National Parivar Mediclaim Plus

National Parivar Mediclaim Plus

National Parivar Mediclaim Plus Plan - Product Overview

The National Insurance Company Limited offers the National Parivar Mediclaim Plus Plan to cover your medical needs. Tailored to meet your health requirements, this plan comes with an array of features, benefits, and optional add-ons. You will also be able to enjoy attractive discounts when you choose the National Parivar Mediclaim Plus Plan. Opting for this plan means you can confidently access necessary medical care and stay worry-free from concerns about unexpected financial burdens. You can choose from three plan options: Plan A, Plan B, and Plan C.
 

Eligibility Criteria For The National Parivar Mediclaim Plus Plan

  • Minimum Age Of Entry: Adults can join the plan if they are at least 18 years old, while children as young as 90 days can be covered.
  • Maximum Age Of Entry: The maximum age to enter the plan is 65 years for adults, and if you are including dependent children, they can be covered up to the age of 18 years.
     

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Benefits And Coverage Overview Of The National Parivar Mediclaim Plus Plan

The National Parivar Mediclaim Plus Plan takes care of more than just inpatient hospitalisation costs—expenses when you stay in a hospital for over 24 hours, covering room, board, nursing charges, medical practitioner’s fees, ICU charges, prescribed medicines, drugs, and other such related costs. Here's a quick look at some of the expenses it covers for you –

  • Pre & Post Hospitalisation Expenses
    Do not worry if the doctor needs to do tests before or after your hospital stay, as the insurer has got you covered for such costs. The National Parivar Mediclaim Plus policy will cover pre and post-hospitalisation expenses up to the sum insured for a reasonable time – 30 days before you get hospitalised and 60 days after you get discharged. You should remember that the insurance company will cover these expenses only when they are related to the medical condition/disease for which you were hospitalised, and your claim must be approved as part of inpatient hospitalisation coverage.
     
  • Daycare Treatment Coverage
    Daycare treatment are those medical procedures or surgeries that used to require a long period of hospitalisation but can now be done within 24 hours as medical advancements are evolving every day. The National Parivar Mediclaim Plus Plan covers 140 daycare procedures with no limit on any treatment. This ensures that expenses will be covered up to the sum insured.
     
  • Domiciliary Treatment Coverage
    Domiciliary treatments are undergone for illnesses or injuries that need urgent care in a hospital but are given at home because you're too sick or injured to go to a hospital safely, or there are no available beds nearby. The National Parivar Mediclaim Plus Plan will cover the costs of domiciliary treatment up to a specific limit, depending on the plan you choose to buy.

Type of Plan

Maximum Limit

Plan A

Up to Rs. 1 Lakh

Plan B

Up to Rs. 2 Lakh

Plan C

Up to Rs. 3 Lakh

  • Organ Donor Coverage
    The National Parivar Mediclaim Plus Plan includes coverage for expenses related to organ donation when you are the recipient. It takes care of the inpatient costs for organ transplantation, covering up to the sum insured you choose in the policy.
     
  • Modern Treatment Coverage
    Healthcare is advancing quickly with new technologies, bringing about treatments that were once thought impossible. The National Parivar Mediclaim Plus Plan is designed to stay updated with these changes and covers the costs of modern treatments, up to 25% of the sum insured.
     
  • No Claim Discount
    If you don't make a claim in a policy year, you get a discount on your renewal premium called the no-claim discount. For a one-year policy term, you can receive a maximum 5% discount on the base premium. If your policy term lasts more than one year, i.e., in case of multi-tenure policies, you will accumulate discounts for each claim-free year, earning you up to 5% of the total base premium.
     
  • Restoration Benefit Due To Accident
    Under this benefit, if your sum insured gets used up during a policy year because of claims from a road accident injury, it gets restored. This benefit kicks in when your base sum insured is completely exhausted. It is available for subsequent claims within the same policy year. You can use this restoration benefit once per year, but it only applies if your hospitalisation expenses are within the sum insured.
     
  • Room Rent Limit
    The maximum amount your insurance company covers for the room you stay when you get hospitalised is called the room rent limit. If you choose a room within this limit, you will not incur any extra expenses. But, if you choose to go for a room with a higher rent than your allowance, a proportional deduction will apply. This means that you will need to pay a share of the whole bill, not just the extra room cost.
    With National Parivar Mediclaim Plus, if your plan type is B or C, you can freely choose any room without the insurer’s influence, as there are no restrictions on room rent. However, there is a room rent limit of 1% of the sum insured except if you get treated in a Preferred Provider Network (PPN) under Plan A.
     

Other Important Features of the Product

The National Parivar Mediclaim Plus comes with many additional key features that include –

  • Critical Illness Cover
    Dealing with critical illnesses can quickly surpass the limits of a regular family health insurance policy. However, with National Parivar Mediclaim Plus, you will be financially protected if you get diagnosed with a critical illness during the policy period. Opting for this add-on allows you to receive a lump sum in addition to your chosen sum insured if, unfortunately, you are diagnosed with a covered critical illness and survive for at least 30 days after the diagnosis.
    You can choose the benefit amount you want when you start the policy based on your required healthcare needs. You should, however, keep in mind that this lump sum amount should not exceed 50% of the sum insured, and there are also other conditions related to coverage.
     
  • Maternity Benefit
    The plan provides financial support for childbirth, but it comes with a waiting period that you need to fulfil. This helps expecting mothers and their families concentrate on the joyful event without worrying about the costs. The cover takes care of pregnancy-related expenses, either up to the sum insured or specific limits, depending on your chosen plan type. It also includes coverage for newborns, including vaccination expenses. But you should keep in mind that certain terms and conditions in the policy apply to this coverage.
     
  • Outpatient Treatment Coverage
    The National Parivar Mediclaim Plus Plan doesn't just cover hospital stays; it also includes outpatient care expenses that include the costs incurred for medications, tests, consultations, dental treatment, etc. With this add-on, you can choose the maximum limit of the cover from various options to suit your preferences for outpatient care. You should, however, remember that this coverage is subject to specific terms and conditions.
     

Waiting Period

When you buy a health insurance policy, certain illnesses and diseases might not be covered for a specific time, called the waiting period. After this time, you can claim for these conditions. There are various types of waiting periods including –

  • Initial Waiting Period: There is a typical 30-day initial waiting period for all medical conditions except accidents. This means that you cannot make a claim for hospitalisation in the first 30 days unless it is due to an accident.
     
  • Waiting Period For Pre-existing Diseases: A pre-existing disease is any condition you had in the 48 months before getting the health insurance policy. In the National Parivar Mediclaim Plus Plan, there is a 36-month waiting period for pre-existing diseases. During this time, the policy will not provide coverage for any expenses related to your pre-existing conditions.
     
  • Waiting Period For Specific Diseases: Insurers maintain a list of certain medical conditions or illnesses, separate from your pre-existing ones, and they come with a waiting period. This waiting period is set by the insurer and does not depend on your current health status. In the National Parivar Mediclaim Plus Plan, the waiting period for specific diseases can be 3, 12, 24, or 48 months, depending on the particular disease.
     

Exclusions

Exclusions are situations not covered by your health insurance policy. They include –

  • Standard Permanent Exclusions: The IRDAI has set 'standard permanent exclusions' enforced by all insurers. Some of these include –
    • Investigation And Evaluation: Hospital admission just for observation or monitoring.
    • Rest Cure, Rehabilitation, And Respite Care: Admission for bed rest without active treatment.
    • Obesity/Weight Control: Treatment or surgery for weight control or obesity.
    • Change Of Gender Treatment: Altering the body's characteristics to the opposite sex.
    • Plastic/Cosmetic Surgery: Surgeries/treatments to modify body characteristics or appearance.
    • Profession In Hazardous Or Adventure Sports: Treatment expenses while professionally participating in activities like rafting, mountaineering, scuba diving, horse racing, etc.
    • Breach Of Law: Expenses for treating a person who committed or attempted a breach of law with criminal intent.
    • Excluded Providers: Treatment from a practitioner or hospital excluded by the insurance company.
    • Narcotics: Treatment for addictive conditions like alcohol, drug addiction, etc.
    • Treatments In Establishments For Domestic Purposes: Expenses for treatment in health spas, nursing homes, or similar places arranged for domestic reasons.
    • Dietary Supplements, Substances Without Prescription: Vitamins, minerals, etc., not prescribed by a medical practitioner.
    • Refractive Error: Costs of correcting refractive errors up to 7.5 diopters for better eyesight.
    • Unproven Treatments: Surgeries, medical procedures, or treatments not proven effective.
    • Birth Control, Sterility, Infertility Expenses: Contraception, sterilisation, artificial insemination, advanced reproductive technologies like IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
    • Maternity Expenses: Pre/post-natal costs, childbirth-related hospitalisation expenses, etc.
  • Additional Permanent Exclusions: Apart from the standard permanent exclusions mentioned earlier, insurers may add more exclusions for specific situations or medical conditions. If you have certain diseases or severe medical conditions that insurers find risky to cover, they might permanently exclude them from your policy. However, it is important to know that insurers can only apply permanent exclusions for illnesses listed by the Insurance Regulatory and Development Authority of India (IRDAI).
     
  • Non-Standard Exclusions (Specific Exclusions): These are specific exclusions that go beyond the standard permanent exclusions listed by the IRDAI. These exclusions can differ between insurance companies and may depend on the policy terms and conditions. Here is a list of some top specific exclusions under the National Parivar Mediclaim Plus –
    • Expenses for hormone replacement therapy, unless part of Medically Necessary Treatment, except for Puberty and Menopause related Disorders.
    • General debility, Congenital external anomaly.
    • Treatment for intentional self-inflicted injury, attempted suicide.
    • Stem Cell Surgery (except Hematopoietic stem cells for bone marrow transplant for haematological conditions).
    • Circumcision unless necessary for treatment of a disease (if not excluded otherwise) or necessitated due to an accident.
    • Vaccination or inoculation unless forming part of treatment and requires Hospitalisation, except as and to the extent provided for under Anti Rabies Vaccination and Vaccination for Children cover.
    • Expenses related to any non-allopathic treatment (except for Ayurveda and Homeopathy).
    • Dental treatment, unless necessitated due to an Injury.
    • Spectacles, contact lens, hearing aid, cochlear implants.
    • War (whether declared or not) and war-like occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion, revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints, and detainment of all kinds.

Summary

Product Benefits

Coverage Limits

Pre- Hospitalisation Expenses

Coverage up to the sum insured for 30 days before hospitalisation.

Post Hospitalisation Expenses

Coverage up to the sum insured for 60 days after discharge.

Daycare Treatment Coverage

Covers 140 day care procedures.

No limit on expenses, covered up to the sum insured.

Domiciliary Treatment Coverage

Covered up to a limit based on the chosen plan type.

Plan A – up to Rs. 1 lakh

Plan B – up to Rs. 2 lakhs

Plan C – up to Rs. 3 lakhs

Organ Donor Coverage

Inpatient expenses covered up to the chosen sum insured.

Modern Treatment Coverage

Covered up to 25% of the sum insured.

No Claim Discount

Offers a maximum discount of 5% on base premium for claim-free years.

Applicable during policy renewal.

Restoration Benefit due to Accident

Available for subsequent claims during the policy year.

Can be used once in a policy year, and gets triggered when the base sum insured is completely exhausted

Room Rent Limit

No room restrictions in Plan B and C.

Room rent limit of up to 1% of sum insured or sum insured, whichever is lower, except if you get treated in PPN under Plan A.

Initial Waiting Period

30 days for all medical conditions except accidents.

Waiting Period for Pre-existing Diseases

36 months waiting period for pre-existing diseases.

Waiting Period for Specific Diseases

Waiting period varies (3, 12, 24, or 48 months) depending on the specific disease.

 

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FAQs

  1. What is the maximum coverage available under the National Parivar Mediclaim Plus Plan?
    The maximum cover depends on the plan type you choose –

Plan Name

Maximum Cover

Plan A

10 Lakhs

Plan B

25 Lakhs

Plan C

50 Lakhs

  1. Does the National Parivar Mediclaim Plus Plan cover domiciliary treatments?
    Yes, the plan covers expenses for domiciliary treatment, i.e., treatment taken at home. The coverage amount depends on your selected plan –
  • Plan A covers expenses up to 1 Lakh.
  • Plan B provides coverage up to 2 Lakhs.
  • Plan C offers coverage up to 3 Lakhs.
  1. Are there room rent restrictions under the National Parivar Mediclaim Plus Plan?
    No, you have the freedom to choose any room type. However, under Plan A, there is a room rent limit of up to 1% of the sum insured - this limit won’t apply if you get treated in a Preferred Provider Network (PPN)
     
  2. Does the National Parivar Mediclaim Plus cover AYUSH treatments?
    Yes, the plan includes coverage for AYUSH treatments, such as Ayurveda and Homeopathy, up to the sum insured.
     
  3. Does the National Parivar Mediclaim Plus Plan provide maternity benefits?
    Yes, the National Parivar Mediclaim Plus Plan covers pregnancy-related expenses up to a specified limit, depending on your chosen plan type, as outlined in the policy.