Overview
The National Insurance National Senior Citizen Mediclaim plan is tailored for individuals aged 60 to 80 years, offering sum insured options from ₹1 lakh to ₹10 lakhs. It comes in two variants: Plan A, which covers essential treatments and procedures; and Plan B, which includes all Plan A benefits plus additional features like hospital cash allowance, funeral expenses, and reinstatement of sum insured In addition to this, Plan B includes features like daily hospital cash, post-discharge home care, reinstatement of sum insured after road accidents, funeral expenses, and OPD diagnostic consultations.
Experts' Review
Written by Nikhil Nair
Senior Writer
The National Senior Citizen Mediclaim plan is a decent option for seniors, particularly due to its relatively short two-year waiting period for pre-existing diseases, which is a significant advantage over many peers that make you wait three years by default.
The policy covers a broad spectrum of treatments, including mental illness and modern therapies, and offers domiciliary hospitalization and ambulance expenses, which add practical value for elderly policyholders. However, do note that this has a modest cumulative bonus structure of 5% increase for every claim-free year, and a 5% decrease every year a claim is reported.
Under its Plan B, the policy includes benefits with hospital cash, reinstatement of sum insured, and funeral expenses, providing more comprehensive coverage. The policy also offers optional covers for personal accident, critical illness, outpatient treatment, and pre-existing conditions such as hypertension/diabetes, allowing for customization based on individual needs.
However, the plan has some drawbacks. The sum insured cap of ₹10 lakhs may be insufficient to cover the extensive medical needs common among senior citizens. Room rent & ICU limits, as well as a compulsory 20% co-payment clause on all admissible claims, can lead to high out-of-pocket expenses.
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.
Maternity benefits not offered, which could be a drawback for some.
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.
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, benign prostatic hyperplasia, 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 just 2 years. It’s probably the best deal you can get to be honest.
Customisable
For Diabetes & Hypertension: Pre existing disease waiting period is reduced from 2 Years to Day 1.
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
Pre-existing Diabetes / Hypertension
Recommended
For Diabetes & Hypertension: Pre existing disease waiting period is reduced from 2 Years to Day 1.
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.
Personal Accident Cover
Lump sum payout up to defined limits for Accidental Death, Total Permanent Disability and Permanent Partial Disability.
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
Benign prostatic hypertrophy
Hernia
Hydrocele
Fissure/Fistula in anus
Waiting Period
30 days Initial waiting period
3 years Specific illness waiting period
2 years Pre-existing disease waiting periodCustomisable
Ditto's Take
◦ Excellent ◦
Waiting periods on this policy are excellent. This policy also further allows to reduce the PED waiting period to Day 1 for certain diseases.
What's missing in the policy
No Restoration Benefit.
Maternity benefits not offered.
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Frequently Asked Questions
Does National Senior Citizen 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 2-year waiting period for any pre-existing disease you may have while buying the policy.
Does National Senior Citizen Mediclaim policy have room rent restrictions?
Does National Senior Citizen Mediclaim policy offer a restoration benefit?
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