National Mediclaim Policy

এক নজরে

• One-year individual indemnity policy. (p.4)
• Pre- and post-hospitalisation periods are 45 and 60 days. (p.6)
• Room and ICU daily limits are 1% and 2% of sum insured, with stated rupee caps. (p.5)
• Reinstatement is available for basic sum insured of INR 6 lakh and above, subject to conditions. (p.7)

কারা বিবেচনা করতে পারেন

Individuals comparing hospitalisation cover with explicit room, ICU and expense sub-limits may review this wording and their schedule.

যোগ্যতা

• Where only children under 18 remain covered, the policy continues to expiry and a legal guardian may renew as proposer for the children. (p.13)

Coverage-এর কাঠামো

• The policy period is one year as stated in the schedule. (p.4)
• Hospitalisation medical expenses are covered subject to broad-head sub-limits and the sum insured; ordinary in-patient care requires more than 24 hours, with day-care exceptions. (p.5)
• Medical expenses are covered for up to 45 days immediately before hospitalisation. (p.6)
• Medical expenses are covered for up to 60 days immediately after discharge. (p.6)
• Medical expenses, including pre- and post-hospitalisation, are covered for eligible day-care treatment requiring less than 24 hours as an in-patient, but not OPD treatment. (p.6)

মূল সুবিধা

• Emergency ambulance charges are covered up to 1% of sum insured, maximum INR 2,000 per policy period per insured person, when a hospitalisation claim is admitted. (p.7)
• Eligible organ-donor in-patient hospitalisation expenses are covered when the insured person's transplant claim is admitted. (p.6)
• In-patient AYUSH treatment in an AYUSH hospital is covered up to the sum insured specified in the schedule. (p.6)
• For basic sum insured of INR 6 lakh and above, basic sum insured is reinstated once per policy period for each eligible insured person after exhaustion, for subsequent hospitalisation and not a previously claimed illness or injury. (p.7)
• A claim-free policy period earns 5% of basic sum insured, accumulated up to 50%; a claim reduces accumulated bonus by 5% at next renewal. (p.7)

Sum insured / deductible

• Basic Sum Insured options are INR 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10 lakh. (p.17)

Waiting period

• Illness treatment is excluded for the first 30 days from first policy commencement, except covered accident claims; this does not apply after more than 12 months' continuous coverage. (p.9)
• Listed diseases and procedures carry 90-day, one-year, two-year or three-year waiting periods; accidents are excepted and the longer period applies where PED waiting also applies. (p.8)
• Pre-existing diseases and direct complications are excluded for 36 months of continuous coverage; later coverage requires declaration and acceptance. (p.8)

Co-payment ও sub-limit

• Optional co-payment choices are 20% on each admissible claim for a 25% premium discount, or 10% for a 12.5% premium discount. (p.15)
• Room rent is payable up to 1% of sum insured, maximum INR 10,000 per day; ICU up to 2%, maximum INR 20,000 per day; total room charges for one illness are capped at 25% of sum insured. (p.5)

গুরুত্বপূর্ণ বর্জন

• Admissions primarily for diagnostics or evaluation are excluded. (p.9)
• Professional hazardous or adventure-sports treatment is excluded. (p.9)
• Maternity and specified childbirth or termination expenses are excluded, except ectopic pregnancy and stated accident exceptions. (p.10)
• Domiciliary hospitalisation and OPD expenses are excluded. (p.10)
• Treatment outside India is excluded. The wording contains additional exclusions. (p.11)

Renewal ও portability

• The policy is renewable unless withdrawn, except for established fraud, non-disclosure or misrepresentation; renewal cannot be denied merely because of prior claims. (p.12)
• Migration may be requested at least 30 days before renewal, and portability at least 15 days but not earlier than 60 days before renewal, with continuity credits subject to the stated rules. (p.12)
• The premium grace period is 30 days. Instalment coverage continues if paid within grace; renewal coverage is unavailable for a period for which premium is not received. (p.2)
• The policyholder may cancel with seven days' written notice, subject to claim and refund conditions; new policies have a 30-day free-look period. (p.12)