National Senior Citizen Mediclaim Policy

এক নজরে

• Designed around the wording's definition of senior citizen as age 60 or above. (p.5)
• Available on individual basis or as a floater for the insured and spouse. (p.1)
• PED waiting period is 24 months. (p.10)
• Plan B includes conditional road-traffic-accident reinstatement. (p.8)

কারা বিবেচনা করতে পারেন

Senior citizens comparing individual or spouse-floater cover should review the selected plan, zone, co-payments, limits and schedule.

যোগ্যতা

• Floater cover is available in respect of the insured and spouse. (p.1)

Coverage-এর কাঠামো

• The policy period is one year as stated in the schedule. (p.4)
• In-patient medical expenses are covered under Plans A and B subject to the applicable plan, sum insured and Table of Benefits limits. (p.5)
• Medical expenses for the same admissible condition are covered for 30 days immediately before hospitalisation. (p.5)
• Medical expenses for the same admissible condition are covered for 60 days immediately after discharge. (p.6)
• 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 is covered up to the Table of Benefits limit when hospital-level care is taken at home because the patient cannot be moved or a hospital room is unavailable; treatment under three days and listed conditions are excluded. (p.6)

মূল সুবিধা

• Actual emergency ambulance charges are covered up to INR 2,500 per illness for each insured person when an in-patient claim is admitted. (p.7)
• Eligible organ-donor in-patient hospitalisation expenses are covered when the insured person's transplant in-patient claim is admitted. (p.7)
• AYUSH in-patient, pre-hospitalisation and post-hospitalisation expenses are covered when treatment is taken in an AYUSH hospital. (p.6)
• Plan B reinstates sum insured once per policy period when it is exhausted by a road-traffic-accident claim, for later hospitalisation due to another disease or injury; the reinstated amount is limited to the pre-accident balance exhausted by that claim. (p.8)
• Individual and floater claim-free policies earn 5% of sum insured at renewal; claims reduce bonus by 5%, and bonus is capped at 50%. (p.9)

Sum insured / deductible

• Plan A and Plan B each offer Sum Insured from INR 1 lakh to INR 10 lakh in INR 1 lakh multiples (individual and floater). (p.24)

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.10)
• Pre-existing diseases and direct complications are excluded for 24 months of continuous coverage; later coverage requires declaration and acceptance. (p.10)

Co-payment ও sub-limit

• Zone 2 insureds taking treatment in Zone 1 have 18.5% co-payment. Optional choices are 20% co-payment for a 25% premium discount or 10% for a 12.5% discount. (p.17)
• Plan A: room rent up to 1% of SI per day (max INR 5,000) and ICU up to 2% of SI per day (max INR 10,000). Plan B: room rent up to 2% of SI per day (max INR 10,000) and ICU up to 4% of SI per day (max INR 20,000). Overall room/ICU limit 25% of SI for any one illness; listed PPN package exception applies. (p.24)

গুরুত্বপূর্ণ বর্জন

• Admissions primarily for diagnostics or evaluation are excluded. (p.10)
• Professional hazardous or adventure-sports treatment is excluded. (p.11)
• Maternity and specified childbirth or termination expenses are excluded, except stated exceptions. (p.12)
• OPD treatment is excluded except to the extent of the specified Plan B benefit. (p.12)
• Treatment outside India is excluded. The wording contains additional exclusions. (p.13)

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. 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.14)