN B | PLAN C | |
| Sum insured (SI) | INR 2/ 3 /4 / 5/ 6/ 7/ 8/ 9 /10 Lac | INR 15/ 20 /25 Lac | INR 30/ 40/ 50u00A0Lac |
| Coverage | |||
| Hospitalisation, Pre (30 days) and Post (60 days), Hospitalisation, Daycare procedure | Covered | Covered | Covered |
| Pre existing disease | Covered after 36 months | Covered after 36 months | Covered after 36 months |
| Room/ ICU charges (per day) | Room - Up to 1% of SI, ICU-Up to 2% of SI subject to max. of INR 15,000 | Up to INR 15,000 | Up to INR 20,000 |
| Limit for cataract surgery (for each eye) | Up to 15% of sum insured or INR 60,000 whichever is lower | Up to INR 80,000 | Up to INR 1,00,000 |
| Allopathy, Ayurveda and Homeopathy | Up to sum insured | Up to sum insured | Up to sum insured |
| Organ donoru0092s medical expenses | Covered | Covered | Covered |
| Maternity | Up to INR 30,000 for normal delivery and INR 50,000 for caesarean section | Up to INR 60,000 for normal delivery and INR 75,000 for caesarean section | Up to INR 80,000 for normal delivery and INR 1,00,000 for caesarean section |
| Hospital cash per day (max. of 5 days) | INR 500 | INR 800 | INR 1,000 |
| Ambulance (in a policy period) | Up to INR 2,500 | Up to INR 4,000 | Up to INR 5,000 |
| Air ambulance (in a policy period) | Not covered | Up to 5% of SI | Up to 5% of SI |
| Medical emergency reunion (in a policy period) | Not covered | Up to INR 20,000 | Up to INR 20,000 |
| Doctoru0092s home visit and nursing care during post hospitalization per day, max. of 10 days (in a policy period) | Not covered | INR 750 | INR 1,000 |
| Vaccination for children (up to 12 years) in a policy period | Up to INR 1,000 | Up to INR 1,000 | Up to INR 1,000 |
| Other benefits | |||
| Medical Second Opinion (MSO) for each new diagnosis of any of the major illnesses, in a policy period | One MSO | One MSO | One MSO |
| Good Health Incentives | |||
| Cumulative bonus | Increase in SI by 5% of SI per year up to 50% of SI | Increase in SI by 5% of SI per year up to 50% of SI | Increase in SI by 5% of SI per year up to 50% of SI |
| Health checkup (every 2 years irrespective of claims) | Up to INR 1,000 | Up to INR 2,000 | Up to INR 3,000 |
| Copayment | |||
| Copayment of 20% of admissible claim if treatment undergone in non-networku00A0provider | Applicable | Applicable | Applicable |
| Optional covers | |||
| Critical Illness | INR 2,00,000/ 3,00,000/ 5,00,000/ 10,00,000/ 15,00,000/ 20,00,000/ 25,00,000 | ||
| Outpatient Treatment | INR 2,000/ 3,000/ 4,000/ 5,000/ 10,000 | ||
| Objective | The objective of this policy is to offer protection against high health care costs and make health care and related services easy and accessible. |
| Suited for | his policy can be bought by an individual for self or for family on an individual sum insured basis or as a floater cover. |
| What does it do? | The Policy provides for expenses of hospitalisation, pre & post and day care treatment. Expenses of Allopathic, Ayurvedic and Homeopathic treatment are payable up to the sum insured. The Policy covers expenses of maternity, for new born and vaccination for children. Expenses for medical emergency reunion, air ambulance and hospital cash are also payable. In the event of being diagnosed with a serious illness, a medical second opinion from World Leading Medical Centres will be arranged. In addition, optional covers for Critical illness and Outpatient treatment can also be availed. |
| Pros | This policy can be bought online.The policy offers various discounts such as Family, Youth and Online discount.The policy can be renewed lifelongPremium paid towards the policy is exempt from Income Tax under section 80D of Income Tax Act. |
| Cons | There are sub-limits on the policy benefits. |
| Premium Rate with TPA charges (in INR) | ||||||||||||||
| SI / Age (in Months & Years) | 3m-5 | 6-17 | 18 - 25 | 26-35 | 36-45 | 46-55 | 56-59 | 60-65 | 66-70 | 71-75 | 76-80 | 81-85 | 86 + | |
| 2,00,000 | 5050 | 5101 | 5668 | 5781 | 5897 | 8127 | 11756 | 15299 | 22194 | 25812 | 27225 | 28412 | 29532 | |
| 3,00,000 | 6589 | 6589 | 7321 | 7468 | 7468 | 10804 | 15755 | 20309 | 29863 | 34114 | 37111 | 39040 | 40494 | |
| 4,00,000 | 7982 | 7983 | 8870 | 9047 | 9047 | 13250 | 19421 | 24853 | 36888 | 41601 | 46260 | 48940 | 50684 | |
| 5,00,000 | 9279 | 9279 | 10310 | 10516 | 10517 | 15537 | 22857 | 29082 | 43471 | 48537 | 54898 | 58334 | 60271 | |
| 6,00,000 | 10335 | 10335 | 11483 | 11713 | 11714 | 17707 | 26122 | 33076 | 49722 | 55064 | 62596 | 66768 | 69561 | |
| 7,00,000 | 11334 | 11335 | 12594 | 12846 | 12847 | 19615 | 29082 | 36729 | 55554 | 61113 | 70166 | 75146 | 78343 | |
| 8,00,000 | 12288 | 12289 | 13655 | 13928 | 13928 | 21446 | 31931 | 40230 | 61171 | 66900 | 77473 | 83145 | 86831 | |
| 9,00,000 | 13205 | 13205 | 14673 | 14966 | 15586 | 23214 | 34686 | 43604 | 66606 | 72468 | 84438 | 90901 | 95067 | |
| 10,00,000 | 14088 | 14089 | 15654 | 15967 | 17334 | 24927 | 37361 | 46869 | 71883 | 77847 | 91192 | 98445 | 1,03,083 | |
| 15,00,000 | 19002 | 19003 | 28070 | 31501 | 31816 | 34917 | 49962 | 58719 | 76711 | 82983 | 1,02,105 | 1,19,966 | 1,26,272 | |
| 20,00,000 | 22672 | 22673 | 30291 | 44606 | 45052 | 45502 | 60568 | 68885 | 83460 | 86190 | 1,13,693 | 1,39,731 | 1,47,876 | |
| 25,00,000 | 26055 | 26056 | 32680 | 46682 | 47149 | 50974 | 70221 | 77027 | 86328 | 89518 | 1,20,707 | 1,54,911 | 1,64,683 | |
| 30,00,000 | 29730 | 29732 | 35729 | 49351 | 50627 | 59199 | 79260 | 83996 | 86938 | 93430 | 1,24,801 | 1,66,901 | 1,77,731 | |
| 40,00,000 | 35609 | 35611 | 41473 | 53964 | 58765 | 73381 | 93784 | 93789 | 94620 | 1,00,732 | 1,25,128 | 1,81,594 | 1,94,796 | |
| 50,00,000 | 40905 | 40907 | 47760 | 58118 | 67611 | 87008 | 1,06,084 | 1,06,090 | 1,06,095 | 1,08,605 | 1,25,134 | 1,88,066 | 2,03,053 | |
| Service Tax extra | ||||||||||||||
| Discounts | ||||||||||||||
| Family discount 10% | ||||||||||||||
| Youth discount 10% | ||||||||||||||
| Online discount 5% | ||||||||||||||
