National Mediclaim Plus Policy

What is the Plan all About?

National Mediclaim Plus Policy is a comprehensive health plan that covers in-patient treatment expenses. It does not just provide a traditional health cover, it also covers high health care costs and makes healthcare services accessible with ease.

3 plan variants can be opted under this plan:

Plan A
Plan B
Plan C

Key Features

Complete health cover for your family
Flexible sum insured options
Covers maternity expenses
Get daily hospital cash
Lifelong Renewability
Enjoy tax benefits

Policy Benefits

In-patient hospitalization expenses for which insured requires hospitalization for at least 24 hours are covered.
Pre hospitalization expenses that are incurred before hospitalization are covered up to 30 days
Post hospitalization expenses that are incurred after hospitalization are covered up to 60 days.
Listed day care procedures/surgeries which need the insured to be hospitalized for less than 24 hours are covered.
Organ donor expenses incurred during the course of organ transplant are covered.
Daily hospital cash is payable for a maximum of 5 days, provided hospitalization exceeds 3 continuous days.
Doctor’s Home Visit and Nursing Care allowance (during post hospitalization) is applicable for Plan B & C.
Maternity expenses are covered as limits specified in the policy.
Vaccination for children (male-12 years, female-14 years) is covered as limits specified.
Medical Second Opinion is provided once per family for each new diagnosis in a policy year and is applicable for listed major illnesses.
Out-patient treatment (per individual) is covered as an add-on cover. This benefit can be availed up to the limits specified.
Critical illness is covered as an add-on cover. This benefit can be availed up to the limits specified.

Value Added Benefits

Get Cumulative Bonus. Increase in Sum insured by 5% of SI per year, up to a maximum of 50%.
Enhancement of sum insured at the time of policy renewal.
Emergency ambulance charges are covered.
Air ambulance charges are covered up to the limits specified. This benefit is not applicable for Plan A.
Ayurveda and Homeopathy treatment expenses are covered.
Health check-up is covered after every 2 continuous claim free policy years and it is covered up to up to Rs 1,000, Rs 2000 & Rs 3000 for Plan A, B & C respectively. This benefit can be availed irrespective of claims.
No pre-policy medical check-up is required up to 39 years, except opting for critical illness and Sum Insured 6 Lacs & above.
50% cost of pre-policy medical check-up is reimbursed, upon acceptance of the proposal.
Avail tax benefits u/s 80D as per IT Act, 1961 for premium paid for this plan.

Sub Limits

For Plan A- Room rent is capped up to 1% of SI per day. For Plan A- ICU charges are capped up to 2% of SI, to a maximum of Rs 15,000 per day. For Plan B & C- Room Rent/ICU charges are capped up to Rs 15,000 & Rs 20,000 per day respectively.
20% co-pay applies, in case of treatment in a non-network hospital.
For Plan A- Cataract surgery is capped up to 15% of SI or Rs 60,000 for each eye, whichever is less. For Plan B & C- up to Rs 80,000 and Rs 1 Lac respectively.
Daily hospital cash is capped up to Rs 500, Rs 800 & Rs 1000 for Plan A, B & C respectively.
For Plan A- Maternity expenses are capped up to Rs 30,000 (normal delivery) and Rs 50,000 (caesarean section). For Plan B- Rs 60,000 (normal delivery) & Rs 75,000 (caesarean section). For Plan C- Rs 80,000 (normal delivery) & Rs 1 Lac (caesarean section).
Ambulance charges of Rs 2500, Rs 4000 & Rs 5000 for Plan A, B & C respectively.

Waiting Period Clause

Initial Waiting Period: A waiting period of 30 days from the inception date for all hospitalization claims except in case of accidents.
Specific Waiting Period: Specific illnesses such as Benign ENT disorders, Tonsillectomy, Tympanoplasty, Mastoidectomy, etc are covered after 12 months of policy coverage. Illnesses such as Cataract, Hernia, Hydrocele, Piles, etc are covered after 24 months of policy coverage. Treatment for joint replacement, Osteoarthritis and osteoporosis are covered after 48 months of policy coverage.
Pre existing Disease Waiting Period: Any pre-existing ailment/injury that was diagnosed /acquired within 36 months from the issuance of the first policy.
Maternity Waiting Period: Maternity expenses are covered after a waiting period of 24 months.

Who can Buy the Plan?

Factor	Minimum	Maximum
Age (as on last birthday)	Adult: 18 Years, Children: 3 Months	Adult: 65 Years, Children: 25 Years
Sum Assured	2 Lacs	50 Lacs
Cover Type	Individual/Family Floater	-
Policy Tenure	1 Year	1 Year
Grace Period	30 Days	-
Free Look Period	15 Days	-
Riders	Out-patient Treatment, Critical Illness	-