National Insurance Company Limited

Regd. Office 3, Middleton Street, Post Box 9229, Kolkata 700 071
CIN - U10200WB1906GOI001713 IRDA Regn. No. - 58

National Parivar Mediclaim Plus Policy

Customer Information Sheet
S Refer to
No. Title Features Description policy clause
number
1 Product Name National Parivar Mediclaim Plus Policy
PLAN A PLAN B PLAN C
2 What am I covered Sum insured (SI) (as INR 6/ 7/ 8/ 9 INR 15/ 20 /25
INR 30/ 40/ 50 Lac
for? Floater) /10 Lac Lac
Treatment Allopathy, Ayurveda and Homeopathy
In built Covers (subject
to the SI)
In patient Treatment (as 2.1.1
Up to SI Up to SI Up to SI
Floater)
Room - Up to 2.1.1.1
1% of SI per day
or actual,
whichever is
Room/ ICU charges
lower
(per day per insured Actual Actual
ICU – Up to 2%
person)
of SI per day or
actual,
whichever is
lower
For each eye – 2.1.1.2
Up to 15% of
Limit for cataract
SI or INR
surgery (For each eye Actual Actual
60,000
per insured person)
whichever is
lower
Pre Hospitalisation 30 days 30 days 30 days 2.1.2
Post Hospitalisation 60 days 60 days 60 days 2.1.3
Up to 20% of Up to 20% of Up to 20% of SI, 2.1.4
Domiciliary
SI, subject to SI, subject to subject to
Hospitalisation (as
maximum of maximum of maximum of INR
Floater)
INR 1,00,000 INR 2,00,000 2,00,000
Day Care Procedures 2.1.5
Up to SI Up to SI Up to SI
(as Floater)
Ayurveda and 2.1.6
Homeopathy (as Up to SI Up to SI Up to SI
Floater)
Organ donor’s medical 2.1.7
Covered Covered Covered
expenses (as Floater)
Hospital cash (per INR 500 per INR 1,000 per 2.1.8
INR 2,000 per day,
insured person, per day, max. of 5 day, max. of 5
max. of 5 days
day) days days
Ambulance (per 2.1.9
insured person, in a Up to INR 2,500 Up to INR 4,000 Up to INR 5,000
policy year)
Air Ambulance (per 2.1.10
Up to 5% of SI Up to 5% of SI per
insured person, in a Not covered
per policy year policy year
policy year)
Medical Emergency Not covered No sublimit No sublimit 2.1.11
Reunion (per insured
person, in a policy
year)
Doctor’s Home Visit 2.1.12
and Nursing Care
INR 1,000 per
during Post INR 2,000 per day,
Not covered day, max. of 10
Hospitalisation (per max. of 10 days
days
insured person, in a
policy year)
Anti Rabies 2.1.13
Vaccination (per
Up to INR 5,000 Up to INR 5,000 Up to INR 5,000
insured person, in a
policy year)
Maternity (including Up to INR 2.1.14
Baby from Birth 30,000 for
Cover) (per insured normal delivery
Actual Actual
person, in a policy and INR 50,000
year, waiting period of for cesarean
2 years applies) section
Vaccination for New As part of As part of As part of 2.1.14.iv
Born Baby Maternity Maternity Maternity

Infertility (per insured 2.1.15

person, in a policy Up to INR Up to INR
Up to INR 1,00,000
year, waiting period of 50,000 1,00,000
2 years applies)
Vaccination for 2.1.16
Children, for male
child up to 12 years
and female child up to Up to INR 1,000 Actual Actual
14 years (per insured
person, in a policy
year)
Other benefits
Up to two MSO Up to two MSO 2.2.1
per family for per family for Up to two MSO per
each new each new family for each new
Medical Second diagnosis of any diagnosis of any diagnosis of any of
Opinion (MSO) (for
of the major of the major the major illnesses
160 major illness)
illnesses in illnesses in in Appendix II, in a
Appendix II, in Appendix II, in policy year
a policy year a policy year
Reinstatement of sum 2.2.2
insured due to road Yes Yes Yes
traffic accident
Good Health
Incentives
No claim discount 5% on base premium 2.3.1
Every 2 yrs., up Every 2 yrs., up Every 2 yrs., up to 2.3.1
Health Check Up (as to INR 5,000 to INR 7,500 INR 10,000
Floater) irrespective of irrespective of irrespective of
claims claims claims
Optional covers
Pre-existing First year Up to a maximum of 25% of SI 8.1
Diabetes/Hypertension Second year Up to a maximum of 50% of SI
(as Floater) Third year Up to a maximum of 75% of SI
Out-patient Treatment Limit of cover per family - INR 2,000/ 3,000/ 4,000/ 8.2
 (as Floater in a policy 5,000/ 10,000/ 15,000/ 20,000/ 25,000
year)
Critical Illness (per 8.3
Benefit amount - INR 2,00,000/ 3,00,000/ 5,00,000/
insured person in a
10,00,000/ 15,00,000/ 20,00,000/ 25,00,000.
policy year)
3 What are the a. Treatment outside India 4
Major exclusions in b. HIV, AIDS and sexually transmitted diseases
the policy? c. Treatment for all psychiatric & psychosomatic disorders/diseases, self-inflicted
injuries
d. Treatment for genetic disorders
e. Naturopathy and experimental treatment
f. Surgery for correction of eye sight due to refractive error, spectacles, contact
lens, hearing aid, cochlear implants
g. Any hospital admission primarily for investigation / diagnostic purpose
h. Drug/ alcohol abuse,
i. Any kind of service charges, admission fees/ registration charges levied by the
hospital
j. Hazardous sports, war, warlike operations
k. Radioactivity

(Note: the above is a partial listing of the policy exclusions. Please refer to the policy
clauses for the full listing).
4 Waiting period a. Pre-existing diseases will be covered after a waiting period of thirty six months 4.1
b. Any disease contracted within the first thirty days from the commencement date 4.2
of the policy
c. Some specified diseases are covered after waiting period of twelve, twenty four
4.3
or forty eight months
 One year waiting period
1. Benign ENT disorders
2. Tonsillectomy
3. Adenoidectomy
4. Mastoidectomy
5. Tympanoplasty
 Two years waiting period
1. Cataract 10. Pilonidal sinus
2. Benign prostatic
hypertrophy 11. Gout and Rheumatism
3. Hernia 12. Hypertension and related complications
4. Hydrocele 13. Diabetes and related complications
5. Fissure / Fistula
in anus 14. Calculus diseases
6. Piles 15. Surgery of gall bladder and bile duct
(Haemorrhoids) excluding malignancy
7. Sinusitis and 16. Surgery of genito-urinary system excluding
related disorders malignancy
8. Polycystic 17. Surgery for prolapsed intervertebral disc
ovarian disease unless arising from accident
9. Non-infective
arthritis 18. Surgery of varicose vein
19. Hysterectomy
 Four years waiting period
1. Treatment for joint replacement unless arising from accident
2. Osteoarthritis and osteoporosis.
5 Payout  Reimbursement of covered expenses up to specified limits
basis  Cashless payment of covered expenses up to specified limits in network
providers/ PPN
6 Cost Copayment to Copayment to 5.5.7
Treatment outside Copayment to
sharing apply apply
zone apply
Copayment not Copayment not to 5.5.8
Treatment outside Copayment to
to apply apply
network apply
Above copayments shall not be applicable on Critical illness & Outpatient treatment
optional covers, but shall apply on Pre existing diabetes and/ or hypertension optional
 cover.
7 Renewal The policy can be renewed annually throughout the lifetime of the insured person. 5.15
Conditions The policy may be renewed by mutual consent. The company is not bound to give
notice that it is due for renewal. Renewal of the policy can not be denied other than
on grounds of fraud, moral hazard or misrepresentation or noncooperation. In the
event of break in the policy a grace period of thirty days is allowed.
8 Renewal Good health incentives
Benefits  No claim discount (NCD)
 Health check up
9 Cancellation The company may at any time cancel the policy (on grounds of fraud, moral hazard 5.11
or misrepresentation or noncooperation) by sending the insured person 30 (thirty)
days notice by registered letter at insured person's last known address and in such
event the company will not allow any refund.
For policies with a term of one year, the insured may at any time cancel the Policy
and in such an event, the Company shall allow refund of premium after charging
premium at Company’s short period rate mentioned below, provided claims are not
reported up to the date of cancellation.

Period of risk Rate of premium to be charged

Up to 1month 1/4 of the annual rate
Up to 3 months 1/2 of the annual rate
Up to 6 months 3/4 of the annual rate
Exceeding 6 months Full annual rate

For policies with a term exceeding one year, the insured may at any time cancel the
Policy and in such an event, the Company shall allow pro-rata refund of premium
for the unexpired policy period after retaining 10% of the pro-rata premium,
provided claim are not reported up to the date of cancellation

In the event of cancellation of the policy by either insured or the company, the cover
will also be cancelled as per cancellation clause of the policy

This policy would be cancelled, and no claim or refund would be due to you if:
 you have not correctly disclosed details about your current and past health status
OR
have otherwise encouraged or participated in any fraudulent claims under the policy.

Legal Disclaimer
The information must be read in conjunction with the product brochure and policy document. In case of any conflict between the
CIS and the policy document the terms and conditions mentioned in the policy document shall prevail.

Insurance is the Subject matter of Solicitation