National Health Insurance
Home > Health Insurance > National Health Insurance
naitonal-logo

NATIONAL HEALTH INSURANCE

  • Know everything about Health insurance plans
  • Detailed information on all kinds of medical cover
  • Widest choice from all Health Insurance providers
  • End to End assistance from buying to claims

National Health Insurance

Overview
Incorporated in 1906 and headquartered in Kolkata, National Insurance Company Ltd (NICL) is nation’s oldest general insurance company and was setup to fulfil the nationalist aspiration for Swaraj. In 1972, after nationalisation NICL operated as a subsidiary of General Insurance Corporation of India; and then was spun off as a distinct company under the General Insurance Business Amendment Act in 2002.For the distribution of its general insurance products NIC singed Nainital Bank for selling policies through the bank's branches in Uttarakhand, Haryana and New Delhi in the year 2004. Apart from India, NIC also serves Nepal through a total of 1998 offices by its 14902 skilled personnel. NICL having a strong hold on Motor insurance, was also the first Indian insurer to enter into strategic alliances with the country’s largest automobile manufacturers like M/s Maruti and M/s Hero Moto Corp.

National Health Insurance at a Glance
  • Cashless and hassle free direct claim settlement across 6000+ networked hospitals in the country
  • Annual health check-up for insured members irrespective of their claims history
  • 1749331 Policies were issued in FY 15-16
  • With add-on cover, it provides coverage that too on a cashless basis across a list of network hospitals for listed critical illnesses
  • 96.48% of grievances resolved in FY 15-16
  • 110.4% claim settlement ratio
  • Offers maternity hospitalisation costs including pre and post-natal expenses
  • Committed to act courteously, fairly and reasonably in all dealings with the customers

Awards & Recognitions
  • In 2012 the company bagged “Digital Inclusion Awards”
  • Top 100 CISO Awards in 2012
  • In 2012, National Insurance Company won Business Leadership Award from NDTV Profit
  • It bagged the “The Indian Insurance Awards” in the year 2013
  • Received a AAA rating from CRISIL, a subsidiary of Standard and Poor's Company

Documents needed to apply for National Health Insurance
  • Age proof - (Any One)
    Driving License, Passport, Voter ID Card, Birth Certificate, etc
  • Identity proof – (Any One)
    Driving License, Passport, Voter ID card, PAN Card, Aadhar Card, or any document which proves citizenship
  • Income proof
  • Address proof – (Any One)
    Driving License, Passport and Utility Bill should clearly mention the permanent address
  • Income proof – (Any One)
    Salary Slip, Form 16, ITR
  • Recent passport size photograph

Why National Health Insurance?
Here are some reasons why National Health is the right insurance provider for you:

Features Description
Sum Insured You can choose a sum insured ranging from Rs2 Lacs to Rs50 Lacs.
Cashless hospitalisation National Health has over 6000 network hospitals across India where one can avail cashless facility.
Claim process Offers fast, seamless claim process across wide network of hospitals that makes the claim management quick and convenient. The Claim Settlement Ratio of National Health Insurance for FY2015-16 is 110%.
No-Claim Bonus (NCB)  Earn up to 100% NCB in the form of a 50-150% increase in sum insured.
Discounts Offers 10% discount for individual plans taken and 11% - 18% discount for plans taken on family floater basis, minimum two and maximum four additional members.
Lifelong renewability  All plans offered by National Health have a lifelong renewability option
Maternity benefit With National Health’s Mediclaim Plus policy, insured can enjoy the maternity expense benefits for delivery for only first two children and / or surgeries associated therewith will be considered in respect of any one insured person covered. Expenses for pre natal, post natal and new born baby are also covered.
Health Checkup Insured members of National Health can avail super annual health check-up regardless of their claim history
Air Ambulance In a policy period upto 5% of sum insured is paid as a part of Air ambulance expense for emergencies
AYUSH treatments AYUSH treatment taken at government or accredited hospitals is covered
Riders Apart from specified critical illness coverage, one time additional lumpsum is paid that excludes pre-existing critical conditions.

Types of National Health Insurance Plans
National Health offers insurance coverage with comprehensive health cover, critical illness cover, personal accident cover and senior citizen mediclaim across various plans.

1. National Insurance Mediclaim Policy: This policy from National Health covers hospitalization expenses reasonably and necessarily incurred for treatment of illness or disease or injury contracted and or sustained by the insured persons during the policy period. It also covers 140+ day care procedures and surgeries.

2. National Insurance Mediclaim Plus Policy: This policy from National Health offers a comprehensive coverage that goes beyond the traditional health covers, as it offers protection against high health care costs and makes health care and related services easy and accessible. It also allows treatment under Ayurvedic and Homeopathy.

3. National Insurance Parivar Mediclaim Policy: This policy from National Health is a floater policy that provides protection to families against the financial burden of treatment in hospitals for illness or disease or accidental injury. In this policy the entire family consisting of self, spouse and two dependent children are covered under a single floater sum insured.

4. National Insurance Varistha Mediclaim Policy: This policy protects senior citizens from high treatment costs and safeguards them financially sound at an advanced stage of life, when they are prone to frequent illness. This policy also comes with the option of covering critical illness treatment expenses. Senior citizens can also avail coverage against pre-existing hypertension and diabetes for some extra premium.

5. National Insurance Critical Illness Policy: This policy from National Health covers as many as six diseases listed in policy document and offers the total Sum Insured amount as a lumpsum. It is conveniently available online.

6. National Insurance Individual Personal Accident Policy: This policy provides the beneficiary with a death benefit in the unfortunate event of accidental death of the insured and also provides with cover against Permanent Total Disablement on account of any accident.

7. National Insurance Janata Personal Accident Policy: This policy from National Health covers any person irrespective of sex, occupation and profession in the age group of 10 to 70 years for death and permanent total disablement and permanent partial disablement.

National Health Insurance Plans in detail
1)National Insurance Mediclaim Policy
Features Description
Entry age 18 – 65 years; 3 months to 18 years for children if at least one parent is also covered under this plan.
Type of Plan Individual / Family Floater
Sum Insured Rs 50,000 - 5 Lacs
Coverage for Spouse, dependent children, dependent parents / parents in law. Maximum 6 individuals as a part of it, with the limit on number of adults being at 4 and children being at 4.
Policy term 1 year

Inclusions, Benefits and Features
  • In-Patient Hospitalisation-Medical expenses for hospitalisation for a minimum period of 24 hours will be covered with upto sum assured subject to sub-limits; it does not cover outpatient treatment and treatment outside India.
  • Pre-Hospitalisation - Any medical expenses that have been incurred 30 days prior to the hospitalisation for the same illness will also be covered. This also has ambulance cover.
  • Post-Hospitalisation–Similarly, medical expenses incurred60 days after being released from the hospital and for the same illness will also be covered. Expenses such as doctor consultations, Diagnostic tests, medications etc. are covered under this.
  • Domiciliary Treatment–Treatment of illness done at home for a period exceeding 3 consecutive days in case of emergency, which would normally need hospitalisation will also be covered in the policy.
  • Day Care –This policy covers over 140 day care procedures which require hospitalization for less than 24 hours
  • Annual Health Check-up–As a preventive measure, this policy provides Annual Health Check-up for policyholder and all members covered by under the policy, including children.
  • Hospitalization Reimbursement – Expenses incurred for hospitalisation which are reasonable are reimbursed. Room charges, boarding and nursing expenses along with fees of surgeon, anaesthetist, medical practitioner and consultants can be reimbursed. Other miscellaneous expenses including anaesthesia, blood, oxygen, OT charges, surgical appliances, drugs and medicines, diagnostic material, X-ray, dialysis, chemotherapy, radiotherapy etc. are also covered.
  • Organ Donor–Covers treatment expenses for organ donor. 50% of base sum insured up to a maximum of Rs 5 Lacs is covered.
  • Reinstate the policy–This policy enables reinstate the entire Sum Insured amount if you ever run out of your health cover due to claims made. This additional amount can be used by you or by any other insured member for treatment of any ailment. Reinstatement is valid only if sum insured is Rs 5 Lacs or more.
  • AYUSH treatment - 20% of sum assured for treatment at a government approved centre for Ayurveda, Yoga, Unani, Siddha and Homoeopathy treatments.
  • Ambulance charges – Charges upto 1% of the sum insured, subject to maximum of Rs 2000 in a policy period is covered.

2) National Insurance Mediclaim Plus Policy
Features Description
Entry age 18 – 65 years; 3 months to 18 years for children if at least one parent is also covered under this plan.
Type of Plan Individual / Family Floater
Sum Insured Rs 2 – 10 Lacs
Coverage for Spouse, dependent children, dependent parents / parents in law. Maximum 6 individuals as a part of it, with the limit on number of adults being at 4 and children being at 4.
Policy term 1 year

Inclusions, Benefits and Features
  • In-Patient Hospitalisation
  • Pre-Hospitalisation
  • Post-Hospitalisation
  • Domiciliary Treatment
  • 140 + Day care procedures
  • Organ Donor Expenses
  • Critical Illness sum assured from Rs 2 - 25 Lacs
  • Outpatient Treatment sum assured from Rs 2000 - 10000
  • Daily cash allowance
  • Air Ambulance charges
  • Vaccinations for children under 12 years
  • AYUSH treatment
  • Cataract surgery expenses
  • Maternity expenses
  • Personal accident cover
  • Second opinion expenses
  • Co-payment
  • ICU expenses along with nursing charges

3)National Insurance Parivar Mediclaim Policy
Features Description
Entry age 18 – 60 years; 3 months to 25 years for children if at least one parent is also covered under this plan.
Type of Plan Individual / Floater
Sum Insured Rs 2 to 5 Lacs
Coverage for Self, spouse, dependent children and parents
Policy term 1 / 3 years

Inclusions, Benefits and Features
  • In-Patient Hospitalisation
  • Pre-Hospitalisation
  • Post-Hospitalisation
  • Diabetes treatment
  • Hospital expenses
  • Expenses for Doctors, Consultants, Specialists and Nurses
  • Day Care
  • Ambulance expenses
  • Infertility treatment cover
  • Maternity expenses
  • Medical Second opinion
  • Good health incentives
  • No Claim bonus
  • Vaccination cover

4) National Insurance Varistha Mediclaim Policy
Features Description
Entry age 60 – 80 years
Type of Plan Individual
Sum Insured Hospitalisation cover : 1 Lac
Critical illness cover : 2 Lacs
Coverage for Self

Inclusions, Benefits and Features
  • In-Patient Hospitalisation
  • Pre-Hospitalisation
  • Post-Hospitalisation
  • Hospitalisation expenses
  • Fees payable to doctors, surgeons and consultants
  • Ambulance expenses
  • Other expenses in form of OT, X Rays, chemotherapy, dialysis, radiation
  • Blood pressure & diabetes treatment
  • 8 Critical illnesses
  • Organ transplant cost

5) National Insurance Critical Illness Policy
Features Description
Entry age 20 – 60 years.
Type of Plan Individual / Family Floater
Sum Insured Rs 5 Lacs – 25 Lacs
Coverage for Self, spouse, dependent children and parents

Inclusions, Benefits and Features
  • In-Patient Hospitalisation
  • Pre-Hospitalisation
  • Post-Hospitalisation
  • Day Care
  • OPD expenses
  • ICU expenses
  • Coronary Artery surgery
  • Organ transplant
  • Cancer treatment
  • Kidney failure
  • Stroke

6) National Insurance Individual Personal Accident Policy
Features Description
Entry age 5 - 70 years
Medical Screening NIL
Type of Plan Individual
Sum Insured Cumulative Bonus for every claim-free year under Comprehensive Cover

Inclusions, Benefits and Features
  • Covers Accidental Death, Permanent Total Disablement, Permanent Partial Disablement and Temporary Total Disablement
  • Global coverage
  • Easy online purchase
  • Faster claim process with minimum documentation

7) National Insurance Janata Personal Accident Policy
Features Description
Entry age 5 - 70 years
Medical Screening NIL
Type of Plan Individual / Family Floater
Sum Insured Rs 25000 – 1 Lacs
Policy Term Upto 5 years

Inclusions, Benefits and Features
  • Covers death, loss of sight, loss of limbs, permanent total disablement
  • Global coverage
  • Easy online purchase
  • Faster claim process with minimum documentation

National Health Exclusions:
  • There is an initial waiting period of 30 days for all illnesses except an accidental injury
  • Treatment of any pre-existing condition or diseases
  • HIV, AIDS, STD treatments
  • Convalescence, general debility, run-down condition, sterility etc.
  • Obesity treatment
  • Treatment of genetic disorders
  • Cosmetic treatment, plastic surgery
  • Sex change operation, hormone replacement
  • Naturopathy and experimental treatment
  • Treatment against drug and alcohol abuse
  • Spectacles, contact lens, hearing aid, cochlear implants.
  • Acupressure, acupuncture and magnetic therapies
  • Experimental or unproven treatments/therapies
  • Anything caused due to War, invasion and nuclear perils
  • Dental treatment
  • Congenital diseases, sterility, venereal disease and any intentional self-injury

National Health Login:
  • For Individuals: Log into the National Health Insurance website with your name, email ID, and mobile number
  • For Corporate Employees: Register with your Member ID and Employee ID.
  • For Corporate Administrators: Register using their Policy Number and Group ID.
  • For Sales Partner: Register using Agent Code and Date of Birth.
  • Brokers or Corporate Agencies: Register with Broker or Agency Code and Date of Joining.
  • Using Social media: You can also sign in with your Facebook, Gmail or mobile connect log-in.

National Health Insurance Renewal:
  • Log into the National Insurance’s customer portal with your registered email or member ID and password. You can also login using your policy number through Quick Renewal link (http://niconline.co.in:8082/custportal/)
  • Enter the exact policy number as mentioned in the policy schedule.
  • Enter your age on the renewal calculator to get the renewal premium.
  • You can choose a different policy, altering the sum insured, add or remove dependants, alter rider policy, and edit policy term.
  • The policy schedule contains a unique policy number which changes every year on renewal.
  • Renewal payment can be made 60 days prior to the policy expiry date.
  • There is a 30day grace period within which to renew your policy without losing benefits
  • ou can also opt to renew your policy through an Interactive Voice Response (IVR) and use the direct payment link. Contact 1800-200-7710(Toll Free) for more details.
  • Email can be send for further details to nic.health@nic.co.in

National Health Insurance Claim Settlement:
Cashless Claim Reimbursement Claim
Visit a network hospital of the insurer to avail cashless treatment. If the cashless claim is denied, the insured member can get treated and file for a reimbursement claim after discharge.
Display your health card at the network hospital help desk. Submit the claim form along with the medical documents within 15 days of your discharge from the hospital.
Intimate the Insurer/Agent within 24 hours of unplanned hospitalisation and 48 hours prior to your planned hospitalisation. Claims can be registered at the insurer's customer service centre or any of the branch offices through an application, call, email or in person.
The hospital will verify your identity details and submit a duly-filled and signed pre-authorisation request form to the insurer. To register a claim provide your contact details, name of the insured member, policy number, date and time of the problem, nature of the problem, and location of the problem.
After verification of the pre-authorisation request, the insurer will send an approval letter to the network hospital. Upon successful verification and approval, the claim amount will be sent to the proposer in the form of a cheque within 30 days of receipt of the documents.
The hospital will proceed with the cashless treatment for the insured member. Insurer will settle the bill directly with the hospital. The insured has to pay those bills that are not covered under the policy. For any claim-related queries, call 1800-200-7710 (Toll Free) or email at nic.health@nic.co.in

National Health Insurance FAQs:
1) How National Health Insurance policyholders can get in touch with the insurer for any policy-related queries?
You can get in touch with the insurer by filling out a simple online form or calling the customer support centre on toll-free number 1800-200-7710. You can also mail the insurer with your queries to this email ID nic.health@nic.co.in. You can chat online too.

2) How can I add family members to my existing policy?
You can download Change Request form from the National Health Insurance website, fill it, and submit it at the nearest branch office along with additional premium. Mid-term policy addition is allowed only for a new born baby or newly-wed spouse.

3) How can I increase the sum insured of my National Health Insurance?
You can download the Change Request form from the National Health Insurance website, fill it, and submit it at the nearest branch office along with the revised premium. Sum insured can be increased or decreased only at the time of renewal and not during the policy tenure. In the case of health insurance portability, sum insured cannot be enhanced if there’s a claim in the previous policy.

4) What is Re-instatement in the National Health Plan?
If you exhaust your entire sum insured and cumulative bonus (if any) and still require further hospitalisation for any related or unrelated illness, National Health will refill the full Sum Insured at no extra cost.

5) What is multiplier benefit?
Under this benefit, during the first claim-free year, the sum insured will increase by 50% and the second claim-free year, the sum insured will be increased by 100%.

6) How can I claim OPD expenses from National Health?
You may submit all original medical bills and prescriptions to the insurer for reimbursement of OPD expenses. But make sure OPD expenses are covered in your plan.

7) Is vaccination covered under OPD benefit?
Yes vaccination is covered under OPD benefit.

8) Can I choose multiple sum insured for my family members?
Yes, within the chosen variant, multiple sum insured can be selected for your dependents.