National Parivar Mediclaim Plus Policy

এক নজরে

• Family-floater cover is offered under Plans A, B and C. (p.22)
• Floater sum insured options range from INR 6 lakh to INR 50 lakh depending on plan. (p.22)
• Pre- and post-hospitalisation periods are 30 and 60 days. (p.22)
• Conditional road-traffic-accident reinstatement is included. (p.9)

কারা বিবেচনা করতে পারেন

Families comparing higher floater sum insured options and broader listed benefits may review the plan-specific limits, co-payments and waiting periods.

যোগ্যতা

• Family members are 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 on a floater basis subject to the selected plan, sum insured and Table of Benefits limits. (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.6)
• Domiciliary hospitalisation medical expenses, including pre- and post-hospitalisation, are covered up to the Table of Benefits limit; treatment under three days and listed conditions are excluded. (p.5)

মূল সুবিধা

• Road ambulance (per insured person, per policy year): Plan A up to INR 2,500, Plan B up to INR 4,000, Plan C up to INR 5,000. Air ambulance (per insured person, per policy year): not covered under Plan A; up to 5% of SI under Plans B and C. (p.22)
• Eligible organ-donor in-patient hospitalisation expenses are covered when the insured person's transplant in-patient claim is admitted. (p.6)
• AYUSH treatment is covered up to the floater sum insured under each plan, subject to policy conditions. (p.22)
• Maternity and specified newborn benefits are included, subject to the benefit's 24-month waiting period, age conditions, plan limits and other restrictions. (p.7)
• If sum insured is exhausted by road-traffic-accident claims, it is reinstated once in the policy year for later hospitalisation due to another disease or injury; a single claim cannot exceed the scheduled sum insured. (p.9)

Sum insured / deductible

• Floater Plan A: INR 6/7/8/9/10 lakh; Plan B: INR 15/20/25 lakh; Plan C: INR 30/40/50 lakh. (p.22)

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.10)
• 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.9)
• Pre-existing diseases and direct complications are excluded for 36 months of continuous coverage; later coverage requires declaration and acceptance. (p.9)

Co-payment ও sub-limit

• Zone-based co-payments range from 5% to 22.5% when treatment is taken in a higher-cost zone; optional choices are 20% for a 25% premium discount or 10% for a 12.5% discount. (p.14)
• Plan A limits room to 1% and ICU to 2% of sum insured per day or actual, whichever is lower; Plans B and C allow up to sum insured, subject to their Table of Benefits. (p.22)

গুরুত্বপূর্ণ বর্জন

• Admissions primarily for diagnostics or evaluation are excluded. (p.10)
• Professional hazardous or adventure-sports treatment is excluded. (p.10)
• Alcoholism, drug or substance abuse and their consequences are excluded. (p.11)
• OPD expenses are excluded except where an optional cover expressly applies. (p.11)
• Treatment outside India is excluded. The wording contains additional exclusions. (p.12)

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 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 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.16)