{"uin":"NICHLIP25036V082425","name":"National Mediclaim Policy (Individual Plan)","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425","insurer":{"slug":"national-insurance","name":"National Insurance Company Limited","url":"https://indiainsurances.com/insurer/national-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":null,"kind":"product","status":"active","approved_on":null,"withdrawn_on":null,"summary":"National Mediclaim Policy (Individual Plan) is an indemnity health insurance policy issued on individual sum insured basis with ₹ 1L to 10 L options and a one-year term. It covers hospitalisation in India with 45 days pre-hospitalisation, 60 days post-hospitalisation, a 30-day initial waiting period, a 36-month pre-existing disease waiting period and a 60-month moratorium period.","analysis":{"state":"machine","analysed_at":"2026-10-19 21:53:56.113773+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"quote-verified","value":["Individual Basis"],"display":"Individual Basis","note":null,"quote":"Policy can be issued on Individual Basis (i.e., separate Basic Sum Insured and Cumulative Bonus shall apply on each Insured Person).","sources":[{"clause":"2.1","heading":"Type of Policy","page":4,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/13045#c-2-1"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"The policy period is one year.","display":"one (01) year","note":null,"quote":"Policy Period means period of one (01) year as mentioned in the Schedule for which the Policy is issued.","sources":[{"clause":"2.42","heading":"Policy Period","page":4,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-2-42"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"For both cashless and reimbursement claims, planned hospitalisation must be intimated at least seventy two (72) hours before admission and emergency hospitalisation within twenty four (24) hours of admission.","display":"Planned: at least 72 hours before admission; emergency: within 24 hours of admission","note":null,"quote":"Claim Intimation in case of Cashless facility | TPA must be informed:\nIn the event of planned Hospitalisation | At least seventy two (72) hours prior to the Insured Person’s admission\nIn the event of emergency Hospitalisation | Within twenty four (24) hours of the Insured Person’s admission\nClaim Intimation in case of Reimbursement | Company/TPA must be informed:\nIn the event of planned Hospitalisation | At least seventy two (72) hours prior to the Insured Person’s admission to Hospital\nIn the event of emergency Hospitalisation | Within twenty four (24) hours of the Insured Person’s admission to Hospital","sources":[{"clause":"6.17.1","heading":"Notification of Claim","page":13,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-17-1"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"quote-verified","value":["Completed claim form","Medical practitioner’s prescription advising admission for inpatient treatment.","Cash-memo from the hospital (s)/chemist (s) supported by proper prescription from attending medical practitioner for Pre Hospitalisation, Hospitalisation and Post Hospitalisation.","Payment receipt, investigation test reports and associated plates/CDs in original, supported by the prescription from attending medical practitioner for Pre Hospitalisation, Hospitalisation and Post Hospitalisation.","Attending medical practitioner’s certificate regarding Diagnosis along with date of Diagnosis and bill, receipts etc.","Surgeon’s certificate regarding Diagnosis and nature of operation performed along with bills, receipts etc.","Bills, receipt, sticker of the Implants.","Bills, payment receipts, medical history of the patient recorded, discharge certificate/ summary, break up of final bill from the hospital etc.","Any other document required by Company/TPA."],"display":"Completed claim form, admission prescription, bills/receipts, test reports, diagnosis and surgery certificates, implant stickers, discharge summary, break-up of final bill and any other document required by Company/TPA","note":null,"quote":"The claim is to be supported with the following original documents and submitted within the prescribed time limit.\ni) Completed claim form\nii) Medical practitioner’s prescription advising admission for inpatient treatment.\niii) Cash-memo from the hospital (s)/chemist (s) supported by proper prescription from attending medical practitioner for Pre Hospitalisation, Hospitalisation and Post Hospitalisation.\niv) Payment receipt, investigation test reports and associated plates/CDs in original, supported by the prescription from attending medical practitioner for Pre Hospitalisation, Hospitalisation and Post Hospitalisation.\nv) Attending medical practitioner’s certificate regarding Diagnosis along with date of Diagnosis and bill, receipts etc.\nvi) Surgeon’s certificate regarding Diagnosis and nature of operation performed along with bills, receipts etc.\nvii) Bills, receipt, sticker of the Implants.\nviii) Bills, payment receipts, medical history of the patient recorded, discharge certificate/ summary, break up of final bill from the hospital etc.\nix) Any other document required by Company/TPA.","sources":[{"clause":"6.17.4","heading":"Documents","page":14,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-17-4"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"quote-verified","value":"The company shall settle or reject a claim within 15 days from receipt of the last necessary document. If investigation is warranted, it must complete investigation within 30 days and settle or reject the claim within 45 days from receipt of the last necessary document; delay attracts interest at 2% above the bank rate.","display":"15 days from last necessary document; 45 days if investigation; delay interest 2% above bank rate","note":null,"quote":"i) The Company shall settle or reject a claim, as the case may be, within 15 days from the date of receipt of last necessary document. ... iii) However, where the circumstances of a claim warrant an investigation in the opinion of the Company, it shall initiate and complete such investigation at the earliest, in any case not later than 30 days from the date of receipt of last necessary document. In such cases, the Company shall settle or reject the claim within 45 days from the date of receipt of last necessary document. ... ii) In the case of delay in the payment of a claim, the Company shall be liable to pay interest to the policyholder from the date of receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate.","sources":[{"clause":"6.3(i)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-3-i"},{"clause":"6.3(iii)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-3-iii"},{"clause":"6.3(ii)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-3-ii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"quote-verified","value":["Pre-Existing Diseases (Excl 01)","Specific disease/procedure Waiting Period (Excl 02)","First 30 days waiting period (Excl 03)","Investigation& Evaluation (Excl 04)","Rest Cure, Rehabilitation and Respite Care (Excl 05)","Obesity/ Weight Control (Excl 06)","Change-of-Gender Treatments (Excl 07)","Cosmetic or Plastic Surgery (Excl 08)","Hazardous or Adventure Sports (Excl 09)","Breach of Law (Excl 10)","Excluded Providers (Excl 11)","Drug/Alcohol Abuse (Excl 12)","Non-Medical Admissions (Excl 13)","Birth control, Sterility and Infertility (Excl 17)","Maternity (Excl 18)"],"display":"Waiting-period exclusions, investigation and evaluation, rest cure, obesity/weight control, change of gender, cosmetic surgery, professional hazardous sports, breach of law, excluded providers, drug/alcohol abuse, non-medical admissions, infertility and maternity","note":null,"quote":"Waiting Period EXCLUSIONS a. Pre-Existing Diseases (Excl 01) b. Specified disease/procedure waiting period (Excl 02) c. First 30 days waiting period (Excl 03) Exclusions d. Investigation& Evaluation (Excl 04) e. Rest Cure, Rehabilitation and Respite Care (Excl 05) ... f. Obesity/ Weight Control (Excl 06) g. Change-of-Gender Treatments (Excl 07) h. Cosmetic or Plastic Surgery (Excl 08) i. Hazardous or Adventure Sports (Excl 09) j. Breach of Law (Excl 10) k. Excluded Providers (Excl 11) l. Drug/Alcohol Abuse (Excl 12) m. Non-Medical Admissions (Excl 13) ... q. Birth control, Sterility and Infertility (Excl 17) r. Maternity (Excl 18)","sources":[{"clause":"Row 6","heading":"Exclusions (what the policy does not cover)","page":1,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/13136#c-row-6"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"quote-verified","value":"A grievance may be submitted in writing to the Policy Issuing Office or the Grievance Cell at the Regional Office. If it remains unaddressed, contact the Customer Relationship Management Department of National Insurance Company Limited before approaching Bima Bharosa or the Insurance Ombudsman.","display":"Policy Issuing Office or Regional Office Grievance Cell; then Customer Relationship Management Dept.","note":null,"quote":"In case of any grievance related to the Policy, the insured person may submit in writing to the Policy Issuing Office or Grievance cell at Regional Office of the Company for redressal. If the grievance remains unaddressed, the insured person may contact:\nCustomer Relationship Management Dept., National Insurance Company Limited, Premises No. 18-0374, Plot no. CBD-81, New Town, Kolkata - 700156, email: customer.relations@nic.co.in, griho@nic.co.in","sources":[{"clause":"7","heading":"REDRESSAL OF GRIEVANCE","page":16,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-7"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"quote-verified","value":"Basic Sum Insured options are ₹ 1L to 10 L in slabs of ₹ 1/ 2/ 3/ 4/ 5/ 6/ 7/ 8/ 9/ 10 L.","display":"₹ 1/ 2/ 3/ 4/ 5/ 6/ 7/ 8/ 9/ 10 L","note":null,"quote":"Basic Sum Insured (excluding CB) | ₹ 1L – 10 L\nSlab | ₹ 1/ 2/ 3/ 4/ 5/ 6/ 7/ 8/ 9/ 10 L","sources":[{"clause":null,"heading":"TABLE OF BENEFITS","page":17,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-table-of-benefits"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"quote-verified","value":{"unit":"days","amount":30},"display":"thirty (30) days","note":null,"quote":"a) Expenses related to the treatment of any illness within thirty (30) days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.","sources":[{"clause":"4.3","heading":"First 30 days waiting period (Excl 03)","page":9,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-4-3"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"quote-verified","value":{"unit":"months","amount":36},"display":"thirty six (36) months","note":"Coverage after 36 months is subject to the PED being declared at application and accepted by the insurer; waiting is applied afresh to enhanced sum insured.","quote":"a) Expenses related to the treatment of a Pre-Existing Disease (PED) and its direct complications shall be excluded until the expiry of thirty six (36) months of continuous coverage after the date of inception of the first policy with us.","sources":[{"clause":"4.1","heading":"Pre-Existing Diseases (Excl 01)","page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-4-1"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"quote-verified","value":{"unit":"days","amount":90},"display":"90 days","note":"Specific waiting periods also include one year, two years and three years depending on the listed disease or procedure; accident claims are not subject to this exclusion.","quote":"a) Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 90 days/ one year/ two year/ three years (as specified against specific disease/ procedure) of continuous coverage after the date of inception of the first policy with us. ... i) 90 Days Waiting Period (Life style conditions namely)","sources":[{"clause":"4.2","heading":"Specific disease/procedure Waiting Period (Excl 02)","page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-4-2"},{"clause":"4.2(f)(i)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-4-2-f-i"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"quote-verified","value":["Hypertension and related complications","Diabetes and related complications","Cardiac conditions","Benign ENT disorders","Tonsillectomy","Adenoidectomy","Mastoidectomy","Tympanoplasty","Cataract and age related eye ailments","Refractive error of the eye more than 7.5 dioptres.","Benign prostatic hypertrophy","Hernia","Hydrocele","Fissure/Fistula in anus","Piles (Haemorrhoids)","Sinusitis and related disorders","Polycystic ovarian disease","Non-infective arthritis","Pilonidal sinus","Gout and Rheumatism","Calculus diseases","Surgery of gall bladder and bile duct excluding malignancy","Surgery of genito-urinary system excluding malignancy","Surgery for prolapsed intervertebral disc unless arising from accident","Surgery of varicose vein","Hysterectomy","Congenital Internal Anomaly","Joint replacement unless necessitated due to an accident","Osteoarthritis and osteoporosis","Obesity and its complications","Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered."],"display":"Hypertension, diabetes, cardiac conditions, ENT procedures, cataract, refractive error, hernia, piles, sinusitis, arthritis, calculus diseases, gall bladder/bile duct surgery, genito-urinary surgery, prolapsed disc surgery, varicose vein surgery, hysterectomy, congenital internal anomaly, joint replacement, osteoarthritis/osteoporosis, obesity and stem cell therapy","note":null,"quote":"i) 90 Days Waiting Period (Life style conditions namely)\na. Hypertension and related complications | c. Cardiac conditions\nb. Diabetes and related complications ... ii) One year Waiting Period\na. Benign ENT disorders | d. Mastoidectomy\nb. Tonsillectomy | e. Tympanoplasty\nc. Adenoidectomy ... iii) Two years Waiting Period\na. Cataract and age related eye ailments | m. Gout and Rheumatism\nb. Refractive error of the eye more than 7.5 dioptres. | n. Calculus diseases\nd. Benign prostatic hypertrophy | o. Surgery of gall bladder and bile duct excluding\ne. Hernia | malignancy\nf. Hydrocele | p. Surgery of genito-urinary system excluding\ng. Fissure/Fistula in anus | malignancy\nh. Piles (Haemorrhoids) | q. Surgery for prolapsed intervertebral disc unless arising\ni. Sinusitis and related disorders | from accident\nj. Polycystic ovarian disease | r. Surgery of varicose vein\nk. Non-infective arthritis | s. Hysterectomy\nl. Pilonidal sinus | t. Congenital Internal Anomaly ... iv) Three years Waiting Period Following diseases shall be covered after three years of continuous cover from the inception of the Policy:\na) Joint replacement unless necessitated due to an accident\nb) Osteoarthritis and osteoporosis\nc) Obesity and its complications\nd) Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.","sources":[{"clause":"4.2(f)(i)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-4-2-f-i"},{"clause":"4.2(f)(ii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-4-2-f-ii"},{"clause":"4.2(f)(iii)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-4-2-f-iii"},{"clause":"4.2(f)(iv)","heading":null,"page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-4-2-f-iv"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"quote-verified","value":{"unit":"months","amount":60},"display":"sixty continuous months","note":"For enhanced Basic Sum Insured, sixty continuous months runs from the date of enhancement on the enhanced limits.","quote":"After completion of sixty continuous months of coverage (including Portability and Migration), no claim shall be contestable by the Company on grounds of non-disclosure, misrepresentation, except on grounds of established fraud. This period of sixty continuous months is called as Moratorium Period.","sources":[{"clause":"6.11","heading":"Moratorium Period","page":13,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-11"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"quote-verified","value":"The insured person can port the policy to other insurers by applying at least 15 days before, but not earlier than 60 days from, the policy renewal date. Continuity benefits are given for specific waiting periods, pre-existing disease waiting period and moratorium period, to the extent of previous sum insured and accrued cumulative bonus.","display":"Can port to other insurers; apply at least 15 days before and not earlier than 60 days from renewal date","note":null,"quote":"The Insured Person will have the option to port the Policy to other insurers by applying to such Insurer to port the entire policy along with all the members of the family, if any, at least 15 days before, but not earlier than 60 days from the policy renewal date ... i) The proposed Insured Person will get all the accrued continuity benefits for specific waiting periods, waiting period for pre-existing diseases and Moratorium period of the Insured Person under the previous health insurance Policy. ... Portability benefit will be offered to the extent of Sum Insured and accrued Cumulative Bonus (as part of the sum insured) of the previous policy. Portability benefit shall not apply to any other additional increased Sum Insured.","sources":[{"clause":"6.8","heading":"Portability","page":12,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-8"},{"clause":"6.8(i)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-8-i"},{"clause":"6.8(ii)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-8-ii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"quote-verified","value":true,"display":"Yes, throughout the lifetime","note":"Covered children or siblings can renew till the insured person’s marriage.","quote":"i) The Policy can be renewed without break throughout the lifetime of the Insured Persons except for the covered Children or siblings, who can renew till the Insured Person’s marriage","sources":[{"clause":"2.10","heading":"Renewal Terms","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/13045#c-2-10"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"quote-verified","value":"No loading applies on renewals based on individual claims experience.","display":"No loading on renewals based on individual claims experience","note":null,"quote":"vi) No loading shall apply on renewals based on individual claims experience.","sources":[{"clause":"6.9","heading":"Renewal of Policy","page":12,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-9"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"quote-verified","value":"The policyholder may cancel during the term by giving 7 days written notice. The company refunds proportionate premium for the unexpired policy period if no claim has been made; no refund is made if any claim has been admitted or lodged or any benefit availed.","display":"Proportionate premium for unexpired period if no claim; 7 days written notice","note":null,"quote":"ii) The policyholder may cancel his/her policy at any time during the term, by giving 7 days notice in writing. The Company shall refund proportionate premium for unexpired policy period, if there is no claim(s) made during the policy period. Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of Cancellation where, any claim has been admitted or has been lodged or any benefit has been availed under the Policy.","sources":[{"clause":"6.6(ii)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-6-ii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"quote-verified","value":"All medical treatment for this policy must be taken in India only.","display":"India only","note":null,"quote":"All medical treatment for the purpose of this Policy will have to be taken in India only.","sources":[{"clause":"6.19","heading":"Territorial Limit","page":15,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-19"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"thirty days","note":"Applicable to new individual health insurance policies, not renewals or porting/migration.","quote":"The insured person shall be allowed free look period of thirty days from date of receipt of the policy document to review the terms and conditions of the policy.","sources":[{"clause":"6.13","heading":"Free Look Period","page":13,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-13"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"quote-verified","value":{"unit":"days","amount":30},"display":"thirty days","note":null,"quote":"The Grace Period for payment of the premium shall be thirty days.","sources":[{"clause":"2.19","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-2-19"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"quote-verified","value":"The proposer must be between eighteen (18) years and sixty five (65) years. Family members can enter up to sixty five (65) years, and unmarried children over three (03) months may be covered for the first time if parent(s) are covered at the same time.","display":"Proposer: 18 to 65 years; family member: up to 65 years; unmarried children over 3 months if parent(s) covered","note":null,"quote":"i) Entry age of Proposer should be between eighteen (18) years and sixty five (65) years.\nii) Maximum entry age of any family member is sixty five (65) years.\niii) Un married Children over the age of three (03) months may be covered for the first time, provided parent(s) is/are covered at the same time.","sources":[{"clause":"2.2","heading":"Eligibility","page":4,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/13045#c-2-2"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"quote-verified","value":["annually","half yearly","quarterly"],"display":"annually, half yearly or quarterly","note":null,"quote":"v) As opted in the Proposal Form, Insured have the option to either pay the premium annually, or in half yearly or quarterly Instalment as per factors provided in Rate Chart.","sources":[{"clause":"2.9","heading":"Payment of Premium","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/13045#c-2-9"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"quote-verified","value":["Home Care","Non-Medical Expenses"],"display":"Home Care; Non-Medical Expenses","note":null,"quote":"Add-ons (cover available on payment of additional premium)\nHome Care | INR 10,000/ 15,000/ 20,000/ 25,000/ 30,000/ 35,000/ 40,000/ 45,000/ 50,000, subject to 10% of Basic SI under base Policy\nNon-Medical Expenses (available to SI 5 lacs & above) | Up to 10% of Basic Sum Insured (excluding Cumulative Bonus, if any) of base Policy and shall be part of the base Policy Basic Sum Insured (excluding Cumulative Bonus, if any).","sources":[{"clause":null,"heading":"Discounts","page":17,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-discounts"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"quote-verified","value":"For renewal, coverage is not available during the grace period for which no premium is received. For instalment premiums, if the due instalment is paid within the grace period, coverage is available during the grace period.","display":"Renewal: no coverage during grace period; instalments: coverage available if paid within grace period","note":null,"quote":"In case of Premium payment in instalments, if the due instalment premium is paid within Grace Period, coverage shall be available during the Grace Period. In case of Renewal, Coverage shall not be available during the period for which no premium is received.","sources":[{"clause":"2.19","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-2-19"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"quote-verified","value":"Room rent is payable up to 1% of Sum Insured subject to a maximum of ₹ 10,000 per day. Total Room Charges for any one illness are capped at 25% of Sum Insured, but the broad sub-limits in Sections 3.1, 3.2 and 3.3 do not apply for listed PPN package treatment.","display":"Up to 1% of Sum Insured, maximum ₹ 10,000 per day; Room Charges up to 25% of SI for Any One Illness","note":null,"quote":"i. Room Rent per day shall be payable up to 1% of Sum Insured subject to max of ₹ 10,000 per day ii. ICU Charges per day shall be payable up to 2% of Sum Insured subject to max of ₹ 20,000 per day | Maximum amount admissible under Room Charges for Any One Illness shall be 25% of Sum Insured (i.e., Basic Sum Insured and Cumulative Bonus) as mentioned in the Schedule. ... Note: Sub limits as mentioned in Section 3.1, 3.2 and 3.3 above, will not apply in case of treatment undergone in a Preferred Provider Network (PPN) for a listed procedure as per eligible package.","sources":[{"clause":"3","heading":"BENEFITS COVERED UNDER THE POLICY","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"not-stated","value":null,"display":null,"note":"The documents give a monetary room rent limit but do not state an allowed room category.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"quote-verified","value":"ICU charges per day are payable up to 2% of Sum Insured, subject to a maximum of ₹ 20,000 per day. Total Room Charges for any one illness are capped at 25% of Sum Insured.","display":"Up to 2% of Sum Insured, maximum ₹ 20,000 per day","note":null,"quote":"ii. ICU Charges per day shall be payable up to 2% of Sum Insured subject to max of ₹ 20,000 per day | Maximum amount admissible under Room Charges for Any One Illness shall be 25% of Sum Insured (i.e., Basic Sum Insured and Cumulative Bonus) as mentioned in the Schedule.","sources":[{"clause":"3","heading":"BENEFITS COVERED UNDER THE POLICY","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"not-stated","value":null,"display":null,"note":"The documents state room-rent and room-charge sub-limits but do not state proportionate deduction for choosing a higher room.","quote":null,"sources":[],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"quote-verified","value":"There is no mandatory co-payment stated for the base policy. If optional co-payment is chosen, each admissible claim is subject to either 20% co-payment with a 25% premium discount or 10% co-payment with a 12.5% premium discount.","display":"None unless opted; optional 20% or 10% co-payment on each admissible claim","note":"Optional co-payment is chosen for a premium discount and may be changed only at renewal.","quote":"Co-payment (optional) | If opted, policyholder may choose either of the two co-payment options- • 20% Co-payment on each admissible claim, with a 25% discount in premium • 10% Co-payment on each admissible claim, with a 12.5% discount in premium","sources":[{"clause":null,"heading":"Discounts","page":17,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-discounts"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"quote-verified","value":"Deductible is not applicable.","display":"Not applicable","note":null,"quote":"iii. Deductible iv. Any other limit | ... Not applicable Not applicable |","sources":[{"clause":"Row 7","heading":"Waiting period","page":2,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/13136#c-row-7"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"quote-verified","value":["Hemodialysis, Chemotherapy (excluding Oral Chemotherapy), Radiotherapy: lower of 50% of Sum Insured or the PPN Package Rate","Modern Treatments: 25% of Sum Insured for each modern treatment","Treatment due to non-professional hazardous or adventure sports: lower of 25% of Sum Insured"],"display":"Hemodialysis/chemotherapy/radiotherapy up to lower of 50% SI or PPN Package Rate; modern treatments up to 25% SI; non-professional hazardous/adventure sports up to lower of 25% SI","note":null,"quote":"3.4 | Expenses for the following procedures inclusive of above sub limits (i.e., Section 3.1, 3.2, 3.3) i. Hemodialysis ii. Chemotherapy (excluding Oral Chemotherapy) iii. Radiotherapy | Maximum amount admissible for Any One Illness shall be lower of 50% of Sum Insured (i.e., Basic Sum Insured and Cumulative Bonus) or the PPN Package Rate. ... 3.5 | Following Modern Treatments will be covered (wherever medically indicated) either as In patient or as part of Day Care Treatment in a Hospital, inclusive of above sub limits ... | Maximum amount admissible for the related modern procedure / component / medicine of each modern treatment shall be 25% of Sum Insured (i.e. Basic Sum Insured and Cumulative Bonus) during the Policy Period. ... 3.6 | Expenses related to treatment necessitated due to participation as a non-professional in hazardous or adventure sports, inclusive of above sub limits (i.e., Section 3.1, 3.2, 3.3) | Maximum amount admissible for Any One Illness shall be lower of 25% of Sum Insured (i.e., Basic Sum Insured and Cumulative Bonus)","sources":[{"clause":"3","heading":"BENEFITS COVERED UNDER THE POLICY","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":45},"display":"forty five (45) days","note":null,"quote":"3.7 | Pre Hospitalisation Medical expenses incurred before Hospitalsation. | Up to forty five (45) days immediately before the Insured Person is Hospitalised","sources":[{"clause":"3","heading":"BENEFITS COVERED UNDER THE POLICY","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"quote-verified","value":{"unit":"days","amount":60},"display":"sixty (60) days","note":null,"quote":"3.8 | Post Hospitalisation Medical expenses incurred after discharge from Hospital. | Up to sixty (60) days immediately after the Insured Person is discharged","sources":[{"clause":"3","heading":"BENEFITS COVERED UNDER THE POLICY","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"quote-verified","value":"Day Care Treatments requiring hospitalisation as an in-patient for less than 24 hours in a Hospital or Day Care Centre are covered, including pre and post hospitalisation expenses, but not treatment in the outpatient department.","display":"Covered for Day Care Treatments requiring less than 24 hours, not OPD","note":null,"quote":"The Company shall indemnify the Medical Expenses (including Pre and Post Hospitalisation Expenses) for Day Care Treatments requiring Hospitalization as an In-Patient for less than 24 hours undergone by the Insured Person in a Hospital/ Day Care Centre, but not in the Outpatient department of a Hospital.","sources":[{"clause":null,"heading":"3.9.1 Day Care Procedure","page":6,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3-9-1-day-care-procedure"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"quote-verified","value":"Domiciliary Hospitalization is excluded, as is OPD treatment.","display":"Excluded","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","sources":[{"clause":"5.24","heading":"Domiciliary Hospitalization & Out Patient Department (OPD) treatment","page":10,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-5-24"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"quote-verified","value":"Inpatient care under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy is covered during each policy period up to the Sum Insured in an AYUSH Hospital.","display":"Covered up to Sum Insured in any AYUSH Hospital","note":null,"quote":"The Company shall indemnify Medical Expenses incurred for Inpatient Care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Period up to the limit of Sum Insured as specified in the Policy Schedule in any AYUSH Hospital.","sources":[{"clause":null,"heading":"3.9.2 AYUSH Treatment","page":6,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3-9-2-ayush-treatment"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"quote-verified","value":"Modern treatments listed in the policy are covered when medically indicated as inpatient or day-care treatment, with the related modern procedure/component/medicine of each modern treatment capped at 25% of Sum Insured during the policy period.","display":"Covered up to 25% of Sum Insured for each modern treatment","note":"Listed modern treatments include Uterine Artery Embolization and HIFU, Balloon Sinuplasty, Deep Brain Stimulation, Oral Chemotherapy, Immunotherapy - Monoclonal Antibody, Intravitreal injections, Robotic Surgery, Stereotactic Radio surgeries, Bronchial Thermoplasty, Vaporization of the prostrate, IONM and specified hematopoietic stem cell therapy.","quote":"3.5 | Following Modern Treatments will be covered (wherever medically indicated) either as In patient or as part of Day Care Treatment in a Hospital, inclusive of above sub limits (i.e., Section 3.1, 3.2, 3.3): ... | Maximum amount admissible for the related modern procedure / component / medicine of each modern treatment shall be 25% of Sum Insured (i.e. Basic Sum Insured and Cumulative Bonus) during the Policy Period.","sources":[{"clause":"3","heading":"BENEFITS COVERED UNDER THE POLICY","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Emergency ambulance charges are reimbursed up to 1% of Sum Insured, subject to a maximum of ₹ 2,000 in a policy period for each insured person, for specified transportation connected with the same hospitalisation, if the hospitalisation claim is admitted.","display":"Up to 1% of Sum Insured, maximum ₹ 2,000 per policy period per insured person","note":null,"quote":"The Company shall reimburse the Insured the expenses incurred for emergency ambulance charges, up to 1% of Sum Insured subject to maximum ₹ 2,000/- in a Policy Period for each Insured Person, for transportation to the Hospital or from the Hospital to another Hospital or from the Hospital to diagnostic center and return during the same Hospitalisation. Ambulance charges shall be admissible provided a Hospitalisation claim has been admitted under the Policy.","sources":[{"clause":null,"heading":"3.9.6 Ambulance Charges","page":7,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3-9-6-ambulance-charges"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"quote-verified","value":"For Basic Sum Insured of ₹ 6 lacs and above, if the available Sum Insured is exhausted during the policy period by hospitalisation claims, the company reinstates the Basic Sum Insured once for subsequent hospitalisations. An illness or injury for which a claim was admitted or paid before reinstatement is not considered under the reinstated sum insured, and unused reinstated amount is not carried forward.","display":"Once per policy period for Basic SI ₹ 6L and above; only for subsequent hospitalisations; not for the same illness/injury already admitted or paid","note":null,"quote":"For Insured Persons with Basic Sum Insured of ₹ 6 lacs and above, in the event of available Sum Insured being exhausted anytime during the Policy Period on account of Hospitalisation claim(s), the Company shall reinstate the Basic Sum Insured (i.e., excluding any CB) to be utilized in any subsequent Hospitalisation(s), provided that ... ii. Any Illness/ Injury for which a claim has been admitted or paid under the Policy prior to such reinstatement, shall not be considered under the Reinstated Basic Sum Insured ... iv. Reinstatement shall be allowed only once during the Policy Period for each eligible Insured Person.\nv) Reinstated Basic Sum Insured, if not exhausted, will not be carried forward to next Policy Period on Renewal","sources":[{"clause":null,"heading":"3.10 OTHER BENEFITS","page":7,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3-10-other-benefits"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"quote-verified","value":"For each claim-free policy period, the insured person gets a Cumulative Bonus of 5% of the expiring policy’s Basic Sum Insured on renewal, up to a maximum of 50% of the renewed policy’s Basic Sum Insured. If claims occur, accumulated CB is reduced at the next renewal by 5% of the expiring policy’s Basic Sum Insured, but the Basic Sum Insured is not reduced.","display":"5% of Basic Sum Insured for each claim-free year, maximum 50%; reduced by 5% after a claim","note":null,"quote":"For each claim free Policy Period (i.e., no claims are reported by the Insured Person and admitted by the Company) provided the policy is continuously renewed with the Company without a Break in Policy, each Insured Person will be eligible to get a Cumulative Bonus (CB) at the rate of 5% of the Basic Sum Insured of the expiring Policy. ... CB shall be accumulated for each subsequent claim free Policy Periods and the maximum CB shall not exceed 50% of the Basic Sum Insured of the renewed Policy. ... In case of claim(s) during a Policy Period in respect of an Insured Person, who has accumulated CB for earlier claim free Policy Periods, the accumulated CB will be reduced on the next Renewal at the rate of 5% of Basic Sum Insured of the expiring policy. However, Basic Sum Insured will be maintained and not be reduced.","sources":[{"clause":null,"heading":"3.11 GOOD HEALTH INCENTIVE 3.11.1 Cumulative Bonus","page":7,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3-11-good-health-incentive-3-11-1-cumulative-bon"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"quote-verified","value":"The base policy excludes items of personal comfort and convenience and certain non-medical items. A Non-Medical Expenses add-on is available for Sum Insured of 5 lacs and above up to 10% of Basic Sum Insured, on payment of additional premium.","display":"Excluded in base for personal comfort/non-medical items; optional Non-Medical Expenses add-on up to 10% of Basic SI for SI 5 lacs & above","note":"The Non-Medical Expenses cover is an add-on available only if bought for additional premium.","quote":"Items of personal comfort and convenience including telephone, television, aya, barber, beauty services, baby food, cosmetics, napkins, toiletries, guest services. ... Add-ons (cover available on payment of additional premium)\nHome Care | INR 10,000/ 15,000/ 20,000/ 25,000/ 30,000/ 35,000/ 40,000/ 45,000/ 50,000, subject to 10% of Basic SI under base Policy\nNon-Medical Expenses (available to SI 5 lacs & above) | Up to 10% of Basic Sum Insured (excluding Cumulative Bonus, if any) of base Policy and shall be part of the base Policy Basic Sum Insured (excluding Cumulative Bonus, if any).","sources":[{"clause":"5.30","heading":"Items of personal comfort","page":11,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-5-30"},{"clause":null,"heading":"Discounts","page":17,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-discounts"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"quote-verified","value":"Maternity is excluded: medical treatment expenses traceable to childbirth, including complicated deliveries and caesarean sections during hospitalisation, are not covered except ectopic pregnancy. Miscarriage expenses are excluded unless due to an accident, as is lawful medical termination of pregnancy during the policy period.","display":"Excluded, except ectopic pregnancy; miscarriage only if due to accident","note":null,"quote":"i) Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;\nii) Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period","sources":[{"clause":"5.15","heading":"Maternity (Excl 18)","page":10,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-5-15"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"quote-verified","value":"Newborn cover from birth is not stated. Midterm inclusion is allowed only for a newborn between three (03) months and six (06) months, and children over three (03) months may be covered for the first time if parent(s) are covered at the same time.","display":"Not from birth; newborn inclusion between 3 and 6 months only","note":null,"quote":"iii) Un married Children over the age of three (03) months may be covered for the first time, provided parent(s) is/are covered at the same time. ... vi. Midterm inclusion of family members at pro-rata premium is allowed only in case of\na) newborn between the age of three (03) months and six (06) months","sources":[{"clause":"2.2","heading":"Eligibility","page":4,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/13045#c-2-2"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"quote-verified","value":"Medical expenses, including pre and post hospitalisation expenses, related to mental illnesses are covered if treatment is undertaken at a hospital with a specific department for mental illness and under the specified qualified practitioner. Psychological counselling and psychotherapy not requiring hospitalisation are not covered.","display":"In-patient mental illness covered; counselling/psychotherapy without hospitalisation not covered","note":null,"quote":"The Company shall indemnify the Medical Expenses (including Pre and Post Hospitalisation Expenses) related to Mental Illnesses, provided the treatment shall be undertaken at a Hospital with a specific department for Mental Illness, under a Medical Practitioner qualified as Psychiatrist or a professional having a post-graduate degree (Ayurveda) in Mano Vigyan Avum Manas Roga or a post-graduate degree (Homoeopathy) in Psychiatry or a post-graduate degree (Unani) in Moalijat (Nafasiyatt) or a post-graduate degree (Siddha) in Sirappu Maruthuvam. ... Any kind of Psychological counselling, cognitive/ family/ group/ behavior/ palliative therapy or other kinds of psychotherapy for which Hospitalisation is not necessary shall not be covered.","sources":[{"clause":null,"heading":"3.9.4 Mental Illness Cover","page":6,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3-9-4-mental-illness-cover"},{"clause":null,"heading":"Exclusions","page":6,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-exclusions"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"quote-verified","value":"Preventive health check-up or prescribed diagnostic test expenses are reimbursed once at the end of a block of four continuous policy periods if no claims are reported and admitted during the block and the policy has been continuously renewed without break. The benefit is up to 1% of the average Basic Sum Insured of the block, subject to ₹ 5,000 per insured person.","display":"Once after 4 continuous claim-free policy periods, up to 1% of average Basic SI, maximum ₹ 5,000 per insured person","note":null,"quote":"Expenses of preventive health check-up/ prescribed diagnostic tests will be reimbursed once at the end of a block of four (04) continuous Policy Periods provided no claims are reported and admitted during the block and the policy has been continuously renewed with the Company without a Break in Policy. Expenses payable shall be up to 1% of the average Basic Sum Insured of the block, subject to a maximum of ₹ 5,000 per Insured Person.","sources":[{"clause":null,"heading":"3.11.2 Preventive Health Check Up","page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-3-11-2-preventive-health-check-up"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"quote-verified","value":"OPD treatment is excluded.","display":"Excluded","note":null,"quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment","sources":[{"clause":"5.24","heading":"Domiciliary Hospitalization & Out Patient Department (OPD) treatment","page":10,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-5-24"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"quote-verified","value":"Cashless facility can be availed if TPA service is opted. Treatment may be taken in a Network Provider, PPN or Non Network Provider, subject to pre-authorisation by the TPA.","display":"Available if TPA service is opted; Network Provider / PPN or Non Network Provider subject to pre-authorisation","note":null,"quote":"i) Cashless Facility for treatment can be availed, if TPA service is opted.\nii) Treatment may be taken in a Network Provider / PPN or Non Network Provider and is subject to pre-authorisation by the TPA. Updated list of Network Provider/PPN is available on the website of the Company and the TPA mentioned in the schedule.","sources":[{"clause":"6.17.2","heading":"Procedure for Cashless Claims","page":14,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-17-2"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims may be processed by a TPA if TPA service is opted, or by the Company if claims are processed by the Company. TPA services include pre-authorisation and processing, but do not include claim settlement or rejection.","display":"TPA if TPA service is opted; otherwise Company","note":null,"quote":"For reimbursement of claims the Insured Person shall submit the necessary documents to TPA (if claim is processed by TPA)/ Company (if claim is processed by the Company) within the prescribed time limit. ... Servicing of claims, i.e., claim admissions and assessments, under this Policy by way of pre-authorization of cashless treatment or processing of claims other than cashless claims or both, as per the underlying terms and conditions of the Policy. The services offered by a TPA shall not include\ni) Claim settlement and claim rejection;","sources":[{"clause":"6.17.3","heading":"Procedure for Reimbursement of Claims","page":14,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-17-3"},{"clause":"6.17.6","heading":"Services Offered by TPA","page":15,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950#c-6-17-6"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":false,"display":"No; individual basis with separate Basic Sum Insured and Cumulative Bonus for each insured person","note":null,"quote":"Policy can be issued on Individual Basis (i.e., separate Basic Sum Insured and Cumulative Bonus shall apply on each Insured Person).","sources":[{"clause":"2.1","heading":"Type of Policy","page":4,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/13045#c-2-1"}],"law":[]}],"documents":[{"kind":"wording","label":"NMP Wordings","pages":19,"fetched_at":"2026-10-17 19:55:22+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMP%20Policy%20Wordings.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/12950"},{"kind":"prospectus","label":"NMP Prospectus","pages":19,"fetched_at":"2026-10-17 19:58:02+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMP%20Prospectus.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/13045"},{"kind":"cis","label":"NMP CIS","pages":6,"fetched_at":"2026-10-17 20:00:47+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMP%20CIS.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/13136"},{"kind":"premium","label":"NMP Rate Chart","pages":null,"fetched_at":"2026-10-17 19:51:25+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMP%20Rate%20Chart%20Revised.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/30362"},{"kind":"proposal","label":"NMP Proposal","pages":null,"fetched_at":"2026-10-17 20:00:03+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMP%20Proposal%20Form%20Revised.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/30380"},{"kind":"claim-form","label":"NMP Claim Form","pages":null,"fetched_at":"2026-10-17 20:01:12+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMP%20Claim%20Form.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425/document/30397"}],"versions":[],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"National Insurance official website","url":"https://nationalinsurance.nic.co.in","note":"Website as listed by IRDAI. Not checked: the site could not be reached from our crawler on 2026-10-19 (connection or TLS error)."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"National Mediclaim Policy (Individual Plan) (UIN NICHLIP25036V082425), IndiaInsurances, https://indiainsurances.com/policy/national-insurance/national-mediclaim-policy-individual-plan-nichlip25036v082425"}