National Mediclaim Policy (Individual Plan)
Call Us On:
1800 345 0330
Email Us:
nic[dot]health[at]nic[dot]co[dot]in
Policy Details:
This policy indemnifies for In-patient treatment expenses (minimum 24 hour hospitalization) and 140+ Day Care Procedures on Cashless/ Reimbursement basis during the policy period. The expenses incurred should be reasonable, customary and medically necessary.
Why buy NMP:
- Annual Increase in SI by 5% for each claim free year up to maximum 50% of SI opted.
- Health Check Up Facility: Expenses of health check-up once at the end of a block of four claim free policy periods @ maximum of 1% of the average sum insured.
- Instalment facility is available under the policy.
- Online Discounts: 10%, where no intermediary is involved.
- Tax Rebate under Section 80D of Income Tax Act 1961 for premium paid.
- COVID Vaccination discount
Pre Policy Check Up
For Whom –Proposers aged 50 years and above (including dependents) and availing the policy for the first time.
List of Tests/Reports:
- Physical examination (report to be signed by the Doctor with minimum MD (Medicine) qualification)
- Blood sugar (fasting/ post prandial), HbA1c (for Policies beyond 6 Lakhs)
- Lipid profile
- Serum creatinine
- Urine routine and microscopic examination
- ECG
- Eye check-up (including retinoscopy)
- Any other test required by the company and considered necessary
Note: The date of medical reports should not exceed 30 days prior to the date of proposal. 50% of the expenses incurred for pre policy check-up shall be reimbursed, if the proposal is accepted. Terms and conditions apply.
-
Exclusions
- Only claims arising out of accidents are payable for the first 30 days of Inception of the Policy
- All pre-existing diseases included after first forty eight months (48) of Policy
- 90 days, One, Two and Four Years waiting period for specific diseases.
- Change-of-Gender Treatments, Cosmetic or Plastic Surgery, Excluded Providers
- Vitamins, Tonics Drug/alcohol abuse, Self-Inflicted Injury
- Non Prescription Drug, Home visit charges
- Dental treatment (unless arising out of accident and requiring hospitalization) and Out Patient Department treatment (OPD treatment)
How to report a claim?
For Cashless Facility – available only for policies serviced by a Third Party Administrator (TPA)
- Check if the hospital falls under the networked hospitals (Preferred provider network/other network Hospitals), as cashless is available only for empanelled network hospitals of the Company/TPA.
- For planned hospitalisation, intimation is to be sent to the TPA/Company in advance (72 hours prior) with details of Name and address of the hospital and condition requiring hospitalization.
- In case of an emergency hospitalisation, intimation is to be sent to the TPA/Company within 24 hours of admission.
- On admission, a Pre-Authorisation Request for cashless will be sent to the TPA by the hospital – duly signed by the insured and Hospital Authorities giving the details of admission, illness, proposed line of treatment and the estimated expenses. Pre and post hospitalisation expenses can be claimed separately after treatment.
- All documents in original are to be submitted within 15 days to TPA, after completion of Post Hospitalisation treatment.
For Reimbursement Claims:
- Written intimation/mail/fax about hospitalisation is to be sent to TPA /Company within 72 hours of hospitalisation in the case of emergency hospitalisation and 72 hours prior in case of planned admission.
- Before leaving the hospital, Discharge Summary, investigation report and other relevant documents (Claim form – Part A& Part B) may be obtained from the hospital authorities. All the documents in original are to be submitted to TPA / Office within 15 days from date of discharge.
- Pre and post hospitalisation expenses can be claimed separately after treatment.
- All documents in original to be submitted within 15 days after completion of Post Hospitalisation treatment.
What are the Documents required (originals)?
- Duly filled Claim form issued by insurer (Part A & Part B)
- Original bills, payment receipts, medical history of the patient recorded, discharge certificate/ summary from the hospital etc.
- Original cash-memo from the hospital (s)/chemist (s) supported by proper prescription
- Original payment receipt, investigation test reports etc. supported by the prescription from attending medical practitioner
- Attending medical practitioner’s certificate regarding diagnosis and bill receipts etc.
- Surgeon’s original certificate stating diagnosis and nature of operation performed along with bills/receipts etc.
- Any other document required by company/TPA
