National Health Insurance

National Health Insurance Company Limited is a frontrunner in the general insurance arena of India. The company is fully owned by the Central Government and has its headquarters in Kolkata. Established way back in the year 1906, NIC has seen a steady growth in its customer and premium base, year after year.  Despite being one of the oldest, NIC has constantly kept up with the market insurance needs. National Health Insurance offers customized health insurance schemes and comprehensive health covers to its customers. National Health Insurance covers almost all health areas through its wide array of health insurance schemes. The health policies cater to all age groups and individuals as well as groups.

National Health Insurance schemes provide extensive health coverage to individuals as well as families through its family floater plans. National Insurance Health Insurance also has customized health plans for senior citizens and groups through the group mediclaim covers.

Some of the key features of National Health Insurance are:

 

  • It has a wide network of more than 6000 hospitals that are covered by National Health Insurance schemes

 

  • Their grievance solvency ratio is excellent, touching almost 97%
  • The incurred claims ratio is also 97%
  • National Health Insurance has around 1300 plus offices in India and Nepal

The various kinds of covers under National Insurance Health Insurance are:

  • National Insurance Mediclaim Policy
  • National Insurance Mediclaim Plus Policy
  • National Insurance Parivar Mediclaim Policy
  • Varistha Mediclaim Policy for Senior Citizens
  • National Insurance Critical Illness Policy
  • National Insurance Individual Personal Accident Policy
  • National Insurance Janata Personal Accident Policy  

The basic features of some of them have been elaborated below:

National Health Insurance Mediclaim policies

Features Mediclaim Policy Mediclaim Plus Policy Parivar Mediclaim
Eligibility 18 -65 years. Children between 3 months- 18 years covered Same as Mediclaim Policy 18-60 years. Children between 3 months – 25 years
Renewability Age No limits No Limits 65 years
Sum Assured INR 50,000 to INR 5 lakhs (in increments of INR 25,000).
  1. INR 2 lakhs- INR 10 lakhs (increments of INR 1 lakh)
  1. INR 15 lakhs to INR 20 lakhs (increments of INR 5 lakhs)
  1. INR 30 lakhs to INR 50 lakhs (increments of INR 10 lakhs)
INR 2 lakhs to INR 5 lakhs (in increments of INR 50,000). Limit of 50 % of the chosen sum assured on the payout for each illness
Coverage Individual / Family Floater. (Family includes the proposer, his/her spouse, dependent children and dependent parents) Individual / Family Floater Family Floater only (It includes the proposer, his/her spouse and dependent kids)
Events insured -Inpatient hospitalization (minimum 24 hours)

-Over 140-day care procedures covered

-Up to 30 days of pre-hospitalisation expenses covered

-No waiting period for accidental injuries

-Up to 25% of sum assured allowed for room expenses

-Up to 50% of sum assured allowed for procedures like anesthesia etc

The features of the mediclaim policy are present with some add-ons like:

-Up to 60 days of post-hospitalization expenses allowed

-Critical Illness sum assured from INR 2 lakhs to INR 25 lakhs

– Outpatient Treatment sum assured from INR 2,000 – INR 10,000

-Maternity expense covered subject to a limit

-Newborn expenses are also covered under this National Insurance Health Policy

Up to 1% of sum assured allowed for room charges

-Up to 15 days of pre-hospitalisation expenses covered

-Up to 30 days of post-hospitalization expenses covered

-Inpatient hospitalization (minimum 24 hours)

-Up to 2% of sum assured allowed for ICU charges per day

-Up to 1% of sum assured allowed for room charges allowed –including nursing and RMO charges

-Covers costs related to anesthesia, consultants, nurses, medicines, drugs, X-rays, dialysis etc

The waiting period for pre-existing diseases 4 years 3 years -In case of diabetes, the waiting period contingency is waived off by paying an added premium

-For specific diseases it is 2 years

-For other diseases it is 4 years

Major Benefits National Insurance Health Insurance is applicable for deduction US 80D of the IT Act

-5% increment in sum assured for every claim-free year if there are successive renewals (up to 50%)

Same as Mediclaim policy with few additions -Applicable for deduction US 80D of the IT Act
Exclusions STDs including HIV and other related diseases, maternity, obesity, psychiatric ailments, genetic disorders, cosmetic/sex change surgeries, microscopic exams, ECGs, eye checkups In addition to the ones in mediclaim exclusions- naturopathy, unscientific treatment, abuse of intoxicants, spectacles, contact Lens, hearing aids, and Cochlear Implants Dental treatment, complications/ailments resulting from pregnancy/delivery, irrelevant diagnostic, lab exams, non-allopathic treatment

-Terrorism and war-related acts are not covered

 

*the features of all the above-mentioned policies are quite exhaustive and the table above covers only the prominent ones and is indicative of all the benefits being offered under each of the National Insurance Health Policy

 

Primary features of other National Health Insurance schemes

Varistha Mediclaim Policy for Senior Citizens

  • The renewability age for this National Insurance Health Policy is 90 years with a premium loading
  • Hospitalisation Cover is INR 1 lakh and critical illness cover is for INR 2 lakhs
  • Critical illness cover available
  • There is a waiting period of 1 year for pre-existing diseases
  • The exclusions to this National Insurance Health Insurance comprises of dental treatment,  cosmetic treatment, pregnancy, childbirth, general debility, congenital defects, self-injury,  war injuries, nuclear activity, vaccinations

National Insurance Health Policy for Critical Illness

  • Upon diagnosis of specified critical illnesses, the sum assured is paid out in one go
  • The entry age eligibility is 20-60 years with renewability age being 65 years
  • There is a 90 day waiting period
  • Subject to survival for 30 days post-diagnosis, the sum assured is payable with a cap of 20% in the case or coronary artery surgery and also in case of cancer, kidney failure, stroke, MS, and major organ transplant

National Health Insurance Individual Personal Accident Policy

  • The eligibility for entry is between 5-70 years
  • It covers accidental death, permanent disablement, partial and temporary total disablement
  • Choice of only death cover or comprehensive coverage is also available
  • The insured gets a global coverage
  • Exclusions include self – injury, suicide, insanity, injury as a result of intoxication or criminal activity

National Health Insurance Janta Personal Accident Policy

  • 100 % of sum assured payable in case of death, loss of sight in both or single eye, loss of both or one limb, permanent total disablement:
  • In case of loss of one limb or loss of sight in one eye, the sum assured payable is 50%