New National Parivar Mediclaim Policy

এক নজরে

• Floater cover with INR 1 lakh to INR 10 lakh sum insured options. (p.21)
• Pre- and post-hospitalisation periods are 45 and 75 days respectively. (p.21)
• Includes maternity after 36 months' continuous cover, subject to limits and conditions. (p.6)
• Reinstatement is available for basic sum insured of INR 6 lakh and above, subject to conditions. (p.9)

কারা বিবেচনা করতে পারেন

Families comparing floater hospitalisation cover with the stated waiting periods, sub-limits and optional covers may review this wording and the policy schedule.

যোগ্যতা

• Family members are defined as the insured's spouse, children and parents covered by the policy. (p.2)
• If only children under 18 remain covered, the policy continues to expiry and grandparents may renew as proposer for the grandchildren. (p.16)

Coverage-এর কাঠামো

• The policy period may be one, two or three policy years, as stated in the schedule. (p.4)
• In-patient medical expenses are covered subject to the policy's limits; hospitalisation ordinarily requires at least 24 consecutive hours, except day-care procedures. (p.5)
• Medical expenses for the same admissible condition are covered for up to 45 days immediately before hospitalisation. (p.5)
• Medical expenses for the same admissible condition are covered for up to 75 days immediately after discharge. (p.5)
• 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)
• Domiciliary hospitalisation medical expenses, including pre- and post-hospitalisation, are covered up to the Table of Benefits limit; listed conditions and treatment under three days are excluded. (p.6)

মূল সুবিধা

• Transportation to a hospital, between hospitals, or to a diagnostic centre and back during the same hospitalisation is covered up to the Table of Benefits limit when an in-patient claim is admitted. (p.6)
• Eligible organ-donor in-patient hospitalisation expenses for harvesting an organ donated to an insured person are covered when the insured person's in-patient 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)
• Maternity, specified pre- and post-natal hospitalisation and necessary newborn vaccination are covered up to the Table of Benefits limit after 36 months' continuous cover; the newborn is automatically covered under the mother's available sum insured up to three months of age. (p.6)
• For floater basic sum insured of INR 6 lakh and above, the basic sum insured is reinstated once per policy year after exhaustion, for a subsequent hospitalisation and not for an illness or injury already claimed before reinstatement. (p.9)
• A claim-free policy year earns 5% of floater basic sum insured; claims reduce accumulated bonus by 5%, and the maximum bonus is 50% of floater basic sum insured. (p.9)

Sum insured / deductible

• Floater sum insured options are INR 1, 2, 3, 4, 5, 6, 7, 8, 9 or 10 lakh. (p.21)

Waiting period

• Illness treatment is excluded for the first 30 days from first policy commencement, except covered accident claims; the exclusion does not apply after more than 12 months' continuous coverage. (p.13)
• Listed conditions carry 90-day, one-year, two-year or three-year waiting periods; accidents are excepted, and the longer period applies where a PED waiting period also applies. (p.12)
• Pre-existing diseases and direct complications are excluded for 36 months of continuous coverage; later coverage requires declaration and acceptance. (p.12)

Co-payment ও sub-limit

• Optional diabetes/hypertension cover: 10% co-payment for either condition alone and 25% for both (wording p.9). Zonal co-payments include 13% when Zone II premium is used for Zone I treatment, and 28%/13.5% when Zone III premium is used for Zone I/Zone II treatment; optional co-payment of 20% or 10% is available with the stated premium discounts (p.19). (p.19)
• Room rent is limited to 1% of sum insured per day and ICU to 2% per day, each subject to actual cost; proportionate deduction applies for a higher room, but not for ICU. (p.21)

গুরুত্বপূর্ণ বর্জন

• Admissions primarily for diagnostics or evaluation, and unrelated diagnostic expenses, are excluded. (p.13)
• Professional hazardous or adventure-sports treatment is excluded. (p.13)
• Alcoholism, drug or substance abuse and their consequences are excluded. (p.13)
• Unproven treatments and supplies are excluded. (p.14)
• Treatment outside India is excluded. The wording contains additional exclusions. (p.15)

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.16)
• Migration may be requested at least 30 days before renewal, and portability to another insurer at least 15 days but not earlier than 60 days before renewal, with continuity credits subject to the stated rules. (p.16)
• The premium grace period is 30 days. Instalment coverage continues if the due instalment is 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 from receipt of the policy document. (p.16)