National Insurance Parivar Mediclaim Policy Complete Guide

1. Overview

The Parivar Mediclaim Policy is a comprehensive health insurance product offered by National Insurance Company Limited (NICL). Designed for families, the policy provides cashless hospitalization and reimbursement for medical expenses incurred by the insured members. It is suited for both salaried individuals and selfemployed persons who want a single plan that covers the entire household.

2. Who Can Buy?

• Individuals aged 070 years (inclusive) at the time of policy purchase.
• Families residing in India, irrespective of their employment status.
• Both Indian citizens and Persons of Indian Origin (PIO) holding a valid Indian passport.

3. Key Features & Benefits

• Family Floater Cover One sum insured shared by the whole family.
• Cashless Hospitalisation at network hospitals across the country.
• Preand PostHospitalisation expenses covered up to 30 days each.
• DayCare Treatments covered without 24hour admission.
• AYUSH (Alternative) Treatments Covers therapies under Ayurveda, Yoga, Unani, Siddha and Homeopathy up to a specified limit.
• Free Health Checkup for the primary insured once every policy year.
• Renewal Benefit No medical test required for renewal up to age 70.
• Portability Policy can be transferred to another insurer after the first policy year.

4. Coverage Details

The table below summarises the core coverages under the Parivar Mediclaim Policy.

5. What Is Not Covered?

Understanding exclusions helps avoid claim rejections. The main exclusions are:

• Preexisting diseases within the first 24 months of policy inception.
• Cosmetic surgery, dental procedures (unless medically essential) and organ donation.
• Selfinflicted injuries, attempted suicide, or injuries caused while under the influence of alcohol/drugs.
• War, nuclear risks, or any acts of terrorism.
• Expenses related to infertility treatment, vaccination, or routine checkups other than the free annual one.
• Any medical expenses incurred outside the network of cashless hospitals unless reimbursed with original bills.

6. How Premium Is Calculated

Premium depends on the following variables:

• Sum Insured Higher sum means higher premium.
• Age of the Primary Insured Premium rises steeply after 45 years.
• Number of Family Members Includes spouse, children (up to 25 years), and parents (optional).
• Geographical Zone Premium varies for metropolitan, tier1, tier2 and tier3 cities.
• Policy Term Usually 1 year renewable; longer terms are not available.
• Optional Addons Critical illness rider, increased limit for AYUSH, etc., increase the premium.

7. Claim Process Step by Step

1. Inform the Insurer Call the 24hour helpline within 24 hours of admission.
2. Submit Required Documents Claim form, admission form, doctors prescription, discharge summary, original bills, and diagnostic reports.
3. Cashless Claim (Network Hospital)
   • Hospital submits the preauthorization request electronically.
   • Insurer approves and issues a Cashless Authorization Card.
   • Patient pays only the portion not covered (deductible, if any).
   • Final settlement occurs at discharge.
4. Reimbursement Claim (NonNetwork Hospital)
   • Collect all original documents and submit to the nearest NICL office.
   • Claim is processed within 1520 business days after document verification.
5. Track Claim Status Use the online portal or mobile app with the claim reference number.

8. Tax Advantages

Premium paid for the Parivar Mediclaim Policy qualifies for deduction under:

• Section 80D of the Income Tax Act Up to 25,000 for self, spouse, and dependent children; additional 25,000 for parents (50,000 if parents are senior citizens).
• If the policy covers both health and personal accident (available as a rider), the same deduction limits apply.

9. Renewal & Policy Lapse

Renewal is automatically offered a month before expiry. The policy can be renewed for a maximum of 5 consecutive years without a medical examination, provided the insured is not above 70 years at the time of renewal. Failure to pay the premium within the grace period (usually 30 days) results in policy lapse. Reinstatement after lapse is possible within 90 days of expiry by paying the due premium plus interest.

10. How It Stands Against Competitors

When compared with other family floater plans in the market, Parivar Mediclaim offers:

• Competitive premiums for sum insured up to 5 lakh.
• Inclusion of AYUSH coverage, which many rivals exclude.
• A relatively high network hospital count (over 2,000 across India).
• Simple renewal process with no medical test up to age 70.
• Lower posthospitalisation limit compared to some premium brands (30 days vs. 60 days in a few plans).

11. Frequently Asked Questions

Q1: Can I add a newborn baby after the policy is issued?

Yes. A newborn can be added within 30 days of birth by paying the applicable premium for the additional life cover.

Q2: Is there a waiting period for preexisting diseases?

There is a 24month waiting period for preexisting illnesses. After this period, those conditions are covered like any other illness.

Q3: What is the claim limit for AYUSH treatment?

The maximum AYUSH benefit is 5,000 per policy year, provided the patient has already been hospitalized for at least 30 days during the same year.

Q4: Does the policy provide coverage for maternity expenses?

Maternity expenses are not covered under the standard Parivar Mediclaim policy. A separate maternity rider must be purchased if required.

Q5: How many times can I claim in a year?

There is no limit on the number of claims, as long as the cumulative expenses do not exceed the sum insured.

Q6: Can I switch to another insurer during the policy term?

Portability is allowed after the completion of the first policy year, provided you have not missed any premium payments.

For the most uptodate information, policy wording, and detailed terms, always refer to the official brochure or contact a licensed National Insurance agent.