National Parivar Mediclaim Policy

The National Parivar Mediclaim Policy is a governmentbacked health insurance scheme designed to provide comprehensive medical coverage for families across India. It aims to reduce the financial burden of hospitalization, encourage preventive health care, and increase accessibility to quality treatment for both the economically weaker sections and the middleincome groups.

Key Features

• Family Coverage: Insures the entire family (father, mother, and up to 4 dependent children) under a single sum insured.
• High Sum Insured: Options ranging from 2 lakh to 12 lakh per family per year.
• Cashless Hospitalisation: Network of over 12,000 empanelled hospitals nationwide.
• Preand PostHospitalisation: 30 days prehospitalisation and 60 days posthospitalisation expenses covered.
• Ayush & Maternity Benefits: Coverage for AYUSH treatments, maternity, and newborn care.
• No Claim Bonus (NCB): Automatic increase of sum insured by 10% for every claimfree year, up to a maximum of 25%.
• Portability: Policy can be transferred across states without loss of benefits.

Eligibility Criteria

The policy is open to Indian residents who meet any of the following conditions:

• Families with an annual income up to 8 lakh (economically weaker sections).
• Middleincome families earning between 8 lakh and 20 lakh, subject to a modest premium.
• All members of the family must be Indian citizens and residents of the same address.
• Age of the head of the family: 1855 years at the time of purchase.
• Children up to 25 years of age (or up to 30 years if they are fulltime students).

How It Works

1. Application: Fill the online application form or visit a participating bank/insurance office.
2. Document Submission: Provide identity proof, address proof, income proof, and family members age proof.
3. Premium Payment: Pay the premium in a lump sum or via convenient EMIs.
4. Policy Issuance: Receive the policy document and health card within 710 business days.
5. Hospitalisation: For cashless admission, present the health card at any empanelled hospital. The hospital verifies eligibility and authorises treatment.
6. Reimbursement: If treatment is taken outside the network, submit the bills for reimbursement within 30 days.

Benefits at a Glance

Premium Structure (Indicative)

Premiums are calculated based on the sum insured, family size, and age of the head of the family. Below is an approximate range for a family of four:

• 2 lakh sum insured 6,800 per annum
• 5 lakh sum insured 15,200 per annum
• 10 lakh sum insured 28,600 per annum
• 12 lakh sum insured 34,500 per annum

Additional riders (e.g., critical illness) will increase the premium by 1015%.

Exclusions

While the policy is extensive, certain expenses are not covered:

• Cosmetic surgery without medical justification.
• Experimental or unproven treatments.
• Selfinflicted injuries or injuries due to illegal activities.
• Preexisting conditions within the first 24 months.
• Dental procedures (unless part of a hospitalization claim).

Claim Process Step by Step

Cashless Claim

1. Inform the hospitals insurance desk of your National Parivar Mediclaim coverage.
2. Present your health card and a valid ID proof.
3. The hospital uploads a preauthorization form to the insurers portal.
4. Insurer verifies eligibility and approves the claim instantly (usually within 30 minutes).
5. Treatment proceeds; you pay only for noncovered items, if any.

Reimbursement Claim

1. Pay the hospital bills upfront.
2. Collect original bills, discharge summary, doctors prescription, and investigation reports.
3. Fill the claim form (available on the insurers website) and attach all documents.
4. Submit the claim online or at the nearest insurer office.
5. The insurer processes the claim within 15 business days and transfers the amount to your bank account.

Why Choose National Parivar Mediclaim?

• Government Backed: Strong financial security and credibility.
• OneStop Family Cover: No need for multiple individual policies.
• Flexible Sum Insured: Choose a coverage level that matches your familys needs.
• Tax Benefits: Premiums qualify for deduction under Section 80D of the Income Tax Act.
• Easy Renewals: Automatic renewal reminders via SMS/email.
• Customer Support: 24hour helpline and dedicated claim assistance teams.

Frequently Asked Questions

1. Can I add a newborn to the policy?

Yes. Newborns can be added within 30 days of birth without any waiting period.

2. What if I move to another state?

The policy is portable across states. Inform the insurer of the change of address, and your benefits continue seamlessly.

3. Is there a lifetime renewal?

Yes. The policy can be renewed indefinitely as long as premiums are paid on time.

4. How is the sum insured utilized?

The insured amount is a shared pool for the entire family. All eligible expenses across members are deducted from the same sum.

5. Can I switch to a higher sum insured later?

During renewal, you can upgrade the sum insured. The premium will be adjusted accordingly.

How to Enroll

Enrollment is simple and can be completed in three easy steps:

1. Visit the official National Parivar website or a participating bank/insurance office.
2. Complete the online application and upload required documents.
3. Pay the premium and receive your policy document and health card by email or post.

For more detailed information, policy documents, and a list of empanelled hospitals, visit the official portal.