National Insurance Company Health plan

Features:

1. Family floater coverage available up to 6 memebers of a family including dependant children and dependant parents.

2. Covers
- Pre-existing diseases covered immediately (excluding Chemotherapy, Radiotherapy & Dialysis) &
- Maternity Coverage
{ Nine months waiting period applicable}
» Rs. 25,000/- for a Cesarean &
» Rs. 15,000/- for a normal delivery.
All these at no extra cost !!

3. No Medical Test required.



4.Applicable Age Group: 3 months to 65 years;

5.Cashless policy;

6.Critical illnesses buffer cover: Additional coverage up to Rs. 75,000/- per family for hospitalization in case of :
Heart Surgery , Organ Transplant, Neuro Surgery; Cancer Road Traffic Accidents

Other Features:
Income Tax benefits available u/s 80 (D):

- Rs. 15,000/- for covering self, spouse and dependant children.
- An additional Rs. 15,000/- (Rs 20,000/- if they are senior citizens) for covering parents.




National Health Plan – Frequently Asked Questions

Who all can be covered under the term ‘family’ in context of the policy?

The family can be made up of 1+5 persons, i.e. Primary member + Spouse + Dependent children + Dependent Parents.
For children who are enrolled with any recognized educational institution as students, the age limit will be 25 years. Dependent daughters who are unmarried shall be added to family of insured members irrespective of their age.

Family member needs to be aged between 3 months and 65 years to be eligible for getting insured under this policy.


What are options available for the sum insured value?

The policy offers 5 sum insured options of Rs.1,00,000/-, Rs.2,00,000/-, RS 3,00,000/-, Rs.4,00,000/- and Rs.5,00,000/- for coverage to a family. These options are available with the family floater benefit

What is the standard cover available under the policy?

The benefits under this policy will be available to all the insured persons provided the stay in the hospital is for a minimum of 24 Hours as per the attending Doctor’s advises. This time is however not applicable for specific treatments i.e. dialysis, chemotherapy, radiotherapy, eye surgery, dental surgery, lithotripsy, tonsillectomy, and dog bite.

The expenses covered under the policy, subject to maximum of the sum insured amount chosen and various sub limits mentioned in the policy document, are:
 Room, boarding expenses as provided by the hospital/Nursing Home.
 Nursing Expenses
 Surgeon, anesthetist, Medical Practitioner, Consultants, Specialist’s Fees
 Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical appliances, Medicines and drugs, Diagnostics materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of pace maker, Artificial limbs and Cost of organs and similar expenses.
 Ambulance charges will be reimbursable subject to maximum Rs.500/- per hospitalization.

Here, “Hospital/Nursing Home” means an institution in India established for indoor care and treatment of sickness and injuries and which has been registered either as a hospital or Nursing Home with the local authorities and is under supervision of registered and qualified medical practitioner or should comply with minimum criteria as under:
a. It should have least 15 inpatient beds.
b. Fully-equipped operation theatre of its own where surgical operations are carried out.
c. Fully qualified nursing staffs under its employment round the clock.
d. Fully qualified Doctor (s) should be in charge round the clock.

Are there any medical tests required to be undertaken for this policy?

No medical tests are required for taking this policy.


Does the policy cover pre-existing diseases?

All pre-existing diseases are covered under the policy. There is no waiting period for this coverage to come into effect.
However, the treatment for Chemotherapy / Radiotherapy and Dialysis will not be covered for persons who are already suffering from Cancer and Renal Disease at the time of commencement of policy.

Does the policy provide maternity benefit coverage?

Yes, the policy covers the maternity expenses for an insured person to the extent of Rs.15,000 for a normal delivery and Rs.25,000 for a caesarian delivery. This cover is subject to a waiting period of 9 months from the date of commencement of policy.

Does the policy cover the pre and post hospitalization expenses?

Yes, the relevant medical expenses incurred up to 15 (Fifteen) days prior to hospitalization and up to 30 (thirty) days post-hospitalization are covered under the policy.


Does the policy critical illnesses diagnosed during the currency of the policy?

Yes, the policy covers the treatment of 5 critical illnesses, that is heart surgery, neurosurgery, organ transplant, cancer and road traffic accidents. This cover is available in the form of an additional buffer of Rs.75,000/- per family.





Is there a provision for ‘Day Care Treatment’?

Yes, there is a provision for Day Care treatment in some cases as would be applicable in a normal health insurance policy.


How much premium does one need to pay for this policy?


The premium payable for this policy (inclusive of service tax) is:

Sum Insured Value	Self	Self + Spouse	Self + Spouse + 1 Dependant	Self + Spouse + 2 Dependants	Self + Spouse + 3 Dependants	Self + Spouse + 4 Dependants
Rs.1,00,000	Rs.3,711	Rs.4,074	Rs.4,436	Rs.4,798	Rs.5,161	Rs.5,523
Rs.2,00,000	Rs.6,442	Rs.7,131	Rs.7,821	Rs.8,511	Rs.9,200	Rs.9,890
Rs.3,00,000	Rs.8,836	Rs.9,813	Rs.10,791	Rs.11,768	Rs.12,745	Rs.13,722
Rs.4,00,000	Rs.11,008	Rs.12,245	Rs.13,483	Rs.14,721	Rs.15,959	Rs.17,197
Rs.5,00,000	Rs.13,180	Rs.14,678	Rs.16176	Rs.17,675	Rs.19,173	Rs.20,672

To whom is the premium required to be paid?

Premium cheque needs to be issued as in favor of “NATIONAL INSURANCE CO. LTD.”.


Who is the TPA (third party administrator) servicing this policy?

M/s. Family Health Plan Ltd. will be the TPA for this policy. The details about the network of hospitals for this policy is available at website www.fhpl.net

Once the policy is issued, the TPA will send the photo-id card and the process to be adopted in case of an emergency