National Insurance Company Limited is a general insurance provider in India. The company was incorporated in 1906 and is headquartered in Kolkata, West Bengal. National Insurance Company Limited offers National Group Mediclaim Insurance Policy. This insurance policy is designed according to the needs of the policyholder and comes with many other features.
National Group Mediclaim Policy is a group indemnity health insurance product specially designed to address the basic health insurance requirements of both employer-employee and non-employer-employee groups. The policy covers hospitalization expenses for reasonable and customary inpatient treatment (Allopathic, Ayurveda, and Homeopathy) or daycare treatment for the treatment of illness/injury incurred during the policy period.
The Policy provides for Pre Hospitalization (30 days) and Post Hospitalization (60 days) expenses, 140+ Day Care Procedures, Mental Illness treatment, HIV/ AIDS treatment, Organ Donor’s Medical Expenses, Ambulance Charges, Morbid Obesity Treatment, Correction of Refractive Error if applicable according to terms.
Key Highlights of National Group health insurance
- Sum Insured range – The range of sum insured choices is from Rs 50,000 to Rs 10 lacs in 15 slabs – Rs 50,000 to Rs 5,00,000/- in multiples of Rs 50,000 and Rs 6,00,000 to Rs 10,00,000/- in multiples of Rs 1,00,000.
- Groups can be all combinations viz, Employer-Employees, Non-Employer-Employee covering all Social Sectors, Corporates / Non-Corporates. The group shall have a minimum of 7 members (as per Regulation 7 of HIR 2016).
- Age – The policy can be availed by persons 18 years of age and above.
- Children between 3 months and 18 years can be covered, provided the parent(s) are covered at the same time.
- Who can be covered – Self, Spouse, Dependent parents, Dependent natural or legally adopted children, Dependent female child if not employed, till marriage, Dependent male child above 18 years and up to 25 years of age, if bona fide student and not employed.
- The policy can be renewed without a break during the lifetime of the insured individuals, except for covered children, who can renew till their wedding.
- Room rent, intensive care unit charges and associated expenditures (including nursing care by qualified nurses, RMO charges, diet charges, administrative charges for IV fluids/blood transfusions/injections), medical practitioner’s charges, related expenditures, etc.
- Expenses for hemodialysis, Chemotherapy, Radiotherapy, and Expenses related to treatment necessitated due to participation as a non-professional in hazardous or adventure sports.
- 12 Modern treatments such as robotic surgery, immunotherapy, oral chemotherapy, etc., genetic disorders, and vision correction are covered.
- Entire daycare procedures are covered, including treatment of mental illness, morbid obesity, refractive error, HIV/AIDS, modern treatments, etc.
- Cataract Treatment is subject to 25% of the Sum Insured or Rs 40,000 per eye.
- Optional Covers like Maternity Cover up to Rs 50,000/- for up to the first two deliveries.
- Attractive Discounts like discounts if co-payment is opted, Group discounts (based on No of Families opted), and Low claim discounts on renewal.
- Ambulance Charges: up to 1% of the Sum Insured subject to a maximum of Rs 1,000/- in a Policy Period for each Insured Person.
- Policyholders are qualified for tax benefits u/s 80D of the ITA 1961.
- Cashless Facility is available at Network Hospitals Only through TPA.
Why buy NGMP?
- Sum insured from INR 50 thousand to INR 10 lakhs.
- Lines of treatment covered – Allopathic, Ayurveda, and Homeopathy (Up to 100% of SI).
- Coverage for Modern Treatment
- Pre and Post Hospitalization up to 30 days and 60 days respectively for the same disease/illness/injury for which Hospitalization occurred.
- Optional Cover for Maternity up to Rs 50,000/- for up to the first two deliveries.
- Pre-existing illnesses (if any) will be covered after 4 years.
- Discount for co-payment option and low claim ratio discount will be applicable on base premium.
- Group Discount shall apply to the total premium.
National Group Health Insurance Policy Features & Benefits
A national group health insurance policy has multiple features and benefits, which are as follows:
- A national group health insurance scheme offers coverage to a group of employees.
- This insurance scheme offers coverage to the employee’s dependents like spouses, kids, and parents.
- Employers can get tax benefits by offering group health insurance policies.
- By offering a National group health insurance policy to the employees, the employer can build goodwill among them.
- The corporation will stand out in its sector and will attract more employees.
- Providing this insurance policy will help in increasing the number of employees in the company.
- The executive of the insurance company will give priority to the employees so the claim process will be easier.
National Group Mediclaim Insurance Policy: Inclusions
The National group health insurance scheme offers coverage for the following:
- Room expenses like boarding, nursing care, and RMO charges are covered.
- Room charges are covered for 1% of the sum insured to a maximum of Rs 5000 per day.
- Administrative charges for blood transfusions/injections and IV fluids are also covered.
- Medical practitioner expenditures such as anesthetists, surgeons, and consultants are covered.
- Coverage for dialysis, chemotherapy, radiotherapy, etc. is provided.
- Coverage for medicines and surgical appliances is provided.
- Organ donation treatment coverage is provided.
- Reimbursement for ambulance charges that is 1% of the sum insured amount and a maximum of up to Rs 1000 is provided.
National Group Mediclaim Insurance Policy: Exclusions
The National group health insurance scheme does not offer coverage for the following:
- The insurance policy will provide coverage for pre-existing diseases until the policy completes the 48 months tenure.
- HIV, AIDS, and STD treatment are not covered.
- Congenital external anomaly and general debility treatment cover are not provided.
- Coverage is not provided for infertility, sterility, and assisted conception procedures.
- Eye-sight correction surgery is not covered.
- Obesity treatment is not covered.
- Stem cell surgery and Genetic disorders are not covered.
- Intentional self-inflicted injury and mental disorders are not covered.
- Circumcision until necessary for treatment is not covered.
- Inoculation and vaccination are not covered.
- Sex transformation operations, cosmetic surgery, plastic surgery, and hormone replacement treatments are not covered.
- Expenses coming out of Naturopathy, massages, Spas, and Steambath are not covered.
- Outpatient treatment and dental treatments are not covered.
- Treatment caused due to intoxication is not covered.
- Hospitalizations that are not medically essential are not covered.
- Irrelevant treatments will not be covered.
- Registration fees and service charges are not covered.
- Injuries caused during a war are not covered.
- Injuries or diseases arising due to adventure sports such as scuba diving, parachuting, hang gliding, rock climbing, etc. are not covered.
How to report a claim?
For Cashless Facility
- A cashless facility is available only for policies serviced by a TPA (Third Party Administrator).
- Check whether the hospital is listed under the networked hospitals (Selected provider network/other network Hospitals), as the cashless facility is available exclusively for empanelled network hospitals of the Company/TPA.
- For planned hospitalization, intimation is to be sent to the TPA/Company in advance (72 hours prior) with details of the Name and address of the hospital and the condition requiring hospitalization.
- In case of emergency hospitalization, intimation is to be sent to the TPA/Company within 24 hours of admission.
- On admission, the hospital will send a pre-authorized request for cashless to the TPA – duly signed by the insured person and hospital administration detailing admission, illness, proposed line of treatment, and estimated cost. Pre-hospitalization and post-hospitalization expenses after treatment can be claimed separately.
- After completion of treatment after hospitalization, real documents are to be submitted to TPA (Third Party Administrator) within a 15 days time period.
For Reimbursement Claims
- Written intimation/mail/fax about hospitalization is to be sent to TPA /Company within 72 hours of hospitalization in the case of emergency hospitalization and 72 hours prior in case of planned admission.
- Before leaving the hospital, the discharge summary, investigation report, and other relevant documents (Claim Form – Part A and Part B) can be received from the hospital administrations. All the documents in original are to be submitted to TPA / Office within 15 days from the date of discharge.
- Pre-hospitalization and post-hospitalization expenses after treatment can be claimed separately.
- Original documents are to be submitted within 15 days of completion of treatment after hospitalization.
What are the Documents required (originals)?
- Duly filled Claim form given by the insurance provider (Two Parts: A & B).
- Original bills, payment receipts, medical history of the registered patient, hospital discharge certificate/summary, etc.
- Real cash memo from the hospital/chemist with a valid prescription.
- Actual payment receipt, investigation examination reports, etc. backed by the attending medical practitioner’s prescription.
- Attending a medical practitioner’s certificate concerning diagnosis and bill invoice etc.
- Original surgeon’s certificate indicating nature of diagnosis and operation made along with bills or receipts etc.
- Any other document required by the company/TPA.
What is the Renewal procedure for National Group Mediclaim Insurance Policy?
Follow the steps below to renew National Group Health Insurance:
- Step 1: Go to the official webpage of National Insurance.
- Step 2: Login and Search for the policy number of your insurance plan.
- Step 3: Once you have access to your account, review the insurance plan.
- Step 4: If you wish, you can add or remove any add-on according to your need.
- Step 5: The addition and removal of any add-on will reflect in the final premium amount of the insurance policy.
- Step 6: Once you are done, you can pay through net banking, UPI, or your credit or debit cards.
- Step 7: Once the payment is done, the insurance company will mail the updated National group health insurance policy documents to your email address as well as a hard copy to the registered residential address.
Note: It is necessary to renew the insurance scheme before it expires.
FAQs-National Group health insurance
Que 1: Are self-inflicted injuries covered under this insurance policy?
Answer: No, intentionally self-inflicted injuries are not covered under this insurance policy.
Que 2: When can I add or remove any add-ons after purchasing the National group health insurance policy?
Ans: You can either add or remove any add-on while purchasing the insurance policy otherwise you can do it while renewing the insurance policy.
Que 3: Are stem cell surgery and genetic disorders covered under the group insurance scheme?
Ans: No, stem cell surgery and genetic disorders are not covered under the National group health insurance scheme.
Que 4: What is the waiting period for pre-existing illnesses?
Ans: The waiting period for pre-existing is up to 48 months.
Que 5: How much coverage is offered for the room expenses?
Ans: 1% of the sum insured amount up to Rs 5000 daily coverage is provided.
Que 6: Are injuries due to adventure sports covered under this group insurance scheme?
Ans: No, the National Group Health Insurance scheme does not offer coverage for injuries due to adventure sports like scuba diving, parachuting, hang gliding, rock climbing, etc.