National Health Insurance
National Health Insurance
National Health Insurance offers its members various beneficial health plans that may be renewed through a member’s lifetime. The insurance plans come with access to an extensive hospital network, add-on cover plans, cashless claims, and several other exclusive features and benefits. The National Insurance Company Limited (NICL) is a general insurance company that is wholly owned by the Central Government of India. With its headquarters in Kolkata, the company’s gross direct premium income has been on a steady growth. The NICL is one of the first general insurance companies to offer customised health insurance plans and comprehensive health covers in India. This article talks about the various aspects of National Health Insurance.
The National Insurance Company (NIC), first established 113 years ago in 1906, has an immense stronghold in the eastern and northern parts of India which were set through several pioneering efforts. The NIC created flexible general insurance products and tailored them to meet the personalised needs of their customers. It was one of the first companies to reach out to customers through relationships and tie-ups with auto-dealers and other significant players to maximise their prevalence through partnerships.
Currently, the NIC has over 1340 offices and 373 centres throughout the nation with operations being carried out in Nepal as well. Its clientele would include several customers that belong to the retail as well as the large industries. The company ensures to prioritise social and economic inclusion. It continually strives to push the boundaries of the general insurance industry and to establish insurance as a form of financial discipline. The National Insurance Company offers various health insurance solutions to fulfil the needs of both individuals and their families in terms of financial protection. The following are the flagship insurance plans of the National Insurance Company.
- National Insurance Mediclaim Policy
- National Insurance Parivar Mediclaim Policy
- National Insurance Mediclaim Plus Policy
- National Insurance Critical Illness Policy
- Varistha Mediclaim Policy for Senior Citizens
- National Insurance Janata Personal Accident Policy
- National Insurance Individual Personal Accident Policy
Benefits of National Health Insurance
The following are a few of the advantages of having National Health Insurance.
Every policy from the National Health Insurance is eligible for tax exemptions on the payment of premium according to Section 80D of the Income Tax Act of 1961.
A wide range of more than 6,000 authorised hospitals spread across India enables the National Health Insurance to offer various cashless facilities.
Medical checkups before purchasing an insurance policy from the National Health Insurance are not mandatory. However, it is necessary under certain conditions such as the following:
- The policyholder is or above the age of 40 years
- If the applicant requires a sum insured of minimum INR 6 Lakhs.
- If the applicant wants to opt for a Critical Illness cover.
If the proposal for the insurance policy is accepted, the National Insurance reimburses 50% of all the expenses to policyholders who have purchased the National Health Insurance policy.
Claim Settlement Ratio
The claim settlement ratio of the National Health Insurance is at a staggering 90%. This means that out of 100 claims that have been made, 90 of them have been settled.
The National Health Insurance offers a variety of policies that are customised for individuals, families and other groups and may be bought online as well. The insurance company offers its customers with the flexibility and convenience of online renewal of policies as it ensures a fast and hassle-free process.
The National Health Insurance is equipped with professional teams of skilled Customer Service Executives who are experts with assisting and guiding customers as well as members with their queries and services through various platforms such as E-mail, Chat and Toll-Free Number.
- Hospital cash is offered in cases where the number of days for hospitalisation extends to more than 3 days. However, this would depend on the plan selected by the member.
- Benefits that offer and extend Ayurvedic and Homeopathic treatments as well.
- A free look-period for 15 days would be included from the date of joining the National Health Insurance Policy.
- A member may switch to another insurance company. However, the process must be completed at least 45 days before the National Health Insurance Policy’s date of expiry.
- The Insurance company offers a grace period of 30 days from the date of the premium payment or the due date of the policy.
- Add-on riders are available for out-patient treatments, pre-existing diabetic conditions, pre-existing hypertension and critical illnesses.
Scope of the Policy
The following are covered under the National Health Insurance Policy.
- Charges such as doctor consultation fee, surgeon’s fee, specialist doctors and anaesthetist’s fee that are incurred would be insured up to a maximum of 25% of the cost.
- Rent for hospital rooms of 1% of the pre-determined sum would be insured under the condition that the same does not exceed the threshold of INR 5,000.
- Costs for Intensive Care Units of 2% of the pre-determined sum would be insured under the condition that the same does not exceed the threshold of INR 10,000.
- Any expenses towards medications, operations, surgeries, nursing, blood, oxygen, and so on, would be paid by the Company.
- Specific medical treatments such as radiotherapy, chemotherapy, organ transplant, and so on, are payable by the Company up to a certain percentage of the insured sum.
Not Covered under the Policy
The following are not included in the scope of the National Health Insurance Policy.
- Charges that are incurred during hospitalisation solely due to diagnostic purposes.
- Pre-existing diseases would be excluded even after the membership is renewed.
- Expenses due to medication/ hospitalisation due to overuse of drugs, intentional self-injury, alcohol, venereal diseases, congenital external diseases, sterility and many more.
- Conditions such as HIV and AIDS are excluded from this policy.
- Treatments such as Dental Treatments are not included.
- Expenses caused due to maternity requirements and childbirth treatments are not insured.
Claim Process of National Health Insurance
The following is the process to make claims to the National Health Insurance Company.
- The first step is to inform and file a claim by contacting the National Health Insurance Company on their toll-free number, that is 1800 200 7710.
- All the documents and details have to be submitted if asked:
- It is essential to keep the National Insurance Health Card in hand.
- Identification details such as the Name of the Insured, Policy Number, Contact Details, Passport/ Voter’s ID/ PAN has to be provided at the time of claim.
Note:To process a claim, a claim has to be lodged by intimating the Company. Therefore, it is essential to contact the claim support directly to speed the entire process.
Cashless Claim Process
The medical expenses of a policyholder for any treatment for illness, sickness and even, accidents will be provided under the condition that the treatment is carried out in any of the listed National Insurance networks of hospitals. On approval of the said claim, the medical bills are directly paid to the hospital by the National Insurance.
The following documents and information has to be provided at the time of claim:
- Policyholder’s Name
- Policy Number
- Contact Details of the Policyholder
- Name of the Insured
- Details of the Hospital
- Nature of Ailment/ Information on the Accident
Reimbursement Claim Process
The policyholder is required to pay all the medical costs initially. Later, the National Insurance Company would reimburse the same. All the medical expenses and the bills are essential and should be submitted to successfully claim the reimbursement. In the case of a reimbursement process, however, it is not mandatory to be treated in a National Insurance-authorised hospital. The treatment may be carried out in any registered hospital.
The following documents and information has to be provided at the time of reimbursement:
- Claim Form duly signed by the Insured
- Photocopy of the policy certificate
- Photocopy of Identity Card
- Original discharge card/ summary
- Original hospital receipts
- A detailed amount of breakup is essential for consolidated amounts
- Surgeon’s certificate stating that the nature of the surgery performed, bill and paid receipt of the same has to be submitted.
- All investigation reports and bills in the original along with a note from the attending doctors/ surgeons recommending such investigations.
- Attending doctors/ consultants/ specialists/ anesthetists bill, receipt and certificate.
Cancellation of the Policy
If a policyholder is not compliant to the particular terms and conditions, during their free-look period by the Nation Health Insurance within 15 days from the date of receipt of the policy.
Hence, all the premium payments would be refunded certain post deductions like stamp duty and other applicable charges. If a member chooses to cancel a particular policy, they may submit the same at the relevant after the free-look period. They may provide the proper surrender and the essential documents to initiate the cancellation procedure.