Health insurance policies of National Insurance Company

By EH News Bureau On Nov 24, 2014

Medical insurance mitigates the costs of healthcare and brings affordability in healthcare

Why is health insurance essential?

Health insurance is an essential requirement for all individuals and families for the following important reasons:

< Hospitalisation cost can be high and can become unaffordable due to unforeseen emergencies.
< Medical care is seen to be a high frequency risk. Hospitalisation due to accident/illness/disease is quite common.
< Healthcare now offers many more cures and solutions to various health problems but at a high cost.

Health insurance is important to families

Individuals cannot often afford the cost of health risks. Therefore, passing on this risk to us, as insurer, is the best option.

Since health risk is present at all times, continuous coverage is required, from childhood to old age. Cover is available from National Insurance for families from age of three months to 90 years (last entry age is 80).

The policy offers wide coverage and continuous protection for unseen health contingencies to all members of the family.

Thus for a small price, health insurance policies bring affordability in healthcare to everyone in the family.

National Insurance, in the year 2006, has completed 100 years of insurance business in India. In its centenary year, it has launched three new health insurance policies for three different target groups namely:

< Vidyarthi Mediclaim for students
< Parivar Mediclaim for family
< Varistha Mediclaim for Senior Citizens

National Insurance has a bag of Health Insurance Schemes designed to cater to the needs of different ages and income groups. Salient features of some of those schemes are as follows:

National Mediclaim Policy (NMP)

< This policy covers hospitalisation costs for treatment at hospital / nursing home (having at least 15 beds (10 beds in ‘c’ class towns), operation theatre, qualified medical practitioner and nursing staff).
< Hospitalisation treatment can be taken anywhere in India and claim is payable in Indian currency only.
< The policy covers treatment of all illness/disease (other than those specifically excluded) and accidents.
< An insuring person can choose a sum insured between Rs 50,000 and Rs 5 lakh.
< Preexisting diseases will be covered after 48 months.
< Pre and post hospitalisation expenses are payable upto a period of 30 days pre and 60 days post hospitalisation.
< Ayurvedic and homeopathic treatments will be covered upto 20 per cent of sum insured
< Cumulative bonus at 5 per cent for every claim free year up to 50 per cent of sum insured
< Reimbursement of hospitalisation expenses are allowed with sub limits for :

Room, boarding expenses as provided by the hospital/nursing home, nursing expenses
Surgeon, anaesthetist, medical practitioner, consultant, specialist fees.
Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, diagnostic materials and x-ray, dialysis, chemotherapy, radiotherapy, cost of pacemakers, artificial limbs and cost of organs and similar expenses.

Income Tax benefits are available u/s 80 D for individuals and families (Income Tax Act 1961).

National Mediclaim Plus Policy (NMPP)

< This policy has been designed to cater to the needs of modest means to high net worth individuals of our country.
< Sum Insured (SI) ranges between Rs 2 lakh to Rs 50 lakh, in three plans A, B and C.
< Age group: Individuals between 18-65 years. Children between three months to 18 years if both or either parent is covered.
< Pre-acceptance medical check up is required if the person is covered under the policy is aged more than 40 years or opts for a cover more than Rs six lakh.
< Allopathic, ayurvedic and homeopathic treatments will be covered.
< Pre-existing diseases except malignant diseases will be covered after three claim free years.
< Health check up benefit after every two years, irrespective of claim
< Maternity benefit available after two years of continuous coverage
< Vaccinations up to 12 years will be covered.
< Hospital cash benefit available.
< Medical second opinion (MSO) available free of cost
< Cumulative bonus at 5 per cent for every claim free year, up to 50 per cent of sum insured

Three extra benefits available in PLAN B & C

< Air ambulance
< Medical emergency reunion.
< Doctor’s home visit and nursing care during post hospitalisation.

2 optional covers available

< Critical illness
< Outpatient treatment benefits

VIdyarthi mediclaim for students

< This is a unique policy designed to provide health and personal accident cover to the students. It also provides for continuation of insured students education in case of death or permanent total disablement of the guardian due to accident.
< Parents/Legal guardian of individual student in any registered educational institution affiliated to any state board, council, university and AICTE or any other government statutory authority, within the territory of India may take this policy. The educational institutions may also take a Group Policy covering named students enrolled with them.
< The policy is having three sections as under:

Section-I: covers hospitalisation expenses of the student.
Section-II: covers personal accident (Death +PTD) of the guardians
Section III: covers personal accident (Death + PTD) of the students
Age limit: Three years to 25 years

Sum insured

< Section I- SI ranges from Rs 50,000 to two lakhs in multiples of Rs 25000.
< Section II- SI will be two times of the SI under Section I.
< Section III- SI under this section will be Rs 50,000 for all students.
< Premium for hospitalisation cover under this policy is around 25 per cent less than our Standard Mediclaim Policy
< The policy will be serviced by Third Party Administrators (TPA) for hospitalisation expenses.
< Under Section I, cumulative bonus is available at five per cent of SI per claim free year up to a maximum of 50 per cent. Alternatively five per cent discount in premium may be allowed in the renewal if the previous policy year is claim free.
< All diseases / injuries, which are pre-existing when the cover incepts for the first time are excluded. This exclusion will be deleted after three consecutive continuous claims free years under this policy.
< When the student will attain the age of 25 years and will go out of the purview of the policy, all benefits to be accrued under this policy will be available to him under new policy provided there is no break in the continuity of cover.
< A group of students can be insured under group policy wherein group discount up to a maximum of 30 per cent will be available according to group size.
< All claims under this policy shall be payable in Indian currency only. All medical treatments for the purpose of this insurance will have to be taken in India only.

Parivar mediclaim for families

< Any individual residing in India grouped in a family consisting of self, spouse and two dependant children up to 25 years of age.
< Age group: Three months to 60 years.
< Sum insured: Rs 2,00,000 to Rs 5,00,000 (multiples of Rs 50,000)
< It covers reimbursement of hospitalisation expenses / cashless access services for illness / diseases contacted or injury sustained by the Insured person.
< Total expenses incurred for any one illness is limited to 50 per cent of the overall SI per family.
< Hospitalisation expenses of person donating an organ during the course of organ transplant will also be payable.
< Pre-existing diseases will be covered after four continuous claim free years.
< Diabetes and hypertension will be covered from the inception of the policy on payment of additional premium by the insured.
< Entire family covered under a single floater sum insured.
< Income tax benefits are available u/s 80 D for individuals and families to the extent of Rs 15,000 to (Rs 20,000 for senior citizens) as per prevailing Income Tax Rules.
< The policy will be serviced by third party administrator
< Cashless access service also available under the policy through listed networked hospital / nursing home, subject to pre-authorisation by TPA.
< Note: If the policy is extended beyond 60 years, 25 per cent loading on the premium for 56-60 years band is to be charged.

Varistha mediclaim for senior citizen

< This policy has been designed to cater to the needs of the senior citizens of our country.
< The policy has two sections. Section I covers hospitalisation and domiciliary hospitalisation expenses and Section II covers expenses for treatment of critical illnesses. Critical illness cover is optional.
< Sum insured (SI) is fixed. SI under Section I is Rs 1,00,000 and under Section II is Rs 2,00,000.
< Age group: Fresh entrants: 60 to 80 years, can be renewed up to 90 years.
< Pre-acceptance medical check up is not required if the person is covered under any health insurance policy uninterruptedly for preceding three years.
< Pre-existing diseases except malignant diseases will be covered under Section I after one claim free year.
< Pre-existing diabetes and hypertension (excluding any ailment already manifested due to diabetes and hypertension) can be covered from the inception of the policy on payment of additional premium.
< Cumulative bonus @ five per cent of SI for each claim free year up to a maximum of 50 per cent of SI or five per cent discount in renewal premium will be allowed in respect of each claim free year.
< Cost of health check up @ two per cent of average SI at the end of block of three underwriting years.
< Co- payment- 10 per cent (compulsory). Insured may opt for 20 per cent co-payment in which case 10 per cent additional discount in premium will be allowed.
< Under Section I, ambulance charges up to a maximum of Rs 1000 in a policy year will be reimbursed.
< Under Section I, hospitalisation expenses of person donating an organ during the course of organ transplantation will also be payable subject to the sub limits applicable to the insured person within the overall sum insured of the insured person.
< Income tax benefits are available u/s 80 D for individuals and families to the extent of Rs 15,000 to(Rs 20,000 for senior citizens) as per prevailing Income Tax Rules.
< Cashless Access Service is available through TPA

TPA Services rendered to the policy holders of National Insurance

< Assistance to mediclaim policy holders and claim management by third party administrators.
< Who are Third party administrators (TPA)?
< Third party administrators or TPAs are licensed by IRDA to function as claim management specialists. The main benefits to policy holders are the following:

Call centre services

< The TPA will provide services over telephone for the guidance and benefit of insured persons. This guidance will include:
< Answers to queries related to coverage and benefits under the policy
< Information on Insurer’s office procedures and products related to health.
< General guidance and assistance on the various services offered by the TPA.
< The TPA will operate a 24×7 toll-free number for the benefit of the policy-holders.

Cashless access service

< This service provides for cash free treatment at networked hospitals (named or listed in the guide book) up to the limit of sum insured allowed in the policy.

Guide book and ID card

< The TPA will provide a guide book and ID card for the use of the insured person.

Customer grievance service

< The TPA will accept and examine the grievances of the insured person and attempt to solve the grievance. All complaints will be numbered and the insured will be communicated the follow-up action.

Claim processing and payment services

< TPAs will settle claims as under;
< Direct with network hospitals under cash-less service.
< To the insured where the insured person uses a non-net-work hospital.

How to use TPA service?

An insured person should inform the TPA either directly or through network service provider hospital of the need to be hospitalised at least seven days in advance for elective surgery. The TPA after verifying the details will issue pre-authorisation letter / guarantee of payment to the network hospital. In emergency cases, the TPA should be informed immediately within 24-hours of admission to the network hospital and on verification may issue the necessary authorisation / guarantee to the network hospital.

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