National Mediclaim Plus

The National Mediclaim Plus Plan is a health insurance policy that is offered by National Insurance Company Limited.

The National Mediclaim Plus plan is comparatively pricier than other options available in the market. And, it does not cover multiple people under one policy on a floater basis. While it does cover certain expenses such as maternity, vaccinations for children up to 12 years, and surgical treatment for weight loss, it does not provide comprehensive coverage. It also imposes sub-limits on modern and crucial treatments like cataracts, etc. Additionally, there is no option to pay the premium monthly. Our research indicates that the insurer has fewer complaints regarding policy purchases but a higher number of issues with claim settlements. This implies a good record in terms of buying the policy but a less favourable record in handling claims.

What Are The Benefits Offered By The National Mediclaim Plus Plan?

• Inpatient hospitalisation coverage: The National Mediclaim Plus Plan provides coverage for inpatient hospitalisation expenses, which includes costs you incur when you are hospitalised for more than 24 hours. These include room boarding and nursing charges, the cost of prescribed medications and drugs, medical practitioner fees, ICU charges, and other associated expenses.
• Pre-hospitalisation coverage: Expenses that you incur before going to the hospital are called pre-hospitalisation expenses. These include fees for consultations, tests, checkups, lab reports, etc. To get coverage, these expenses must be connected to the medical condition that leads to your hospital stay. Your claim for these expenses needs to be a part of your inpatient hospitalisation coverage. In the National Mediclaim Plus Plan, pre-hospitalisation expenses are covered for 30 days before your hospital stay, up to the sum insured amount.
• Post-hospitalisation coverage: Medical costs you incur after you are discharged from the hospital are called post-hospitalisation expenses. These costs include the expenses related to follow-up consultations with your doctor, medical checkups, rehabilitation sessions, physiotherapy, etc. To be eligible for coverage, these expenses must be related to the condition that led to your hospitalisation, and your claim must be approved under the inpatient hospitalisation cover. In the National Mediclaim Plus Plan, post-hospitalisation expenses are covered for 60 days after your hospitalisation up to the sum insured.
• Daycare treatment coverage: These are essentially medical procedures or surgeries that once required prolonged hospital stays but can now be accomplished within 24 hours due to innovative advancements in the healthcare field. In the National Mediclaim Plus Plan, 140 daycare procedures are covered up to the sum insured you choose while buying the policy. Surgeries or procedures that are not listed are also covered, but you must get approval from the insurer or TPA beforehand.
• Domiciliary treatment coverage: These are essentially medical treatments for illnesses or injuries that demand immediate medical attention at the hospital but can be given at home because of the severity of the patient's medical situation or the unavailability of beds in nearby hospitals. The National Mediclaim Plus Plan, however, does not provide coverage for domiciliary treatments.
• Organ donor coverage: The National Mediclaim Plus Plan covers the inpatient costs of the organ donor in case of organ transplantation up to the specific sum insured – where you are the organ recipient.
• Modern treatment coverage: In today's progressive landscape of healthcare, everyday advancements are making treatments once deemed impossible into a reality. Cutting-edge treatments that include stem cell treatments, radio surgeries, etc., are promising better cures for conditions that were previously considered impossible. The National Mediclaim Plus Plan provides coverage for such modern treatments up to 25% of the sum insured.
• Non-medical expenses coverage: These are costs related to consumables, such as gloves, nebulisation kits, and other essential items that are necessary for treatment. The National Mediclaim Plus Plan, however, does not provide coverage for non-medical expenses.
• No-Claim Bonus: No-Claim Bonus is a reward offered to you if you do not file any claims during a policy year. In the National Mediclaim Plus Plan, you get a No Claim Bonus of 5% of your sum insured. You can gather a maximum bonus of up to 50% of the sum insured. Keep in mind that if you make claims, your accumulated bonus will decrease at the rate it was earned.
• Super No-Claim Bonus: The Super No Claim Bonus is an enhanced version of the standard No Claim Bonus and operates in a similar manner. However, the National Mediclaim Plus Plan does not offer the Super No Claim Bonus feature.
• Restoration benefit: The Restoration Benefit is a valuable feature that replenishes your sum insured once it is used up during a policy year. Unfortunately, the National Mediclaim Plus Plan does not offer this benefit.

Please note that the limits and conditions mentioned in the above benefits and features are for a sum insured of Rs. 10 Lakhs.

National Mediclaim Plus Plan: Financial Limits

• Room rent limit: It is the maximum amount your insurer will pay for the room during your hospital stay. Staying in a room within your plan's limit will not cost you anything extra. But if you choose a room beyond your limit, you will have to pay a proportionate share of the total bill, not just the room difference. In the National Mediclaim Plus Plan, the room rent limit is 1% of the sum insured per day. But there is no limit if you get treated in a network hospital.
• ICU rent limit: This is the highest amount your health insurance policy covers for your stay in the ICU of a hospital. In the National Mediclaim Plus Plan, the ICU rent limit is 2% of the sum insured per day, with a maximum of up to Rs. 15,000 per day.
• Copayment: Copayment is a specific percentage of the approved claim amount that you have to pay yourself. After you pay your share, the insurer will cover the rest. In the National Mediclaim Plus Plan, there is a copayment limit of 20% if you receive treatment in a non-network hospital.
• Deductible: A deductible is a certain amount that you have to pay from your end before your policy steps in to cover the rest of your medical expenses. The National Mediclaim Plus Plan does not have a deductible limit.
• Limits on surgeries/treatments: It is the highest amount your insurer will pay for certain medical procedures or treatments. Some policies might have a maximum amount they will cover for specific procedures, while others might not. In the National Mediclaim Plus Plan, joint replacement surgeries are covered up to the sum insured with no limit. Cataract treatment expenses are covered up to 15% of the sum insured or Rs. 60,000 per eye per policy year, whichever is lower.

Please note that the above financial limits are taken for a 30-year-old individual, opting for a sum insured of Rs. 10 Lakhs.

National Mediclaim Plus Plan: Waiting Periods & Exclusions

👉Waiting Period

Waiting period refers to a specific time frame after you buy a health insurance policy when certain illnesses and diseases may not be covered. Once this period ends, you can claim for these conditions. Here are some types of waiting periods –

• Initial waiting period: The National Mediclaim Plus Plan has an initial waiting period of 30 days for all medical conditions except for accidents. So, you will not be eligible to claim any hospitalisation expenses unless it is a result of an accident.
• Waiting period for pre-existing diseases: Any illness or medical condition that you have experienced within 36 months prior to securing a health insurance policy is known as a pre-existing disease. The National Mediclaim Plus Plan has a waiting period of 36 months for pre-existing diseases. During this period, you cannot file any claim for expenses related to your pre-existing disease.
• Waiting period for specific diseases: Insurance companies may apply waiting periods on certain medical conditions or illnesses apart from your pre-existing diseases. These waiting periods are decided by the insurer and are not based on your current state of health. The National Mediclaim Plus Plan has a waiting period of 3 / 12 / 24 / 48 months for specific diseases.

👉Exclusions

There are certain situations that your insurer will not cover, and they are referred to as exclusions. These include –

• Standard permanent exclusions: All insurance companies must adhere to a set of "standard permanent exclusions" specified by the IRDAI or Insurance Regulatory and Development Authority of India. These exclusions include – 

1. Investigation and evaluation: Hospitalisation for monitoring or observation purposes.
2. Rest cure, rehabilitation, and respite care: Hospital admission to a facility for bed rest where no active medical treatment is administered.
3. Obesity/weight control: Any treatment or surgery designed for weight control or obesity.
4. Change of gender treatment: Any medical treatment designed to alter the characteristics of the body to that of the opposite gender.
5. Plastic/cosmetic surgery: Any surgical or medical procedures for the modification of appearance or body characteristics.
6. Profession in hazardous or adventure sports: Any medical expenses incurred while you are engaging as a professional in adventure activities such as skydiving, river rafting, scuba diving, horse racing, etc.
7. Breach of law: Any expenses incurred for treating a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatment that is received from a medical practitioner or hospital is excluded by the insurance company.
9. Narcotics: Treatment meant for addictive conditions like alcohol addiction, drug usage, etc.
10. Treatments in establishments arranged specifically for domestic purposes: Expenses related to receiving treatments from health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
11. Dietary supplements, substances bought without prescription: Vitamins, minerals, and other dietary supplements not prescribed by a medical practitioner.
12. Refractive error: Expenses related to correcting refractive errors up to 7.5 diopters for improved eyesight.
13. Unproven treatments: Any surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses associated with birth control, sterility infertility: Contraception, artificial insemination, sterilisation, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
15. Maternity expenses: Expenses related to pre/post-natal care, childbirth, hospitalisation, etc.

• Additional permanent exclusions: Apart from the standard exclusions set by the IRDAI, insurance companies can also impose some specific exclusions based on different medical conditions or situations. If the insurer considers certain diseases or severe medical conditions too risky, they may permanently exclude them from your policy's coverage. It is crucial to understand that insurers can only apply permanent exclusions to a pre-approved list of illnesses outlined by the IRDAI. They cannot permanently exclude any disease or medical condition beyond this list.
• Non-standard exclusions (Specific exclusions): These exclusions extend beyond the standard permanent exclusions established by the IRDAI and can differ across insurers based on their conditions and individual policies. Here are some of the specific exclusions under the National Mediclaim Plus Plan –

1. Hormone replacement therapy
2. Expenses linked with general weakness, congenital external issues
3. Treatment for self-harm or attempted suicide by any means
4. Stem cell therapy, except for bone marrow transplants for specific blood conditions
5. Circumcision, unless medically necessary or due to an accident
6. Costs of vaccinations or inoculation, except for newborns and children of certain age groups
7. Expenses for non-allopathic or alternative treatments, except for Ayurveda and Homeopathy
8. Dental treatment, except for injuries
9. Domiciliary treatment (Treatments taken at home)
10. Spectacles, contact lenses, hearing aids, and cochlear implants
11. External medical equipment employed for diagnosis or treatment, unless needed due to an accident
12. Injuries or illnesses from war, enemy actions, etc.
13. Injuries or illnesses from nuclear, chemical attack,  biological attack, weapons, etc.

What To Expect In Terms Of Claims Experience If You Buy From National Insurance Company Limited?

• Speed of claims: The National Insurance Company has settled 82.12% of claims within 30 days. This indicates that they need to improve their claim settlement process.
• Claim-related complaints: According to our research, the National Insurance Company Limited has received a higher number of complaints related to claims, as compared to other insurers, accounting for 0.39%.
• Claims incurred ratio: It is a measure of the financial performance of an insurer. It is the ratio of the total claims incurred by the insurer to the total premiums collected in a financial year. The National Insurance Company's claims incurred ratio is 90.83%.
• Claim settlement ratio: The National Insurance Company's claim settlement ratio is 79.53%. It is the percentage of claims settled by the health insurer compared to the total claims received in a financial year.
• Network hospitals: National Insurance Company offers a vast network of over 3,200+ hospitals. The extensive network ensures that customers can access cashless treatments from a diverse range of healthcare providers across various locations without any financial burdens.

How Is The Customer Service Of National Insurance Company Limited?

• Policy purchase-related complaints: According to our research, the National Insurance Company has received a minimal/nil number of complaints related to their after-sales service, as compared to other insurers, accounting for 0.00%.
• Response on toll-free: As per our research, we found that the response rate on National Insurance Company's toll-free number is average, as compared to other insurers.
• Response on Twitter: As per our research, the National Insurance Company's response time on Twitter is slow.

About the National Insurance Company Limited

The National Insurance Company Limited is among India's oldest General Insurance Companies. It offers various insurance products like health insurance, motor insurance, fire insurance, marine insurance, etc. to meet its customers' needs. Established in 1906, the company is based in Kolkata, West Bengal and Smt. Suchita Gupta serves as the company's CMD.