National Senior Citizen Mediclaim Policy (NSCMP)
Call Us On:
1800 123 230230
Email Us:
nic[dot]health[at]nic[dot]co[dot]in
Policy Details:
National Senior Citizen Mediclaim Policy is an indemnity health insurance policy for the aged having higher Sum Insured up to 10 Lakhs.
The Policy covers expenses in respect of inpatient treatment (allopathy, ayurveda and homeopathy), domiciliary hospitalization, reasonably and customarily incurred for treatment of a disease or an injury contracted/ sustained during the policy period.
Why buy NSCMP:
- Annual Increase in SI by 5% for each claim free year up to maximum 50% of SI opted.
- HIV treatment & Mental illness hospitalization covered.
- Pre-existing diseases are covered after 2 years.
- Optional covers like OPD, Critical illness, Personal accident & coverage of pre-existing Diabetes and Hypertension.
- Reinstatement of SI for road traffic accidents.
- Preventive Health Check Up Facility:
- PLAN A: Every 2 claim free years, prescribed diagnostics tests up to 2 % of the average SI (excluding CB) per insured person (individual basis) or family (floater basis), subject to maximum INR 4,000/- per insured person (individual basis) or per family (floater basis)
- PLAN B: Every 6 claim free months, Regular medical consultation and prescribed diagnostics tests up to INR 1,000 per insured person (irrespective of individual basis or floater basis)
- Online Discounts for purchasing policy online without any intermediary.
- Tax Rebate under Section 80D of Income Tax Act 1961 for premium paid
Pre Policy Check Up
For Whom –For all individuals irrespective of age, for fresh proposal.
List of Tests/Reports:
- Physical examination (report to be signed by the Doctor with minimum MD (Medicine) qualification
- HbA1c
- Lipid profile
- Serum creatinine
- Urine routine and microscopic examination
- ECG
- Eye check-up (including retinoscopy)
- Any other investigation required by the Company
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 twenty four months (24) of Policy
- 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
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)?
The reimbursement claim is to be supported with the following documents and submitted within the prescribed time limit.
- Duly completed claim form
- Photo Identity proof of the patient
- Medical practitioner’s prescription advising admission.
- Original bills with itemized break-up
- Payment receipts
- Discharge summary including complete medical history of the patient along with other details.
- Investigation/ Diagnostic test reports etc. supported by the prescription from attending medical practitioner
- OT notes or Surgeon's certificate giving details of the operation performed (for surgical cases).
- Sticker/Invoice of the Implants, wherever applicable.
- MLR (Medico Legal Report copy if carried out and FIR (First information report) if registered, where ever applicable.
- NEFT Details (to enable direct credit of claim amount in bank account) and cancelled cheque
- KYC (Identity proof with Address) of the proposer, where claim liability is above Rs. 1 Lakh as per AML Guidelines
- Legal heir/succession certificate, wherever applicable
- Any other relevant document required by Company/TPA for assessment of the claim.
