Overview
The National Insurance National Mediclaim policy is a health insurance plan offering coverage with sum insured options ranging from 1L to 10L. It covers hospitalization expenses, daycare procedures, AYUSH, pre-post hospitalization [45-60 days], ambulance charges [ 1% of SI subject to a maximum of ₹ 2,000 in a Policy Period], and coverage for organ donor expenses and lifelong renewability. While it provides essential health protection, it lacks domiciliary coverage.
Experts' Review
Written by Nikhil Nair
Senior Writer
The National Mediclaim policy by National Insurance is a straightforward, budget-friendly health insurance plan suitable for individuals seeking basic coverage. It includes coverage for daycare procedures, coverage for HIV/AIDS, a restoration benefit once per policy, a No Claim Bonus of 5% per claim-free year, up to a maximum of 50%, and organ donor expenses, which add practical value. The policy also offers lifelong renewability and pre- and post-hospitalization coverage, aligning with standard market offerings.
Restrictions include disease-wise sub-limits, room rent limits (up to 1% of SI per day, with a maximum of ₹10,000; for ICU, up to 2% of SI, with a maximum of ₹20,000), and the absence of domiciliary cover; however, there is no co-payment clause. The waiting period for pre-existing conditions is 36 months, which is standard but may be restrictive for some individuals.
Compared to the National Parivar Mediclaim, which is a family floater plan with optional add-ons and domiciliary coverage, the National Mediclaim is more basic. Premiums for National Mediclaim are generally 10-15% lower than family floater plans, but offer less extensive benefits.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No coverage if you are forced to hospitalize at home, which is a notable gap.
Maternity benefits not offered, which could be a drawback for some.
Doctor consultations are not covered, which is a key feature.
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
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Customisable
Choose a co-payment between 15% and 20% to reduce premiums.
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 modern treatments 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 - 45 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Co-payment
Choose a co-payment between 15% and 20% to reduce premiums.
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.
Cataract and age-related eye ailments
Benign prostatic hypertrophy (BPH)
Hysterectomy and myomectomy (unless due to malignancy)
All types of hernia
Hydrocele
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 coverage if you are forced to hospitalize at home.
Maternity benefits not offered.
Doctor consultations are not covered.
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Frequently Asked Questions
Does National Mediclaim 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.
Does National Mediclaim policy have room rent restrictions?
Does National Mediclaim policy offer a restoration benefit?
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