- 1 A Brief Overview of National Insurance Parivar Mediclaim Plan
- 2 Specifications of National Insurance Parivar Mediclaim
- 3 Health Insurance Parivar National Benefits
- 4 What is Included in the National Insurance Parivar Mediclaim?
- 5 What is excluded from coverage under the National Insurance Parivar Mediclaim?
- 6 The National Insurance Parivar Mediclaim Add-Ons
- 7 List of Health Insurance Plans from National Insurance
- 8 National Insurance Parivar Mediclaim Eligibility Requirements
- 9 Required Documents To Purchase National Insurance Parivar Mediclaim
- 10 How Do I File a National Insurance Parivar Mediclaim Claim?
- 11 How to Make Cashless Claims
- 12 Conclusion
- 13 FAQs-
According to the amount of Gross Direct Written Premium collected, National Insurance is India’s second-largest non-life insurer.
Being the oldest general insurance company and oldest health insurance company, it has a history of successful product customization pilot introductions for corporate and rural sectors. It is also one of the first insurance firms in India to form an alliance with major corporations. In addition, it pioneers the introduction of bancassurance in India by working with some of the biggest banks.
With 13000 employees and 1730 offices, it has a sizable workforce and a broad network of operations in India and Nepal. The strong financial position and issuer credit rating of National Insurance Company reflect its successful operations and dominant position in India’s insurance market.
A Brief Overview of National Insurance Parivar Mediclaim Plan
- The National Parivar Mediclaim Plan for Family provides medical insurance coverage that is intended to protect the entire family financially from medical emergencies. The entire family is covered by a single policy because it is a family floater policy.
- Any family member may use the applicable sum insured amount for a variety of illnesses and injuries. The policy’s terms and conditions state that a family can only consist of a spouse, oneself, and two dependent children.
- The policy’s main goal is to lessen a family’s financial loss during an unplanned hospitalization due to illness or an unintentional injury to a family member.
Specifications of National Insurance Parivar Mediclaim
The following is a list of some of the National Parivar Mediclaim Policy’s salient characteristics.
The policy’s coverage sum insured is offered in increments of INR 50,000 from INR 2 lakh to INR 5 lakh. Treatment and reimbursement are both cashless. The policy provides cashless treatment options at hospitals in the National Health Network as well as reimbursement for hospitalization costs in accordance with the policy’s terms and conditions.
- Renewal of National Health Insurance:
The policy holder must renew the policy at the end of its one-year term.
- Prior to and after hospitalization
A pre-hospitalization period of 15 days and a post-hospitalization period of 30 days are both covered.
- Fees for ambulances:
Ambulance fees are capped at INR 1000 for each illness and INR 2500 for the entire policy year.
- Unclaimed Bonus:
If there are no claims during the policy year, a no claim bonus is awarded. The policyholder will be entitled to 5% off the base premium as a No Claims Bonus at renewal.
- Health Examination:
For enrolling in the policy continuously for 4 years, the policy offers a free medical examination. The maximum amount that can be reimbursed for a medical examination is INR 5,000.
- Tax Benefits:
According to the guidelines outlined in Section 80D of the Income Tax Act of 1961, the premium paid toward the policy plan is eligible for tax benefits.
If the policyholder chooses to have a pre-existing condition, such as diabetes or high blood pressure, a 10% co-payment will be required for any claims for treatment of those conditions.
- Pre-existing conditions:
After 48 months of consistent policy coverage, pre-existing conditions are eligible for coverage under the policy.
Health Insurance Parivar National Benefits
|Rent for a hospital room||Up to 1% of the daily sum insured|
|ICU Fees||A maximum of 2% of the sum insured per day|
|Hospital Cover||fees paid to doctors, consultants, anesthetists, and other medical professionals|
|Healthcare Costs||Blood, anesthetic, oxygen, fees for the operating room, medical devices for surgery, medications, chemotherapy, x-rays, pacemaker costs, cost of artificial limbs, etc.|
|Charges/Expenses for Organ Donors||Insurance coverage is offered for medical expenses incurred when an insured person donates an organ to another person|
|Limit On Complete Charges And Expenses||One specific illness’s total charge/expenses are capped at 50% of the sum insured coverage.|
If both parents are covered by the policy, the policy is available to anyone between the ages of 18 and 60 as well as dependent children between the ages of 3 and 25.
- Sum Insured:
For customers’ various coverage needs, the policy offers a choice of the sum insured between INR 2 lakhs and INR 5 lakhs.
Hospitalization for illnesses and unintentional injuries is fully covered by the policy. The policy may also provide coverage for pre-existing conditions.
- Premium Costs:
The family’s oldest child’s age determines the premium costs for this family floater plan.
- Procedures for daycare covered:
Up to the maximum amount insured by the policy, up to 140+ daycare procedures and surgeries are covered.
- Benefits of Organ Donation
The costs associated with organ donation are covered up to the company’s insurance limit.
- Optional plan:
The policy has no available plan options. The company only provides one family floater plan under this arrangement.
- Benefits of AYUSH:
Up to the sum insured under the terms of the plan, the policy offers coverage for allopathic, Ayurvedic, and homeopathic treatments.
- Waiting Time:
The policy has a 30-day initial waiting period for all diseases. The policy document lists a number of different diseases that have waiting periods of one year, two years, and four years after that.
What is Included in the National Insurance Parivar Mediclaim?
- reimbursement for expenses incurred during a hospital stay that were necessary, under the following headings:
- Room, board, and nursing costs are covered by the hospital or nursing home at a rate of 1% of the insured sum for a regular room and 2% of the insured sum for an ICU room per day.
- Fees for the surgeon, the anesthetist, the doctor, the consultant, the specialist’s fees, and the nursing costs.
- costs associated with blood donation, oxygen, anesthesia, operating rooms, surgical instruments, X-rays, dialysis, medications, diagnostic tools, chemotherapy, radiotherapy, cost of organs, pacemaker costs, artificial limb costs, and other comparable costs.
- By paying an additional premium, one can have diabetes and hypertension covered right away.
- For 15 and 30 days, pre- and post-hospitalization costs are covered, respectively.
- For network hospitals, a cashless facility can be processed through TPA.
What is excluded from coverage under the National Insurance Parivar Mediclaim?
Pre-existing medical conditions are one significant exclusion. After four years of continuous coverage, this policy will cover pre-existing conditions. After only four years of uninterrupted policy years without a claim, all diseases and injuries-related conditions that were pre-existing at the time of the policy’s beginning will be covered.
- The insurance provider will not pay any claims during the first 30 days after the policy’s start, with the exception of accidental injuries.
- excluded from coverage for the first two years of the policy are specific named diseases.
- Congenital illnesses, infertility, venereal disease, willful self-harm, drug and alcohol use, rest as a treatment, and so forth.
- HIV/AIDS treatment and other related services.
- Costs primarily associated with diagnostic laboratory tests that are unrelated to or inconsistent with the diagnosis for which the insured person is hospitalized.
- Other than cases where an accident necessitates hospitalization, dental treatment
- Treatment is necessary because of pregnancy and childbirth.
- All forms of treatment are covered, excluding allopathic ones.
- Nuclear dangers, war, and invasion.
The National Insurance Parivar Mediclaim Add-Ons
Pre-existing conditions like diabetes, hypertension, outpatient therapy, and critical illness are available as optional add-ons to the plan.
Extra Savings on National Parivar Mediclaim
- Long Term Discount:
A 4% discount will be permitted on the total premium if the policy is issued for a period of two years. When a policy is issued for three years, a 7.5% discount is applied.
- Online Discount:
There will be a 5% discount on the premium if the policy is purchased online. Likewise, a discount of 2.5% will be applied if the policy is renewed online.
- National Parivar Mediclaim Tax Benefits:
According to the guidelines in Section 80D of the Income Tax Act of 1961, the National Parivar Mediclaim premium payment is eligible for a tax deduction up to a maximum of INR 1,00,000. It should be noted that tax laws change periodically. When purchasing Comprehensive National Health Insurance, the applicant should speak with a financial advisor to learn more about the current income tax benefits and deductions.
List of Health Insurance Plans from National Insurance
National Mediclaim Plus Policy
- A high sum insured health insurance policy, the National Mediclaim Plus Policy covers 140+ day care procedures and surgeries as well as inpatient hospitalization costs for stays longer than 24 hours on a cashless or reimbursement basis during the active policy period. The features and advantages of this policy are numerous.
National Insurance Parivar Mediclaim Policy Plus
- The National Insurance Parivar Mediclaim Policy Plus is a premium product that provides coverage for all family members for inpatient hospitalization costs for stays longer than 24 hours as well as 140+ day care procedures and surgeries on a cashless or reimbursement basis during the active policy period. The unique features of this policy cover the majority of the insured’s health concerns.
Varistha Mediclaim Policy for Senior Citizens
- By name, the Varistha Mediclaim Policy for Senior Citizens is a specific policy for seniors over 60. During the active policy period, it fully covers In-patient hospitalization and domiciliary hospitalization costs as well as 140+ Day Care Procedures and surgeries on a cashless or reimbursement basis.
National Insurance Critical Illness Policy
- A special benefit policy known as the National Insurance Critical Illness Policy protects the insured from financial obligations in the event of any of the critical illnesses listed.
- When a specific illness is diagnosed, the insured will receive a fixed lump sum discount to pay for the necessary post-operative procedures or curative treatments. After the insured receives the lump sum, the policy’s coverage expires.
National Insurance Parivar Mediclaim Eligibility Requirements
- At least two family members, as defined below, must be covered by the policy.
- The age range for the proposer should be 18 to 65.
- The oldest member of the family who may enter is 65 years old.
- If the parents are also covered by the same policy, then children between the ages of three months and twenty-five may be covered.
- Families include the policyholder, their spouse, their parents, and any dependent children (natural or legally adopted).
- Up to 18 years old and still dependent
- Male dependent child who is between the ages of 18 and 25, as long as he is enrolled in school and unemployed
- Female dependent child, if unmarried or employed
- Midterm family member inclusion at pro-rata premium is only permitted in cases where
- Infant between the ages of three and six months
- Within 60 days of a marriage, the spouse
- The appropriate waiting period will be in effect upon the addition of a new family member.
- After reaching the specified exit age, dependent children have the option of porting to a similar health insurance product offered by the company or by any other insurer.
- When the policy period expires, the insured person will be transferred to a comparable health insurance product offered by the company or by any other insurer if the number of members covered during the policy period drops to just one.
Required Documents To Purchase National Insurance Parivar Mediclaim
|PROOF OF AGE||IDENTITY PROOF||PROOF OF ADDRESS|
|a birth record||a driving permit||Ration card|
|12th or 10th grade transcript||PAN Card||electricity invoice|
|Aadhaar card||Aadhaar card||Aadhaar card|
|Voting ID||Voting ID||Voters ID|
- Age Proof: Each person who will be covered by the health insurance policy must have their age verified by the applicant.
- Identity Proof: The applicant may submit any of the following documents as identification:
- Address Proof: The applicant will need to provide a permanent proof of address, which can be any of the following:
- Passport-Sized Images
- In order to enroll in the plan, the applicant might need to undergo medical testing.
How Do I File a National Insurance Parivar Mediclaim Claim?
The insured person, a member of their family, or a representative must notify the TPA if they need hospital care or domiciliary hospital care. The notification can be made in writing via letter, email, or fax, along with all necessary details like the policy number, the nature of the treatment, etc. The company’s official website contains the contact information.
|NOTIFICATION OF APPLICATION FOR A CASHLESS FACILITY||TIME TO LET THE TPA KNOW|
|If a hospital stay is anticipated||At least 72 hours before the insured person is admitted to the network hospital, TPA should be notified.|
|Should a hospitalization for an emergency occur||Within 24 hours of the insured person’s admission to the network hospital, TPA must be notified.|
|Notifying of Reimbursement Claim||Company/TPA must be notified of:|
|When receiving treatment for a planned hospital stay or a home hospital stay||At least 72 hours before the insured person is admitted to the network hospital, TPA should be notified.|
|When receiving treatment for an emergency hospitalization or inpatient care at home||After the insured person is admitted to a network hospital, TPA must be notified within 24 hours.|
- Notifying of vaccination claim: In the case of the anti-rabies vaccine
- Company/TPA must be notified: A minimum of 24 hours before receiving the vaccination
How to Make Cashless Claims
- TPA needs to be notified in order to receive the Cashless facility for treatment in-network hospitals. The insured must fill out a cashless request form and submit it to TPA for approval in order to do this.
- Once you have obtained TPA approval for the treatment at a network hospital (a list of which can be found in the provided booklet or on the business’s official website), you can begin.
- TPA will issue a pre-authorization letter to the hospital after reviewing and validating the request form.
- Following treatment, the insured person is responsible for verifying the discharge paperwork, signing it, and covering any non-medical costs.
- If the policyholder is unable to provide the necessary medical information, the TPA reserves the right to reject the pre-authorization request.
- If cashless treatment is declined, the policyholder may still receive the necessary care as recommended by the treating physician and submit the claim paperwork to the TPA for processing.
Claims Reimbursement Procedure
- The policyholder must deliver the required paperwork to the TPA within the specified window of time in order for claims to be reimbursed. Method for Reimbursement of Claim for Hospitalization at Home
- The policyholder must deliver the required paperwork to TPA within the specified time frame in order for claims under domiciliary hospitalization to be reimbursed.
Settlement of Claim
- The claim must be resolved by the insurance company within 30 days after the TPA/insurance company has received the necessary final document and investigation report, if one is necessary in the case.
- The insurance provider will notify the policyholder in writing within 30 days of receiving the claim if it is rejected for any reason.
- The payment of the claim amount will be made within 7 days of the date that the Health Insurance Company accepts the offer of settlement on behalf of the policyholder.
- If there is a payment delay, the company is responsible for paying the claimant interest at a rate that is 2% higher than the going bank rate.
Family-friendly health insurance is available with National Parivar Mediclaim. It provides flexibility in the insured sum based on the requirements of various customers. The insured and his entire family can take advantage of the plan’s numerous features and advantages. For not filing claims at policy renewal, the plan offers incentives. It Additionally, it provides a discount for online purchases and renewals.
The plan’s terms and conditions are very easy to comprehend, and the claim process is equally straightforward. The insurer quickly approves cashless procedures, and the policyholder is promptly paid for submitted claims.
Q1. What is the national policy for Parivar Mediclaim?
Ans – This policy provides cashless/reimbursement coverage for 140+ daycare procedures, inpatient treatment costs (minimum 24 hour hospitalization), and domiciliary hospitalization for all family members during the policy period.
Q2. Which Cashless Medical Insurance Plan in India is the best?
Ans – The Top Cashless Mediclaim Plans for Families in India
Niva Bupa Health Companion.
Niva Bupa Heartbeat.
Apollo Munich Optima Restore.
Reliance Health Gain Plan.
ICICI Lombard Health Care Plus.
New India Floater Mediclaim Policy.
New India Asha Kiran Policy.
Q3. Which health insurance company has the largest hospital network?
Ans – The largest network of hospitals currently offered by a health insurance provider in India is offered by Care Health Insurance Limited, which has more than 16,500 hospitals in its network.