Question 1

What is the National Insurance Mediclaim Policy?

Accepted Answer

The National Insurance Mediclaim Policy is a health insurance plan offered by National Insurance Company Limited (NICL) that provides coverage for hospitalization expenses, pre and post-hospitalization costs, and other medical expenses. It is available for individuals and families across India.

Question 2

Who is eligible for the National Mediclaim Policy?

Accepted Answer

Any Indian resident aged between 3 months to 80 years can apply for the National Mediclaim Policy. For family floater plans, the primary insured must be an adult (18+ years). Children aged 3 months to 25 years can be covered under their parents' policy.

Question 3

What is the difference between Individual and Family Floater policy?

Accepted Answer

An Individual policy covers a single person with a dedicated sum insured. A Family Floater policy covers the entire family (up to 6 members) under a single sum insured that can be used by any family member. Family Floater is generally more cost-effective for families.

Question 4

Is this calculator official?

Accepted Answer

No, this calculator provides indicative premium estimates only. The actual premium may vary based on your specific details, medical history, and the insurance company's underwriting guidelines. Please contact National Insurance Company or an authorized agent for the official premium quote.

Question 5

How is the premium calculated?

Accepted Answer

The premium is based on several factors including the age of the insured person(s), sum insured amount, zone/city of residence, policy type (individual or floater), co-payment percentage opted, and any optional covers selected. Older age groups and higher sum insured amounts attract higher premiums.

Question 6

What is co-payment and how does it affect the premium?

Accepted Answer

Co-payment is the percentage of the claim amount that you agree to pay from your own pocket at the time of a claim. Opting for a higher co-payment (e.g., 20% or 30%) reduces your premium as you share the risk with the insurer. For example, a 20% co-payment typically gives you a 10% discount on the premium.

Question 7

Is GST applicable on health insurance premium?

Accepted Answer

Yes, Goods and Services Tax (GST) at 18% is applicable on health insurance premiums in India. The premiums shown in this calculator include GST in the final amount. You can claim tax benefits under Section 80D of the Income Tax Act for the premium paid.

Question 8

What are the available sum insured options?

Accepted Answer

The National Mediclaim Policy offers sum insured options ranging from Rs. 1 Lakh to Rs. 10 Lakhs. Available options are: Rs. 1 Lakh, Rs. 2 Lakhs, Rs. 3 Lakhs, Rs. 4 Lakhs, Rs. 5 Lakhs, Rs. 7.5 Lakhs, and Rs. 10 Lakhs.

Question 9

What is covered under the National Mediclaim Policy?

Accepted Answer

The policy covers: Inpatient hospitalization expenses, Pre-hospitalization expenses (up to 30 days before admission), Post-hospitalization expenses (up to 60 days after discharge), Day care procedures, Ambulance charges, Organ donor expenses, and AYUSH treatment. Specific coverage limits depend on the sum insured chosen.

Question 10

What are the waiting periods?

Accepted Answer

The policy has the following waiting periods: Initial waiting period of 30 days (no claim except for accidents), 2 years waiting period for specific diseases/procedures, and 4 years waiting period for pre-existing diseases. These waiting periods reduce progressively with continuous renewal.

Question 11

What are the optional covers available?

Accepted Answer

Optional covers that can be added to the base policy include: Critical Illness Cover (lump sum on diagnosis of specified critical illnesses), Hospital Cash Benefit (daily cash during hospitalization), and Maternity Benefit (coverage for delivery and related expenses). Each optional cover has an additional premium.

Question 12

What are the zones and how do they affect the premium?

Accepted Answer

India is divided into three zones for premium calculation: Zone I (Metro cities - Mumbai, Delhi, Chennai, Bengaluru, Hyderabad, Kolkata) has the highest premium, Zone II (Tier-2 cities like Pune, Ahmedabad, Jaipur) has moderate premiums, and Zone III (all other areas) has the lowest premiums. The zone is based on the city where you reside.

Question 13

How do I file a claim?

Accepted Answer

Claims can be filed in two ways: Cashless Claims - Get treated at a network hospital and the insurer settles the bill directly with the hospital. Reimbursement Claims - Pay the hospital bills yourself and submit the documents to the insurer for reimbursement within 30 days of discharge.

Question 14

What is TPA and how does it affect my policy?

Accepted Answer

TPA (Third Party Administrator) is an intermediary that handles claims processing on behalf of the insurance company. Policies with TPA may have a loading of approximately 5% on the premium but offer wider cashless hospital networks. Without TPA, claims are handled directly by the insurance company.

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