Overview
The National Insurance National Mediclaim Plus policy is a comprehensive health insurance plan offering sum insured options from ₹2 lakhs up to ₹50 lakhs. It includes benefits like hospital cash allowance, ambulance charges, and medical second opinion for major illnesses. Room rent and ICU charges are capped as a percentage of the sum insured, and the plan offers a no-claim bonus of 5% per year up to 50%, making it suitable for families seeking broad coverage with moderate limits.
Experts' Review
Written by Nikhil Nair
Senior Writer
The National Mediclaim Plus policy is a reasonably comprehensive health insurance plan that extends beyond basic coverage by including maternity benefits [Up to INR 80,000 for normal delivery and ₹1,00,000 for caesarean section, depending on the plan option chosen], newborn vaccination, and hospital cash allowances. Its tiered sum insured options up to ₹50 lakhs cater to a wide range of family needs. The policy also offers a medical second opinion for major illnesses, which is a valuable addition.
However, the plan imposes room rent restrictions capped at 1% of the sum insured and ICU charges at 2% [or up to INR 15,000-20,000 per day, depending on plan option], which may lead to out-of-pocket expenses if higher room categories are chosen. Disease-wise sub-limits apply, notably on cataract surgery and modern treatments, which could limit claim amounts for specific treatments. The policy does not offer restoration of sum insured, a feature increasingly expected in family floater plans to protect against multiple claims in a policy year.
Compared to the National Parivar Mediclaim, which is a family floater with restoration benefits and domiciliary coverage, Mediclaim Plus is more individual-focused with fewer comprehensive features. The 20% co-payment clause for non-network hospitals may also increase costs for some policyholders.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No Restoration Benefit, which is a notable gap.
No coverage if you are forced to hospitalize at home, which could be a drawback for some.
Doctor consultations are not covered, which is a key feature. Need to opt add-on for doctor consultations.
National Insurance
Key Insights
Founded
1906
National Insurance was established 119 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
95% claims settled in 30 Days
National Insurance settles 95% of all claims it receives demonstrating strong credibility.
Network Hospitals
3,200+
National Insurance has a limited network of 3,200 hospitals, which may restrict access to cashless services for policyholders.
Complaints
30 complaints per 10,000 claims registered
National Insurance experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
Features
All
Great
Good
Bad
Co-payment
On most occasions the insurer will pay your medical bills in full up to the sum insured — no questions asked. However, if you were forced to be treated in a hospital that’s not a part of their network, then they’ll make you co-pay 20% of the final bill.
Room Rent
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for cataracts and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
OPD
Get coverage for outpatient consultations i.e. doctor visits along with coverage for prescribed diagnostics and pharmacy up to defined limits.
Critical Illness
Lump sum payment in the event you are diagnosed with 8 listed critical illnesses outlined in the policy document.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Expenses for hormone replacement therapy, unless part of Medically Necessary Treatment, except for Puberty and Menopause related disorders.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 3 years.
Pancreatitis
Stones in biliary system
Stones in urinary system
Cataract
Glaucoma
Waiting Period
30 days Initial waiting period
3 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
No Restoration Benefit.
No coverage if you are forced to hospitalize at home.
Doctor consultations are not covered. Need to opt add-on for doctor consultations.
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Frequently Asked Questions
Does National Mediclaim Plus policy have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 90 days to 3 Years-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
- Maternity and Newborn Waiting Period: There’s a 2-year waiting period before you can make claims related to pregnancy and childbirth.
Does National Mediclaim Plus policy have room rent restrictions?
Does National Mediclaim Plus policy offer a restoration benefit?
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