National Health Insurance

If you are looking for affordable and extensive health insurance plans, you can consider checking out National Health Insurance. The Central Government of India completely supports National Insurance Co Ltd (NIC). The corporation was founded in 1906 and nationalised in 1972, with its headquarters in Kolkata. National Insurance is India's first general insurance provider. It was founded in 1906 to aid the Swaraj cause, but in 1972, it amalgamated with 21 international and 11 Indian enterprises to become the Indian General Insurance Corporation (GIC). Nevertheless, in 2002, it separated from GIC and then transformed into an independent insurance firm.

The insurer is well-known for providing health plans that are extensive and tailored to the individual's needs. The health insurance firm is constantly striving to adopt cutting-edge technology in order to succeed at delivering insurance services by combining people and procedures, which has established the insurance company as the most desired choice for clients. To fulfill a variety of healthcare demands, the company provides insurance solutions by offering a wide range of policies such as individual policies, family floater policies, senior citizen plans, critical illness policies, top-up policies, and abroad trip coverage. It was named the Economic Times Iconic Brand in 2018 for its diversified offers and exceptional services.

The insurance has a worldwide presence in Nepal too, at roughly 1340 locations. Its partnerships with 3201+ partner hospitals throughout India allow users to receive cashless health care treatments without compromising precision and saving money.

This page will provide you with a detailed description of National health insurance policy details.

National Health Insurance Key Highlights

Why Should You Buy a National Health Insurance Policy?

National insurance is well-known for providing health plans that are extensive and tailored to the individual's needs. An important part of National's vision is to offer services in a manner that responds to people's individual lifestyles, so they can live their lives comfortably, stress-free and with more dignity.

National Insurance provides you with all of these services and more. Whether you need coverage for surgery or prefer to buy a plan that will cover services such as a critical illness like cancer or heart attack, National Insurance provides you with the protection you deserve.

Here are the highlights of National health insurance policies:

1. Affordable premiums
2. All-around health coverage
3. Quick claim settlement
4. Lifelong renewability
5. Healthcare facility

Choose from a Wide Range of Multiple National Health Insurance Plans

National Health Insurance Policy Details

Here are the health insurance plans offered by National health insurance:

1. National Young India Mediclaim Policy

This is an indemnity-based health insurance plan which is issued either on individual or family floater basis. It offers a sum insured amount of INR 3, 5, 10 lakhs. 

Coverage:

• In-patient hospitalisation
• Pre-hospitalisation
• Post-hospitalisation
• Day care treatment
• Homeopathy and Ayurveda
• Ambulance expenses
• Maternity cover
• AIDS/HIV cover
• Mental illness cover
• Advanced treatment
• Morbid obesity treatment
• Refractive error correction

Additional Coverage:

• Basic insured sum reinstatement
• Personal accident cover

Optional Coverage:

• Pre-existing illness waiting term waiver
• Double sum insured for critical illnesses

2. Corona Kavach Policy – National

This is a corona specific health insurance coverage plan. The sum insured ranges from INR 50,000 to 5 lakhs. It covers both allopathy and AYUSH treatment. Please note that the last date of purchase of this policy is 30th September 2022.

Coverage:

• In-patient COVID hospitalisation
• Pre-hospitalisation (15 days)
• Post-hospitalisation (30 days)
• Ambulance expenses
• Home care treatment
• AYUSH therapy cover

Optional Coverage:

• Hospital daily cash benefit
• Comorbid conditions

3. Arogya Sanjeevani Policy – National

This is a pocket-friendly indemnity-based health insurance plan which aims to provide basic health coverage to people all over the nation. The sum insured ranges from INR 50,000 – 10 lakhs.

Coverage:

• In-patient hospitalisation
• Day care treatments
• AYUSH therapy cover
• Cataract treatment
• Dental treatment (if necessary for treatment)
• Plastic surgery (if necessary for treatment)
• Ambulance expenses

4. National Senior Citizen Mediclaim Policy (NSCMP)

This is an indemnity-based health insurance plan for policyholders who are aged above 60 years. The sum insured is set up to INR 10 lakhs.

Coverage:

• In-patient hospitalisation
• Pre-hospitalisation (30 days)
• Post-hospitalisation (60 days)
• Ambulance expenses
• Domiciliary expenses
• Day care treatment
• Ayurveda and Homeopathy
• HIV/AIDS cover
• Mental Illness cover
• Organ donor cover
• Advanced treatment
• Morbid obesity treatment
• Refractive error correction

Optional Coverage:

• Hospital cash
• Doctor or attendant charges under post-hospitalisation
• Funeral expenses
• Sum insured reinstatement (under accidental hospitalisation)

5. National Super Top Up Mediclaim Policy

This is a super top-up plan which provides additional sum insured coverage at reasonable premium rates. The sum insured ranges from INR 3 lakh to 20 lakhs.

Coverage:

• In-patient hospitalisation
• Pre-hospitalisation (30 days)
• Post-hospitalisation (60 days)
• Day care treatment
• Ayurveda and Homeopathy
• Organ donor cover
• Morbid obesity treatment
• Maternity cover
• Advanced treatments like robotic surgery, oral chemotherapies, etc are covered
• Mental illness cover
• Refractive error correction

Optional Coverage:

• Hospital daily cash benefit
• Ambulance expenses
• Policy migration without threshold

6. Vidyarthi Mediclaim Policy for Students

This policy offers health and accidental cover to student policyholders. This policy is divided into 3 parts – hospitalisation expenses, parent's accidental cover, and insured student accidental cover. The first one offers a sum insured of INR 50,000 – 2 lakhs. The second one will be double the first part. The third one has a sum insured of INR 50,000.

Section I Coverage:

• In-patient hospitalisation
• Pre-hospitalisation (30 days)
• Post-hospitalisation (60 days)
• Advanced treatment
• Refractive error correction
• Morbid obesity treatment
• Mental illness treatment
• HIV/AIDS treatment

Section II Coverage:

• Parent personal accident cover
• Dead body transport cost

Section III Coverage:

• Insured student personal accident cover
• Dead body transport cost

7. National Mediclaim Policy

This is an individual health insurance policy with sum insured ranging from INR 1 lakh all the way to INR 10 lakhs. 

Coverage:

• Room rent
• Fees of the medical practitioner
• Other hospitalisation expense
• Pre-hospitalisation (45 days)
• Post-hospitalisation (60 days)
• Hemodialysis
• Chemotherapy
• Radiotherapy
• Advanced treatments
• Treatment from hazardous and adventure sports participation as a non-professional

8. National Mediclaim Plus Policy

This is an individual coverage indemnity-based plan with the sum insured ranging from INR 2 lakh to 50 lakhs. 

Coverage:

• In-patient hospitalisation
• Pre-hospitalisation (30 days)
• Post-hospitalisation (60 days)
• Day care treatment
• Ayurveda and homoeopathy
• Maternity expenses
• Organ donor expenses
• Hospital cash benefit
• Air ambulance expenses
• Ambulance expenses
• Reunion of medical emergency
• Nursing care and doctor visit on post hospitalisation
• HIV/AIDS cover
• Children vaccination
• Mental illness cover
• Advanced treatment
• Morbid obesity treatment
• Refractive error correction
• Second medical opinion

Optional Coverage:

• Outpatient treatment
• Critical illness

9. National Parivar Mediclaim Policy

This is a family floater coverage health insurance plan. The sum insured range for these policies for INR 1 lakh – 10 lakhs. The policy term is from 1,2,3 years. 

Coverage:

• In-patient hospitalisation
• Pre-hospitalisation expenses (30 days)
• Post-hospitalisation expenses (60 days)
• Domiciliary hospitalisation
• Organ donor expenses
• Hospital cash benefit
• Anti rabies vaccination
• Ambulance expenses
• Maternity cover with new-born cover
• HIV/AIDS cover
• Infertility
• Mental illness cover
• Morbid obesity treatment
• Advanced treatment
• Refractive error correction
• Second medical opinion

Optional Coverage:

• Hypertension and/or pre-existing diabetes
• Critical illness cover
• Outpatient treatment

10. National Parivar Mediclaim Plus Policy

This is an indemnity-based family floater health insurance coverage. The sum insured ranges from INR 6 lakhs to INR 50 lakhs. 

Coverage:

• In-patient hospitalisation
• Pre-hospitalisation expenses (30 days)
• Post-hospitalisation expenses (60 days)
• Domiciliary hospitalisation
• Day care treatment
• Homeopathy and Ayurveda
• Organ donor expenses
• Hospital cash benefit

Ambulance expenses

• Reunion of a medical emergency (covered on plans with INR 15 lakhs+ sum insured)
• Nursing care and doctor visit on post hospitalisation (covered on plans with INR 15 lakhs+ sum insured)
• Anti-rabies vaccination
• Maternity cover
• New baby vaccination
• Child vaccination
• Advanced treatment
• Morbid obesity treatment

Optional Coverage:

• Second medical opinion
• Sum insured reinstatement

11. National Critical Illness Policy

This is a critical illness policy which covers medical expenses of major illnesses and their treatment. The sum insured ranges from INR 1 lakh to 75 lakhs. The policy is divided into 2 variants – A and B. Plan A covers 11 critical illnesses. Plan B covers 36 critical illnesses.

Plan A Coverage:

• Persisting symptoms of multiple sclerosis
• Permanent symptoms of motor neurone disease
• Permanent limb paralysis
• Bone marrow or major organ transplant
• Permanent symptoms of stroke
• Regular dialysis due to kidney failure
• Specified severity coma
• Open heart replacement / heart valve repair
• Open chest coronary artery bypass graft surgery
• Myocardial infarction
• Specified severity cancer

Plan B Coverage:

• Persisting symptoms of multiple sclerosis
• Permanent symptoms of motor neurone disease
• Permanent limb paralysis
• Bone marrow or major organ transplant
• Permanent symptoms of stroke
• Regular dialysis due to kidney failure
• Specified severity coma
• Open heart replacement / heart valve repair
• Open chest coronary artery bypass graft surgery
• Myocardial infarction
• Specified severity cancer
• Speech loss
• Deafness
• Blindness
• Encephalitis
• CJD
• Progressive supranuclear palsy
• Brain surgery
• End-stage failure of lung
• Cardiomyopathy
• Benign brain tumour
• Alzheimer’s disease
• Primary Parkinson’s disease
• Primary pulmonary hypertension (idiopathic)
• Pneumonectomy
• Aorta graft surgery
• Progressive scleroderma
• Multiple system atrophy
• Bacterial meningitis
• Systemic lupus erythematosus along with lupus nephritis
• Aplastic anaemia
• Apallic syndrome
• Goodpasture’s syndrome
• Third degree burns
• End-stage failure of liver

12. Overseas Mediclaim Business and Holiday

This policy covers travel emergencies if the insured is travelling abroad. This is exclusively for travellers who are going on business meets and holidays.

Coverage:

• Medical expenses and repatriation
• Personal accident cover
• Checked-in baggage delay
• Checked-in baggage loss
• Passport loss
• Personal liability

13. Overseas Mediclaim Employment and Studies

This policy covers travel emergencies if the insured is travelling abroad. This is exclusively for travellers who are going for employment and study-related issues.

Coverage:

• Medical accident and illness expenses
• Coverage for mental, nervous and emotional disorders
• Medical evacuation expenses
• Repatriation and alternatives expenses
• Medical emergency reunion expenses

National Health Insurance Benefits

You need to be covered under a comprehensive health insurance plan, especially at this age when major illnesses are rising and medical costs are getting expensive day by day. If you are still not convinced about National health policies, here are the benefits offered by the plans:

Peace of Mind

Life is uncertain. That's why National health insurance offers the peace of mind knowing that you and your family have a financial backup plan in case something goes wrong with their health. Having your family covered by National health insurance is one of the best ways to soften the blow should something untoward happen. A lot of us have been there and done that. We get sick and suddenly we find things are more expensive than they seem they should be. This can make going through it at least a little easier because you know you will be taken care of should something happen to you or your family.

2. HIV/AIDS Cover

National health insurance is one of the few health insurers which offers coverage for sexually transmitted diseases. Such diseases are usually not covered by a standard healthcare plan or by your regular primary care doctor. If you have been diagnosed with HIV or AIDS, there is no need to worry about paying for it because the National health insurance will cover the cost of treatment and medication.

3. Critical Illness Cover

Life can be stressful if you're dealing with a serious illness. You might feel like you are alone in the fight against this disease and not receive the help you need from your employer or even your insurance provider. The good news is that there are options available with National General which can provide affordable coverage for major illnesses such as cancer, heart attack, stroke, and other major illnesses. National Critical Illness Policy covers insured against 37 major illnesses.

4. Homeopathy and Ayurveda Cover

With the increasing number of diseases in our society, it is important for a person to protect themselves from health issues. The best way to do this is with health insurance that gives the patient access to alternative treatment methods. Alternative treatment methods are gaining traction in India. From homeopathy to ayurveda, alternative medicine is becoming more mainstream because of its natural and effective approach. National health insurance offers alternative treatment methods such as homeopathy and ayurveda.

5. Large Network of Hospitals

The ever-increasing demand for cashless health insurance claims has prompted large insurance providers to become more efficient. With the help of technology, they try to keep up with their policyholders’ changing needs. This has led to the development and use of partnered medical facilities that help hospitals provide high-quality medical services at zero cost from the policyholder’s side. National health insurance offers a network of 3,201+ medical facilities.

6. Tax Benefits

Income Tax Act Section 80D offers tax advantages to individuals paying premiums on health insurance policies. For people under the age of 60 years, the limit is INR 25,000 while the same for policyholders above the age of 60 , limit is INR 50,000. Both scenarios include a preventive healthcare benefit of INR 5,000.

Claim Settlement Ratio of National Health Insurance

CSR or Claim Settlement Ratio is among the most checked factors when shopping for health insurance and rightly so. This ratio is the number of successfully settled health insurance claims over the overall number of medical insurance claims received by the company on an annual basis. So, the higher this ratio is, the more dependable the company is in regard to claim settlement. 

National health insurance has a claim settlement ratio of 45.37% in the period of less than 3 months and 12.39% in the period of 3 months to 6 months. 

How to Buy National Health Insurance Online at Paytm Insurance?

The most difficult component of looking for new medical insurance for either yourself or your household might be achieving a balance between cost and benefits. This is the reason you must examine and evaluate several plans. With the Paytm Insurance website, you can simply compare the top-rated medical insurance plans accessible to you and purchase the plan that best matches your needs.

Here is a step-by-step breakdown of the purchase process:

• First, you need to visit the Paytm Insurance website.
• On the homepage, you have to click on ‘Health Insurance’.
• A drop-down list will appear. From that list, you have to select the insurance provider of your choice.
• A new page will open. You have to complete a quick survey on that page and submit the same.
• Next, you have to input your age and local pin code.
• Now, click on ‘Get Quotes’. You will be forwarded to a list of medical insurance plans which are available to you.
• All there is left for you to do is to compare the plans online and purchase the one which best suits your needs.

List of Documents Required to Buy National Health Insurance Online

Customers are required to present certain paperwork to establish their qualification. The following list will provide a summary of the necessary documents so that you can be ready when you do decide to get a medical insurance plan.

1. Recent photographs
2. Recent healthcare reports
3. Duly-filled application forms
4. Proof of address
5. Proof of identity
6. Proof of age
7. Proof of income (if needed)

Note: This list varies from one insurer to the next. Please check with your insurance provider for the necessary documentation.

How to Renew National Health Insurance Online?

It is recommended to renew health insurance policies before the grace period expires, to ensure there is no lapse in the plan and you can enjoy continuous coverage. You can renew National health insurance online from their own website. Here’s how:

1. Visit the official website of National health insurance.
2. Register yourself using the National health insurance login.
3. Click on ‘health’ on the homepage.
4. Click on ‘Renew Policy’.
5. Input your policy number and fill in the captcha.
6. Click on ‘Renew Policy’ and you will be presented with a renewal quotation.
7. Pay the fees online and enjoy health insurance coverage.

How to File a Claim with National Health Insurance Online?

Health insurance claims are mainly two types – cashless and reimbursement. 

While the first one allows you to get treatment without any out-of-pocket expenses, the second one needs you to fully settle the hospital invoice and other bills before filing for a refund claim. However, the first one needs to be done in a network hospital while the second one can be done from any medical facility. Both claims are good in their own respective ways.

Before we dive deeper into the claim procedure, here is how you can initiate claims with the National General Insurance Company.

First, you need to contact the policy issuing branch and collect the claim form. Submit the duly filled claim form to the office along with necessary supporting documents. The office will refer to the doctor(s), if necessary and then verify the policy.

National Cashless Health Insurance Claim Process

The best way to get yourself treated after being diagnosed with a major healthcare issue is to get yourself admitted to a cashless hospital. The medical facility can help you reduce your treatment expenses by offering no out-of-cashless expenses from the policyholder’s side. This helps the policyholder guarantee that the insured will receive treatment of the highest calibre and that too at the lowest expenses. 

The following is a breakdown of the National cashless health insurance claim process:

1. You need to get the insured admitted to a network hospital.
2. You have to submit your pre-authorisation documents with your health card and valid proof of identity to the hospital staff.
3. The hospital staff will send the documents to the National General Insurance.
4. The hospital will approve your cashless treatment application once National General Insurance validates your documents.
5. Once the treatment is complete, the hospital staff will forward your final invoice and your discharge summary to National General Insurance.
6. National General Insurance will review the receipts and invoice and once they are approved, they will settle them with the hospital.

List of Documents Required for National Health Insurance Cashless Claim

Here is a list of documents required for National health insurance cashless claims:

1. Insured and policyholder’s KYC details
2. Insured and policyholder’s proof of age
3. Health card and policy documents of the health insurance plan
4. Current physician’s admission recommendation
5. Pre-authorisation form
6. Any other relevant healthcare report

The hospital staff will handle most of the documentation requirements and they will let you know if the insurance provider needs more paperwork.

What is the Reimbursement Claim of National Health Insurance?

The reimbursement claim requires the policyholder to settle the final hospital invoice and any other medical bills provided by the medical facility. Once you are done, you need to file a refund claim to the National health insurance along with all the hospital invoices and any additional relevant hospital bills. The company will refund the amount if they find your claim to be genuine. 

The following is a breakdown of the National reimbursement health insurance claim process:

1. Following the incidence of a loss, notification should be provided to the insurance policy issuing office as soon as possible.
2. The preceding step will be followed by filing an FIR with the nearby Police Station (if needed).
3. Download the appropriate claim form.
4. Send the claim application to the insurance policy issuing department, either directly or through an authorised agent, together with any needed or requested papers.
5. If required, the insurance policy issuing agency may assign a loss assessor/surveyor or send the matter to committee doctors.
6. The insurance policy issuing agency eventually settles the claim, and money is provided to the health insurance policyholder as a final and complete resolution of the claim.

List of Documents Required for National Health Insurance Reimbursement Claim

Here is a list of documents required for National health insurance reimbursement claims:

1. Authentic bills and receipts
2. Current physician’s admission recommendation
3. Insured and policyholder’s KYC details
4. Diagnostic reports and tests
5. Treatment data and discharge summary
6. Policy documents of the health insurance plan
7. Policyholder bank account details

How to Calculate National Health Insurance Premium?

Despite the different myths, one of the most important features that a customer looks at is premium. No matter how great an insurance company may be in terms of its product and service, it cannot compensate for the loss when the customers come to terms with the premium payment being too much for them. In order to counter this problem, National health insurance offers a way for customers to understand and compare premiums before purchasing the actual product. 

In order to do so, you have to click on ‘Get Quote’ on the product page. After providing a few basic details about yourself, a representative from National General will get in touch with you to provide an estimated quotation of the premium.

National Health Insurance Tax Benefits

Policyholders who actively pay premiums on their health insurance can get tax advantages. Section 80D of the IT Act offers tax deductions up to INR 25,000 to individuals who are below the age limit of 60 years. The policyholders who are above the age limit receive tax breaks up to INR 50,000. 

So, if you are paying for a health insurance policy which covers one policyholder who is under the age of 60 years and one who is a senior citizen, you can get tax breaks up to INR 75,000 (25,000 + 50,000). In the same way, if you are two senior citizens under a single insurance plan, you can get the tax benefits of up to INR 1,00,000 (50,000 + 50,000).

What is Covered Under National Health Insurance Plans?

National health insurance policies cover comprehensive healthcare requirements. The plans provide a wide range of coverage which enables policyholders with different lifestyles to buy insurance plans from National health insurance. 

The following list includes the general inclusions of the plans:

• In-patient hospitalisation

This coverage provides medical expenses cover to insured patients who are admitted to any hospital for treatments for more than 24 hours. It includes expenses like room rent and doctor fees.

• Day care treatment

This coverage provides medical expense cover to insured patients who are admitted to any hospital for treatments which takes less than 24 hours.

• Advanced treatments

This coverage includes modern procedures like robotic surgeries and other processes.

• Homeopathy and ayurveda cover

This coverage provides medical expense cover to insured patients who are admitted for alternative treatments like ayurveda and homoeopathy.

What is not Covered Under National Health Insurance Plans?

As with any other health insurance provider, National health insurance policies offer a list of exclusions – situations that are not covered by the insurance policies. 

1. Pre-existing diseases during the first 36 months of policy inception
2. Diseases in their specific waiting terms
3. Diseases during the initial 30-day waiting term
4. Gender swap treatments
5. Plastic or cosmetic surgeries
6. Treatment from excluded providers
7. Self-inflicted injuries
8. Vitamins, tonics, drug or alcohol abuse
9. Home visit charges
10. Non-prescription drugs
11. Dental treatment (if treatment is necessary)
12. Outpatient department treatment

National Network Hospitals

Network hospitals are partnered healthcare facilities that have ongoing arrangements with an insurance provider to offer cashless treatment to the policyholders.

If the policyholder has an active ongoing health insurance policy, the hospital will provide cashless reimbursement claims. This is a great feature for customers who are looking for facilities in their neighbourhood where they can get quality treatment at low or no out-of-pocket expenses.

You can locate nearby National network hospitals on the website.

National Health Insurance Reviews

National health insurance is one of the most common health insurance providers in India. We all know that Indian hospitals and doctors are not very affordable. If you have ever been to a hospital or a doctor, you must have noticed that the rates are quite high compared to other countries. But don't worry; there is a good way out for you.

National health insurance covers basic healthcare needs and helps you save a lot of money on health expenses by reducing your out-of-pocket expenses. It has set its eyes on providing quality care at affordable rates to people across the country.

How to Contact a National Health Insurance Company?