National Mediclaim Plus Policy

এক নজরে

• Individual cover is offered under Plans A, B and C with different sum insured and benefit limits. (p.18)
• Pre- and post-hospitalisation periods are 30 and 60 days. (p.18)
• Maternity is covered after 24 months, subject to plan-specific limits and conditions. (p.18)
• Claim-free cumulative bonus accrues at 5%, capped at 50%. (p.7)

কারা বিবেচনা করতে পারেন

Individuals comparing broader hospitalisation benefits across multiple sum-insured plans may review the plan-specific Table of Benefits and conditions.

যোগ্যতা

Refer to the policy wording and schedule.

Coverage-এর কাঠামো

• The policy period is one year as mentioned in the schedule. (p.3)
• In-patient medical expenses are covered subject to the selected plan's Table of Benefits, limits and individual sum insured. (p.5)
• Medical expenses for the same admissible condition are covered for up to 30 days immediately before hospitalisation. (p.5)
• Medical expenses for the same admissible condition are covered for up to 60 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, but not OPD treatment. (p.5)

মূল সুবিধা

• Road ambulance: Plan A up to INR 2,500, Plan B up to INR 4,000, Plan C up to INR 5,000 per policy period. Air ambulance: not covered under Plan A; up to 5% of SI per policy period under Plans B and C. (p.18)
• Eligible organ-donor in-patient hospitalisation expenses are covered when the insured person's transplant in-patient claim is admitted. (p.5)
• AYUSH treatment is covered up to the sum insured under each plan, subject to policy conditions. (p.18)
• Maternity expenses are covered after 24 months, with plan-specific limits; the benefit includes specified pre- and post-natal hospitalisation and newborn provisions subject to conditions. (p.18)
• At renewal a claim-free insured person earns 5% of sum insured; a claim reduces bonus by 5%, and bonus is capped at 50%. (p.7)

Sum insured / deductible

• Plan A: INR 2/3/4/5/6/7/8/9/10 lakh; Plan B: INR 15/20/25 lakh; Plan C: INR 30/40/50 lakh (individual basis). (p.18)

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.8)
• 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.12)
• Room and ICU limits vary by Plan A, B and C and are stated in the Table of Benefits; the selected plan must not be flattened across variants. (p.18)

গুরুত্বপূর্ণ বর্জন

• Admissions primarily for diagnostics or evaluation are excluded. (p.9)
• Professional hazardous or adventure-sports treatment is excluded. (p.9)
• Sterility and infertility services are excluded. (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.14)
• 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.14)
• The premium grace period is 30 days; 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.13)