National Senior Citizen Mediclaim Policy (NSCMP)

Policy Details:
National Senior Citizen Mediclaim Policy is an indemnity health insurance policy for the aged having higher Sum Insured up to 10 Lakhs.
The Policy covers expenses in respect of inpatient treatment (allopathy, Ayurveda and homeopathy), domiciliary hospitalization, reasonably and customarily incurred for treatment of a disease or an injury contracted/ sustained during the policy period.

Highlights
Sum Insured range The Policy is available with following SI under both Individual Basis and Floater Basis for two Plans i.e., Plan A and Plan B:

Plan A 10 slabs, INR 1,00,000 to INR 10,00,000 in multiple of INR 1,00,000
Plan B 10 slabs, INR 1,00,000 to INR 10,00,000 in multiple of INR 1,00,000. (Additional features like hospital cash, reinstatement of SI, no sub-limits for room rent, funeral expenses covered in Plan B)

Entry Age and Eligibility
If Proposer is the Senior Citizen, Policy on Individual Basis can be availed for
Self only aged between 60 to 80 years at inception.
Self and Spouse, both aged between 60 to 80 years at inception.
If Proposer is the Senior Citizen, Policy on Floater Basis can be availed for
Self and Spouse together, where self is aged between 60 to 80 years and spouse is aged between 50 to 80 years at inception. 18 to 65 years
Lines of treatment covered Allopathy, Ayurveda and Homeopathy
Room Rent/ICU charges, Medical practitioners, surgeon, anesthetist, consultants, specialists fees and other charges as per limits mentioned in the policy.
Ambulance Charges, funeral expenses & Organ Donors expenses covered up to sublimit mentioned and as per Plan opted.
The Company shall reimburse the insured the medical expenses incurred under domiciliary hospitalization, up to 20% of the SI.
HIV & Mental illness cover
Pre and Post Hospitalization up to 30 days and 60 days respectively for same disease/illness/injury for which Hospitalization occurred.
12 Modern treatments like Robotic surgery, oral chemotherapies, immunotherapies and etc., are now covered in the policy.
Treatment for morbid obesity are now covered after specified waiting periods. (refer policy for complete details)
Correction of eyesight, i.e., refractive errors above -7.5 D are now covered after specified waiting periods.
Treatment related to participation as a non-professional in hazardous or adventure sports subject sub-limits.
Hospital cash, Mental illness, HIV/AIDS, Genetic disorders are now covered.
Cashless Facility available at Network Hospitals Only through TPA.
Pre Negotiated Package rates for specific surgeries/procedure in network hospitals.
Life Long Renewability.
Portability (migration) allowed from/to similar products as per IRDAI guidelines.

Covered

Why buy NSCMP:
Annual Increase in SI by 5% for each claim free year up to maximum 50% of SI opted.
HIV treatment & Mental illness hospitalization covered.
Pre-existing diseases are covered after 2 years.
Optional covers like OPD, Critical illness, Personal accident & coverage of pre-existing Diabetes and Hypertension.
Reinstatement of SI for road traffic accidents.


Preventive Health Check Up Facility:
PLAN A: Every 2 claim free years, prescribed diagnostics tests up to 2 % of the average SI (excluding CB) per insured person (individual basis) or family (floater basis), subject to maximum INR 4,000/- per insured person (individual basis) or per family (floater basis)

PLAN B: Every 6 claim free months, Regular medical consultation and prescribed diagnostics tests up to INR 1,000 per insured person (irrespective of individual basis or floater basis)

Online Discounts for purchasing policy online without any intermediary.
Tax Rebate under Section 80D of Income Tax Act 1961 for premium paid

Pre Policy Check Up
For Whom For all individuals irrespective of age, for fresh proposal.

List of Tests/Reports
1. Physical examination (report to be signed by the Doctor with minimum
MD (Medicine) qualification
2. HbA1c
3. Lipid profile
4. Serum creatinine
5. Urine routine and microscopic examination
6. ECG
7. Eye check-up (including retinoscopy)
8. Any other investigation required by the Company

Note: The date of medical reports should not exceed 30 days prior to the date of proposal. 50% of the expenses incurred for pre policy check-up shall be reimbursed, if the proposal is accepted. Terms and conditions apply.

Exclusions
Only claims arising out of accidents are payable for the first 30 days of Inception of the Policy
All pre-existing diseases included after first twenty four months (24) of Policy
Change-of-Gender Treatments, Cosmetic or Plastic Surgery, Excluded Providers
Vitamins, Tonics Drug/alcohol abuse, Self-Inflicted Injury
Non Prescription Drug, Home visit charges
Dental treatment (unless arising out of accident and requiring hospitalization