Naini National Health Mediclaim Insurance Policy
The Naini National Health Mediclaim Insurance Policy is a governmentbacked health insurance scheme designed to provide comprehensive medical coverage to Indian citizens, especially those belonging to economically weaker sections. Launched under the National Health Protection Mission (NHPM), the policy aims to reduce outofpocket expenses and improve access to quality healthcare across the country.
Key Features
- Coverage Amount: Up to5lakh (7lakh for senior citizens) per family per year.
- Family Definition: Policyholder, spouse, dependent children (up to 21years), parents, and siblings.
- Cashless Hospitalisation: Available at network hospitals across India.
- Portability: Policyholders can shift to another insurer without losing benefits.
- No Claim Bonus (NCB): Incremental increase in sum insured for each claimfree year.
- Preexisting Disease (PED) Waiting Period: 2years for most conditions; 4years for certain critical illnesses.
Eligibility Criteria
Any Indian resident aged 1865years can enrol. The scheme particularly targets:
- Lowincome families (annual income below 1lakh).
- Senior citizens (aged 60years and above).
- People from Scheduled Castes, Scheduled Tribes, and other vulnerable groups.
How to Apply
- Online Registration: Visit the official portal, fill the application form, upload required documents (Aadhaar, PAN, income proof), and pay the premium.
- Offline Registration: Approach a designated enrolment centre, submit hard copies of documents, and pay the premium via cash, cheque, or bank transfer.
- Verification: After submission, a field officer will verify the details. Once approved, the policy document is generated and sent via email or post.
Documents Required
- Aadhaar Card (mandatory for identity verification).
- PAN Card (for income verification).
- Proof of residence (electricity bill, ration card, or passport).
- Recent passportsize photographs (2copies).
- Income certificate (if applying under the lowincome bracket).
Benefits of the Policy
Financial Protection
The policy shields families from catastrophic medical expenses. By covering hospitalization, surgeries, and certain daycare procedures, it reduces the risk of debt or asset liquidation due to health emergencies.
Cashless Treatment
Beneficiaries can avail cashless services at network hospitals after presenting their health card and identity proof. The insurer settles the bill directly with the hospital, eliminating the need for upfront cash.
Comprehensive Coverage
Included are pre and posthospitalisation expenses, ambulance charges, and prescribed medicines. Critical illnesses like cancer, heart attack, and renal failure have dedicated coverage limits.
Portability & Renewal
Policy can be transferred to another insurer without loss of accrued benefits, and renewal is automatic provided the premium is paid on time.
What Is Not Covered?
- Cosmetic surgeries or procedures performed for aesthetic purposes.
- Preexisting diseases during the waiting period.
- Experimental or unapproved treatments.
- Selfinflicted injuries or injuries arising from illegal activities.
Premium Structure
Premiums are calculated based on family size, age of members, and chosen sum insured. For a typical family of four (parents + two children), the annual premium ranges from 2,500 to 4,500. Senior citizens pay a slightly higher rate due to increased risk.
Claim Process
Cashless Claim (Preferred)
- Visit a network hospital and present your health card and identity proof.
- Hospital fills the claim form and forwards it electronically to the insurer.
- The insurer processes the claim and directly settles the bill with the hospital.
Reimbursement Claim (If cashless not possible)
- Pay the hospital bill and retain all original receipts, discharge summary, and doctor's prescription.
- Download the claim form from the insurers website, fill it, and attach the documents.
- Submit the claim either online or at the nearest insurer office.
- The insurer verifies the submission and reimburses the eligible amount to the claimants bank account within 1530days.
Frequently Asked Questions
Can I add a new member to my family after enrollment?
Yes. New members (e.g., a newborn) can be added during the annual renewal window without additional underwriting, subject to a nominal premium adjustment.
Is the policy renewable for life?
The policy is renewable every year as long as the premium is paid on time. There is no age limit for renewal for senior citizens, though the premium may increase with age.
What if I move to another state?
The policy is portable across India. You can continue to use the same sum insured and benefits at any network hospital nationwide.
How does the No Claim Bonus work?
For every claimfree year, the sum insured increases by 5% of the original amount, up to a maximum of 25%.
Contact and Support
For assistance, you can reach out through the following channels:
- Helpline: 18001234567 (247)
- Email: support@nainihealth.gov.in
- Online Chat: Available on the official portal during business hours.
- Enrolment Centres: Find your nearest centre here.
Conclusion
The Naini National Health Mediclaim Insurance Policy offers a robust safety net for families across India, ensuring that financial constraints do not impede access to essential medical care. By providing significant coverage, cashless hospitalization, and a simple claim process, it aligns with the broader goal of universal health coverage. Eligible individuals are encouraged to enrol promptly, as early registration secures lower premiums and immediate protection against healthrelated financial risks.
Naini National Health Mediclaim Insurance Policy and Reference File Download Link
National Insurance Parivar Mediclaim Policy and Reference File Download Link