| Name of policy |
Mediclaim insurance policy |
Mediclaim 2007 |
Mediclaim policy |
| Eligibility |
3mon - 59yrs |
3mon - 60yrs |
3mon - 75yrs |
| Renewable |
for 80 yrs |
after 60 yrs provided they are insured under Mediclaim policy with NIA |
for life time. |
| Min -Max S.I limit |
Rs 50000 - 5lac |
Max of 5lac |
Rs 25000 - 5lac |
| Policy Coverage |
| Pre- and Post-Hospitalisation |
30 and 60 days |
30 and 60 days |
30 and 60 days . |
| Domiciliary Hospitalisation |
Not covered |
Not indicated |
Rs. 3,000/- to Rs. 50,000/- depends on SI |
| Cummulative Bonus |
10% of S.I claim free yrs max 50% |
5% of SI for every claim free year to max of 30%. |
5 % is added to your SI for every claim free year, to max of 25% |
| Medical check up |
Not indicated |
Not indicated |
Not Required |
| Cost of health check up |
1% of Average SI of 4 claim free years |
reimburse actual cost to max of 1% of Average SI of 4 claim free years |
Free medical check up provided at the end of 3 claim free years. |
| Co pay |
No limit |
Not indicated |
Not indicated |
| Maternity expense |
Not indicated |
Not indicated |
SI or Rs. 50,000/- whichever is lower on payment of extra premium |
| Pre existing disease |
diseases are covered only after 4 continuous claim free renewals. |
disease / illness covered after 4 continuous claim free renewals. |
disease / illness covered after1st year. |
| Family Discount |
10 % is applicable |
Family Discount |
10% of total premium |
| Emergency Ambulance Charges |
1% of S.I Max. Rs. 1000 |
are covered up to the limits specified in the policy |
Not mentioned |
| Coverage |
- Room, Boarding expenses and nursing expense - min 1% of SI/day, max 25% of SI or 5000
- If admitted in ICU - upto2% of SI/day,max of 25% of SI or 10000/-.
- Surgeon, Anaesthetist, Consultant, specialists fees, - upto 25% of SI.
- Anaesthesia, Blood, Oxygen, OT charges, Medicines, Diagnostic material & X-Ray, Dialysis, Radiotherapy, Chemotherapy, Cost of pacemaker, Artificial limb, - upto 50% of SI.
|
- Room, Boarding expenses upto 1% of SI/day
- If admitted in ICU upto2% of SI/day.
- Surgeon, Anaesthetist, Consultant, specialists fees, Nursing expenses.
- Anaesthesia, Blood, Oxygen, OT charges, Medicines, Diagnostic material & X-Ray, Dialysis, Radiotherapy, Chemotherapy, Cost of pacemaker, Artificial limb, etc
|
- .Includes room rent and boarding and operation charges
- Nursing expenses, Srgeon's fees,Consultant's fees,Anaesthetist's nursing, diagnostic test and Specialist's fees, OT Charges.
- Cost of medicine & drugs blood, oxygen, appliances like pace-maker, artificial limbs etc.
|
| Cashless facility |
Available |
Available |
Available |
| Tax benefit on premium |
Max. Limit as per Section 80D |
Max. Limit as per Section 80D |
Max. Limit as per Section 80D |
| Exclusion |
| First 30 days |
Any disease/injury contracted during first 30 days |
Any disease/injury during first 30 days except due to an accident |
Any disease/injury during first 30 days except due to an accident |
| 1st year |
Nil |
2nd year
Condition like hypertension ,diabetes are covered after payment of additional premium. |
1st year
Cataract, Benign Prostatic Hyperthropathy, Hysterectomy, Hernia, Congenital internal disease, Fistula in anus, sinusitis
|
| Permanent Exclusion |
- Dental treatment except arising out of accident.
- HIV (AIDS)
- Congential external disease, self injury, use of drugs or alcohol,etc.
- charges for diagonostic,treatment outside India
- Vaccination and Inoculation
- Pregnancy and child birth
- Naturopathy treatment, war
|
- Corrective, cosmetic, plastic or aesthetic dental surgery or treatment.
- Cost of spectacles, contact lens and hearing aid.
- Vaccination, inoculation, change of life or cosmetic treatment or surgery
- HIV, AIDS, Sterility, Venereal Disease,
- Intentional Self injury, use of Intoxicating Drugs/ Alcohol.
- Pregnancy and child birth, War,
- Diagnostic expenses not related to sickness/ injury.
- Naturo pathy treatment.
|
- Vaccination, inoculation circumcision or cosmetic or aesthetic treatment, plastic surgery,
- dental treatment unless due to accident .
- Cost of spectacles, contact lenses, hearing aids.
- venereal disease, intentional self-injury use of intoxicants
- AIDS.
- Hospital / nursing home charges not consistent with or incidental to the diagnosis and treatment : Vitamins, tonics not forming part of any treatment.
- pregnancy, child birth and voluntary medical termination of pregnancy during the first 12 weeks of pregnancy
- Nuclear perils and war group of perils
- Naturo pathy treatment.
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