National Mediclaim Plus Policy

National Mediclaim Plus Policy . With medical expenses increasing exponentially, the drain on one’s resources can be worrying. National Mediclaim Plus Policy with its comprehensive coverage goes beyond the traditional health covers, as it offers protection against high health care costs and makes health care and related services easy and accessible. 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.

Key Benifits Features Plans 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/ 50 Lac Coverage Hospitalisation, Pre (30days) 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 donor’s 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 Doctor’s 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-network provider 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. Plans and Sum Insured The Policy offers three plans with varying covers Plan AINR 2 lac to INR 10 lac in multiples of 1lac Plan BINR 15 lac, INR 20lac,INR 25 lac Plan C: INR 30 lac, INR 40 lac ,INR 50 lac Eligibility Self, spouse, dependent children and parents. Entry age of proposer - 18 years to 65 years. Children - 3 months to 18 years. Entry age of members - 18 years to 65 years. The policy can be renewed lifelong. Pre existing diseases Covered after a waiting period of 3 years Treatment The Policy covers Allopathy, Ayurveda and Homeopathy treatment. In-patient treatment i.      Room charges and intensive care unit charges ii.     Medical practitioner(s) iii.    Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances iv.    Medicines and drugs v.     Diagnostic procedures vi.    Prosthetics and other devices or equipment if implanted internally during a surgical procedure. Pre and Post hospitalisation Expenses incurred 30 days prior to hospitalisation and 60 days post hospitalisation Day care procedure    140+ day care procedures are covered Organ donor’s medical expenses Hospitalisation expenses of the organ donor. Maternity and new born Hospitalisation expenses for the first two deliveries or termination during the lifetime of the insured or his spouse, provided the policy is in force for 2 continuous years. Expenses for pre natal, post natal and new born baby are also included. Vaccination Expenses for vaccination of children are covered. Hospital Cash Daily hospital cash allowance is payable. Ambulance     Expenses for transportation to the hospital, or from one hospital to another hospital are payable. Air Ambulance Expenses for medical emergency evacuation to the hospital, or from one hospital to another hospital are covered. Medical Emergency Reunion In the event of hospitalisation away from the place of residence,  under any life threatening condition, expense for a round trip travel of a family member is payable. Doctor’s home visit and nursing care Doctor’s home visit and nursing care post hospitalisation are covered Adjustment in premium In the event of the insured or family members going abroad and covered by an Overseas Travel Insurance Policy of any insurer, the policy will be temporarily inactive in respect of the member, and the premium for the inactive period will be adjusted on renewal. Medical Second Opinion In the event of being diagnosed with a serious illness, a Medical Second Opinion from World Leading Medical Centre, will be arranged .The Policy provides one Medical Second Opinion for each new diagnosis covering 160 plus diseases. Optional covers Critical Illness Lump sum payment will be made on diagnosis of a named critical illness. Benefit amount – INR 2 lac to INR 25 lac Outpatient Treatment Limit of cover - INR 2,000 to INR 10,000. Good Health Incentives Cumulative Bonus (CB) Sum insured will increase by 5% for each claim free year. Health Checkup Health check-up expenses once at the end of 2 continuous years, irrespective of any claims reported. Treatment of HIV, AIDS, STD, etc. Convalescence, general debility, run-down condition, sterility, etc. Treatment of obesity Treatment of genetic disorders Cosmetic treatment, plastic surgery,  change of sex, hormone replacement Naturopathy and experimental treatment Drug/ alcohol abuse Spectacles, contact lens, hearing aid, cochlear implants. Salient Features Plans and Sum Insured The Policy offers three plans with varying covers Plan AINR 2 lac to INR 10 lac in multiples of 1lac Plan BINR 15 lac, INR 20lac,INR 25 lac Plan C: INR 30 lac, INR 40 lac ,INR 50 lac Eligibility Self, spouse, dependent children and parents. Entry age of proposer - 18 years to 65 years. Children - 3 months to 18 years. Entry age of members - 18 years to 65 years. The policy can be renewed lifelong. Covered Pre existing diseases :- Covered after a waiting period of 3 years Treatment :- The Policy covers Allopathy, Ayurveda and Homeopathy treatment. In-patient treatment Room charges and intensive care unit charges Medical practitioner(s) Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances Medicines and drugs Diagnostic procedures Prosthetics and other devices or equipment if implanted internally during a surgical procedure. Pre and Post hospitalisation :- Expenses incurred 30 days prior to hospitalisation and 60 days post hospitalisation Day care procedure :- 140+ day care procedures are covered Organ donor’s medical expenses :- Hospitalisation expenses of the organ donor. Maternity and new born ;- Hospitalisation expenses for the first two deliveries or termination during the lifetime of the insured or his spouse, provided the policy is in force for 2 continuous years. Expenses for pre natal, post natal and new born baby are also included. Vaccination :- Expenses for vaccination of children are covered. Hospital Cash :- Daily hospital cash allowance is payable. Ambulance ;- Expenses for transportation to the hospital, or from one hospital to another hospital are payable. Air Ambulance :- Expenses for medical emergency evacuation to the hospital, or from one hospital to another hospital are covered. Medical Emergency Reunion :- In the event of hospitalisation away from the place of residence, under any life threatening condition, expense for a round trip travel of a family member is payable. Doctor’s home visit and nursing care :- Doctor’s home visit and nursing care post hospitalisation are covered Adjustment in premium :- In the event of the insured or family members going abroad and covered by an Overseas Travel Insurance Policy of any insurer, the policy will be temporarily inactive in respect of the member, and the premium for the inactive period will be adjusted on renewal. Medical Second Opinion ;- In the event of being diagnosed with a serious illness, a Medical Second Opinion from World Leading Medical Centre, will be arranged . The Policy provides one Medical Second Opinion for each new diagnosis covering 160 plus diseases. Optional covers Critical Illness Lump sum payment will be made on diagnosis of a named critical illness. Benefit amount – INR 2 lac to INR 25 lac Outpatient Treatment Limit of cover - INR 2,000 to INR 10,000. Good Health Incentives Cumulative Bonus (CB) Sum insured will increase by 5% for each claim free year. Health Checkup Health check-up expenses once at the end of 2 continuous years, irrespective of any claims reported. Not Covered Treatment of HIV, AIDS, STD, etc. Convalescence, general debility, run-down condition, sterility, etc. Treatment of obesity Treatment of genetic disorders Cosmetic treatment, plastic surgery, change of sex, hormone replacement Naturopathy and experimental treatment Drug/ alcohol abuse Spectacles, contact lens, hearing aid, cochlear implants.

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