{"uin":"NICHLIP25038V032425","name":"National Mediclaim Plus Policy (Individual Plan)","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425","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 Plus Policy is an individual health indemnity policy with Plans A, B and C and sum insured from INR 2 Lac to INR 50 Lac. It covers India-only hospitalisation with 30 days pre-hospitalisation and 60 days post-hospitalisation, with optional Critical Illness, Outpatient Treatment, Optional Co-payment, Home Care and Non Medical Expenses covers.","analysis":{"state":"machine","analysed_at":"2026-10-19 21:53:58.181991+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":["PLAN A","PLAN B","PLAN C"],"display":"PLAN A, PLAN B and PLAN C","note":null,"quote":"Features | PLAN A | PLAN B | PLAN C\nSum insured | INR 2/ 3 /4 / 5/ 6/ 7/ 8/ 9 /10 Lac | INR 15/ 20 /25 Lac | INR 30/ 40/ 50 Lac","sources":[{"clause":null,"heading":"Table of Benefits","page":18,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-table-of-benefits"}],"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 runs for one year.","display":"One year","note":null,"quote":"Policy Period means period of one year as mentioned in the schedule for which the policy is issued.","sources":[{"clause":"2.38","heading":"Policy Period","page":3,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-2-38"}],"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 72 hours before admission and emergency hospitalisation within 24 hours of admission.","display":"Planned: at least 72 hours before admission; emergency: within 24 hours of admission","note":null,"quote":"Notification of claim in case of Cashless facility | TPA must be informed:\nIn the event of planned hospitalisation | At least 72 (seventy two) hours prior to the insured person’s admission\nIn the event of emergency hospitalisation | Within 24 (twenty four) hours of the insured person’s admission\nNotification of claim in case of Reimbursement | Company/TPA must be informed:\nIn the event of planned hospitalisation | At least 72 (seventy two hours prior to the insured person’s admission to hospital\nIn the event of emergency hospitalisation | Within 24 (twenty four) hours of the insured person’s admission to hospital","sources":[{"clause":null,"heading":"5.5 Claim Procedure","page":11,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-5-5-claim-procedure"}],"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","Bills, payment receipts, medical history of the patient recorded, discharge certificate/ summary from the hospital etc.","Cash-memo from the hospital (s)/chemist (s) supported by proper prescription","Payment receipt, investigation test reports etc. supported by the prescription from attending medical practitioner","Attending medical practitioner’s certificate regarding diagnosis along with date of diagnosis and bill receipts etc.","Surgeon’s original certificate stating diagnosis and nature of operation performed along with bills/receipts etc.","In the event of claim under Section 2.1.11, confirmation of the need of family member from attending medical practitioner","Any other document required by company/TPA"],"display":"Completed claim form; hospital bills and receipts; discharge summary; prescriptions and test reports; doctor and surgeon certificates; other documents required by company/TPA","note":null,"quote":"i. Completed claim form\nii. Bills, payment receipts, medical history of the patient recorded, discharge certificate/ summary from the hospital etc.\niii. Cash-memo from the hospital (s)/chemist (s) supported by proper prescription\niv. Payment receipt, investigation test reports etc. supported by the prescription from attending medical practitioner\nv. Attending medical practitioner’s certificate regarding diagnosis along with date of diagnosis and bill receipts etc.\nvi. Surgeon’s original certificate stating diagnosis and nature of operation performed along with bills/receipts etc.\nvii. In the event of claim under Section 2.1.11, confirmation of the need of family member from attending medical practitioner\nviii. Any other document required by company/TPA","sources":[{"clause":null,"heading":"5.5.4 Documents","page":12,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-5-5-4-documents"}],"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 required, it must complete investigation within 30 days and settle or reject within 45 days from receipt of the last necessary document, with interest at 2% above bank rate for delay.","display":"15 days from last necessary document; 45 days if investigation is required","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. ... iv. In case of delay beyond stipulated 45 days, the Company shall be liable to pay interest to the policyholder at a rate 2% above the bank rate from the date of receipt of last necessary document to the date of payment of claim.","sources":[{"clause":null,"heading":"5.5.5 Claim Settlement","page":12,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-5-5-5-claim-settlement"}],"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)","Specified 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)","Unproven Treatments (Excl 16)","Treatment taken outside the geographical limits of India"],"display":"Waiting-period exclusions plus key standard exclusions including investigation, rest cure, obesity conditions, change of gender, cosmetic surgery, professional hazardous sports, breach of law, excluded providers, drug/alcohol abuse, non-medical admissions, unproven treatments and treatment outside India","note":null,"quote":"4.1. Pre-Existing Diseases (Excl 01) 4.2. Specified disease/procedure waiting period (Excl 02) 4.3. First 30 days waiting period (Excl 03) 4.4. Investigation& Evaluation (Excl 04) 4.5. Rest Cure, Rehabilitation and Respite Care (Excl 05) 4.6. Obesity/ Weight Control (Excl 06) 4.7. Change-of-Gender Treatments (Excl 07) 4.8. Cosmetic or Plastic Surgery (Excl 08) 4.9. Hazardous or Adventure Sports (Excl 09) 4.10. Breach of Law (Excl 10) 4.11. Excluded Providers (Excl 11) 4.12. Drug/Alcohol Abuse (Excl 12) 4.13. Non Medical Admissions (Excl 13) ... 4.16. Unproven Treatments (Excl 16) ... 4.37. Treatment taken outside the geographical limits of India","sources":[{"clause":"Row 6","heading":"Exclusions (what the policy does not cover)","page":2,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13128#c-row-6"},{"clause":null,"heading":"Customer Information Sheet","page":3,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13128#c-customer-information-sheet-2"}],"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":"The insured person may first submit a grievance in writing to the Policy Issuing Office or the Grievance cell at the Regional Office. If it remains unaddressed, the insured person may contact the Customer Relationship Management Department.","display":"Policy Issuing Office or Regional Office Grievance cell first; 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":null,"heading":"6 Redressal of Grievance","page":15,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-6-redressal-of-grievance"}],"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":"Plan A offers INR 2, 3, 4, 5, 6, 7, 8, 9 or 10 Lac; Plan B offers INR 15, 20 or 25 Lac; Plan C offers INR 30, 40 or 50 Lac.","display":"Plan A: INR 2/3/4/5/6/7/8/9/10 Lac; Plan B: INR 15/20/25 Lac; Plan C: INR 30/40/50 Lac","note":null,"quote":"Sum insured | INR 2/ 3 /4 / 5/ 6/ 7/ 8/ 9 /10 Lac | INR 15/ 20 /25 Lac | INR 30/ 40/ 50 Lac","sources":[{"clause":null,"heading":"Table of Benefits","page":18,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#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":"30 days","note":"Does not apply to accident claims if covered.","quote":"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":null,"heading":"4.3. First 30 days Waiting Period (Excl 03)","page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-4-3-first-30-days-waiting-period-excl-03"}],"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":"36 months","note":"On enhancement of sum insured, the exclusion applies afresh to the increase.","quote":"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":null,"heading":"4.1. Pre-Existing Diseases (Excl 01)","page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-4-1-pre-existing-diseases-excl-01"}],"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":"conflicting","value":{"unit":"days","amount":90},"display":"90 days","note":"Policy wording has tiers of 90 days, one year, two years and three years. CIS says for the three-year tier: \"Following diseases even if pre-existing shall be covered after four years of continuous cover from the inception of the policy.\"","quote":"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. ... iv. Three years waiting period Following diseases shall be covered after three years of continuous cover from the inception of the Policy. ... iv. Three years waiting period Following diseases even if pre-existing shall be covered after four years of continuous cover from the inception of the policy.","sources":[{"clause":null,"heading":"4.2. Specified Disease/Procedure Waiting Period (Excl 02)","page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-4-2-specified-disease-procedure-waiting-period-e"},{"clause":null,"heading":"Customer Information Sheet","page":3,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13128#c-customer-information-sheet-2"}],"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","Tympanoplast","Cataract","Benign prostatic hypertrophy","Hernia","Hydrocele","Congenital internal anomaly (not applicable for New Born Baby)","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","Refractive error of the eye more than 7.5 dioptres","Treatment for joint replacement unless arising from accident","Osteoarthritis and osteoporosis","Morbid 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, hernia, piles, sinusitis, arthritis, calculus diseases, specified surgeries, joint replacement, osteoarthritis/osteoporosis, morbid obesity and specified stem cell therapy","note":null,"quote":"i) 90 Days Waiting Period (Life style conditions)\na) Hypertension and related complications\nb) Diabetes and related complications\nc) Cardiac conditions\nii. One year waiting period\na. Benign ENT disorders | d. Mastoidectomy\nb. Tonsillectomy | e. Tympanoplast\nc. Adenoidectomy\niii. Two years waiting period\na. Cataract | l. Gout and Rheumatism\nb. Benign prostatic hypertrophy | m. Calculus diseases\nc. Hernia | n. Surgery of gall bladder and bile duct excluding\nd. Hydrocele | malignancy\ne. Congenital internal anomaly (not applicable for | o. Surgery of genito-urinary system excluding\nNew Born Baby) | malignancy\nf. Fissure/Fistula in anus | p. Surgery for prolapsed intervertebral disc unless\ng. Piles (Haemorrhoids) | arising from accident\nh. Sinusitis and related disorders | q. Surgery of varicose vein\ni. Polycystic ovarian disease | r. Hysterectomy\nj. Non-infective arthritis | s. Refractive error of the eye more than 7.5 dioptres\nk. Pilonidal sinus Above diseases/treatments under 4.2.f).i, ii, iii shall be covered after the specified Waiting Period, provided they are not Pre Existing Diseases.\niv. Three years waiting period Following diseases shall be covered after three years of continuous cover from the inception of the Policy.\na) Treatment for joint replacement unless arising from accident\nb) Osteoarthritis and osteoporosis\nc) Morbid Obesity and its complications\nd) Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.","sources":[{"clause":null,"heading":"4.2. Specified Disease/Procedure Waiting Period (Excl 02)","page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-4-2-specified-disease-procedure-waiting-period-e"}],"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":"60 continuous months","note":"For enhanced Basic Sum Insured, 60 continuous months applies from the date of enhancement only 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":null,"heading":"5.6 Moratorium Period","page":13,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-5-6-moratorium-period"}],"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 may port the policy to other insurers by applying to the other insurer to port the entire policy with all family members, at least 15 days before but not earlier than 60 days from the renewal date. Accrued continuity benefits for specific waiting periods, pre-existing disease waiting period and moratorium period are carried over.","display":"Allowed, with continuity benefits, if applied at least 15 days before but 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 ... 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.","sources":[{"clause":null,"heading":"5.19 Portability","page":14,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-5-19-portability"}],"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 of the Insured Persons except covered Children","note":null,"quote":"The Policy can be renewed without break throughout the lifetime of the Insured Persons except for the covered Children","sources":[{"clause":"2.10","heading":"Renewal Terms","page":6,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13039#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":"No loading shall apply on renewals based on individual claims experience.","sources":[{"clause":"7(d)(vi)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-7-d-vi"}],"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":"quote-verified","value":["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)","Vitamins, Tonics (Excl 14)","Refractive Error (Excl 15)","Unproven Treatments (Excl 16)","Birth control, Sterility and Infertility (Excl 17)","Hormone Replacement Therapy","General Debility, Congenital External Anomaly","Self Inflicted Injury","Stem Cell Surgery","Circumcision","Vaccination or Inoculation.","Massages, Steam Bath, Alternative Treatment (Other than Ayurveda and Homeopathy)","Dental treatment","Domiciliary Hospitalization & Out Patient Department (OPD) treatment","Stay in Hospital which is not Medically Necessary.","Spectacles, Contact Lens, Hearing Aid, Cochlear Implants","Non Prescription Drug","Treatment not Related to Disease for which Claim is Made","Equipments","Items of personal comfort","Service charge/ registration fee","Home visit charges","War","Radioactivity","Treatment taken outside the geographical limits of India"],"display":"Permanent exclusions include Excl 04 to Excl 17 and product exclusions such as hormone replacement therapy, self-inflicted injury, stem cell surgery, domiciliary/OPD treatment, non-prescription drugs, personal comfort items, war, radioactivity and treatment outside India","note":null,"quote":"4.4. Investigation& Evaluation (Excl 04) 4.5. Rest Cure, Rehabilitation and Respite Care (Excl 05) 4.6. Obesity/ Weight Control (Excl 06) 4.7. Change-of-Gender Treatments (Excl 07) 4.8. Cosmetic or Plastic Surgery (Excl 08) 4.9. Hazardous or Adventure Sports (Excl 09) 4.10. Breach of Law (Excl 10) 4.11. Excluded Providers (Excl 11) 4.12. Drug/Alcohol Abuse (Excl 12) 4.13. Non Medical Admissions (Excl 13) 4.14. Vitamins, Tonics (Excl 14) 4.15. Refractive Error (Excl 15) 4.16. Unproven Treatments (Excl 16) 4.17. Birth control, Sterility and Infertility (Excl 17) 4.18. Hormone Replacement Therapy 4.19. General Debility, Congenital External Anomaly 4.20. Self Inflicted Injury 4.21. Stem Cell Surgery 4.22. Circumcision 4.23. Vaccination or Inoculation. 4.24. Massages, Steam Bath, Alternative Treatment (Other than Ayurveda and Homeopathy) 4.25. Dental treatment 4.26. Domiciliary Hospitalization & Out Patient Department (OPD) treatment 4.27. Stay in Hospital which is not Medically Necessary. ... 4.28. Spectacles, Contact Lens, Hearing Aid, Cochlear Implants 4.29. Non Prescription Drug 4.30. Treatment not Related to Disease for which Claim is Made 4.31. Equipments 4.32. Items of personal comfort 4.33. Service charge/ registration fee 4.34. Home visit charges 4.35. War 4.36. Radioactivity 4.37. Treatment taken outside the geographical limits of India","sources":[{"clause":"Row 6","heading":"Exclusions (what the policy does not cover)","page":2,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13128#c-row-6"},{"clause":null,"heading":"Customer Information Sheet","page":3,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13128#c-customer-information-sheet-2"}],"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 at any time by giving 7 days notice in writing. The company refunds proportionate premium for the unexpired policy period if no claim has been made, and no refund is made where any claim has been admitted or lodged or any benefit availed.","display":"Proportionate premium for unexpired period if no claim; no refund if a claim is admitted, lodged or any benefit availed","note":null,"quote":"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":"7(d)(ii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-7-d-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 insurance must be taken in India only.","display":"India only","note":null,"quote":"All medical treatment for the purpose of this insurance will have to be taken in India only.","sources":[{"clause":null,"heading":"5.8 Territorial limit","page":13,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-5-8-territorial-limit"}],"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":"conflicting","value":{"unit":"days","amount":30},"display":"30 days from date of receipt of the policy document","note":"Policy wording gives 30 days from date of receipt of the policy document. CIS says: \"within 30 days from the beginning of the policy.\"","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. ... You may cancel the insurance policy if you don’t want it, within 30 days from the beginning of the policy.","sources":[{"clause":null,"heading":"5.22 Free look period","page":15,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-5-22-free-look-period"},{"clause":"Row 6(d)(xiv)","heading":null,"page":7,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13128#c-row-6-d-xiv"}],"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":"30 days","note":null,"quote":"The Grace Period for payment of the premium shall be thirty days.","sources":[{"clause":"2.18","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-2-18"}],"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 entry age is 18 to 65 years, maximum entry age of any individual is 65 years, and children from 3 months to 18 years may be covered if parent(s) are covered at the same time.","display":"Children: 3 months to 18 years with parent(s); proposer: 18 to 65 years; maximum individual entry age: 65 years","note":null,"quote":"Entry age of proposer is between 18 (eighteen) years and 65(sixty-five) years.\niii) Maximum entry age of any individual is 65(sixty five) years.\niv) Children between the age of 3 (three) months and 18 (eighteen) years may be covered, provided parent(s) is/are covered at the same time.","sources":[{"clause":"2.2","heading":"Eligibility","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13039#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":["paid in full before the commencement of the policy"],"display":"Paid in full before commencement of the policy","note":"No monthly, quarterly or half-yearly instalment mode is stated.","quote":"Premium as per the premium table attached is to be paid in full before the commencement of the policy.","sources":[{"clause":"2.9","heading":"Payment of Premium","page":6,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13039#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":["Critical Illness","Outpatient Treatment","Optional Co-payment","Home Care","Non Medical Expenses"],"display":"Critical Illness, Outpatient Treatment, Optional Co-payment, Home Care and Non Medical Expenses","note":"Optional covers are available only if opted and paid for.","quote":"Optional covers\nCritical Illness | Benefit amount per individual - INR 2,00,000/ 3,00,000/ 5,00,000/ 10,00,000/ 15,00,000/ 20,00,000/ 25,00,000.\nOutpatient Treatment | Limit of cover per individual - INR 2,000/ 3,000/ 4,000/ 5,000/ 10,000.\nOptional Co-payment | 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\nAdd-on Covers\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":"Table of Benefits","page":18,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-table-of-benefits"}],"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":"Coverage is not available during the grace period.","display":"No cover during grace period","note":null,"quote":"Coverage shall not be available during the period for which no premium is received.","sources":[{"clause":"2.18","heading":"Grace Period","page":2,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-2-18"}],"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":"Plan A pays room charges up to 1% of Sum Insured per day. Plan B pays up to INR 15,000 per day and Plan C pays up to INR 20,000 per day.","display":"Plan A: Room up to 1% of SI per day; Plan B: up to INR 15,000 per day; Plan C: up to INR 20,000 per day","note":"The room/ICU limit does not apply if treatment is taken in a Preferred Provider Network as a package.","quote":"Room/ ICU charges | Room - Up to 1% of SI per day ICU – Up to 2% of SI per day subject to max. of INR 15,000 per day | Up to INR 15,000 per day | Up to INR 20,000 per day","sources":[{"clause":null,"heading":"Table of Benefits","page":18,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-table-of-benefits"}],"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-applicable","value":null,"display":null,"note":"The policy states room rent as a rupee or percentage limit, not as a room category such as shared or single private room.","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":"Plan A pays ICU charges up to 2% of Sum Insured per day subject to a maximum of INR 15,000 per day. Plan B pays up to INR 15,000 per day and Plan C pays up to INR 20,000 per day.","display":"Plan A: ICU up to 2% of SI per day, max INR 15,000 per day; Plan B: up to INR 15,000 per day; Plan C: up to INR 20,000 per day","note":"The room/ICU limit does not apply if treatment is taken in a Preferred Provider Network as a package.","quote":"Room/ ICU charges | Room - Up to 1% of SI per day ICU – Up to 2% of SI per day subject to max. of INR 15,000 per day | Up to INR 15,000 per day | Up to INR 20,000 per day","sources":[{"clause":null,"heading":"Table of Benefits","page":18,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-table-of-benefits"}],"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":null,"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 stated compulsory co-payment in the base cover. If the insured opts for Optional Co-payment, each admissible claim is subject to either 20% co-payment with 25% discount in total premium or 10% co-payment with 12.5% discount in total premium.","display":"None unless optional co-payment is chosen; optional 20% or 10% on each admissible claim","note":"Optional co-payment is chosen by the insured for a premium discount.","quote":"The Insured may opt for Optional Co-payment, with discount in premium. In such cases, each admissible claim under the Policy shall be subject to the same Co-payment percentage. Any change in Optional Co-payment may be done only during Renewal. Insured may choose either of the two Co-payment options:\n• 20% Co-payment on each admissible claim under the Policy, with a 25% discount in total premium.\n• 10% Co-payment on each admissible claim under the Policy, with a 12.5% discount in total premium.","sources":[{"clause":null,"heading":"5.5.7 Optional Co-payment","page":12,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-5-5-7-optional-co-payment"}],"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":"Not applicable.","display":"Not applicable","note":null,"quote":"iii. Deductible iv. Any other limit | Doctor’s home INR 750 INR 1,000 visit and nursing per per Not covered careduring post day,max. day,max. hospitalisation of 10 days of 10 days ... Not applicable Not applicable","sources":[{"clause":"Row 6(d)","heading":"Stem Cell Therapy","page":4,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13128#c-row-6-d"}],"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":["Limit for Cataract Surgery: Plan A for each eye up to 15% of sum insured or INR 60,000 whichever is lower; Plan B up to INR 80,000; Plan C up to INR 1,00,000","Maternity: Plan A up to INR 30,000 for normal delivery and INR 50,000 for caesarean section; Plan B up to INR 60,000 and INR 75,000; Plan C up to INR 80,000 and INR 100,000","Modern Treatment: up to 25% of SI for the related modern procedure/ component/ medicine","Treatment due to Participation in Hazardous or Adventure Sports (Non-Professionals): up to 25% of SI"],"display":"Cataract, maternity, modern treatment and non-professional hazardous/adventure sports have sub-limits","note":"Cataract limit does not apply if treatment is taken in a Preferred Provider Network as a package.","quote":"Limit for Cataract Surgery | For each eye – Up to 15% of sum insured or INR 60,000 whichever is lower | For each eye – Up to INR 80,000 | For each eye – Up to INR 1,00,000\nAYUSH | Up to Sum Insured | Up to Sum Insured | Up to Sum Insured\nOrgan Donor’s Medical Expenses | Covered | Covered | Covered\nMaternity (Covered after waiting period of 2 years) | Up to INR 30,000 for normal delivery and INR 50,000 for caesarean section | Up to INR 60,000 for normal delivery and INR 75,000 for caesarean section | Up to INR 80,000 for normal delivery and INR 100,000 for caesarean section ... Modern Treatment (12 nos) | Up to 25% of SI for the related modern procedure/ component/ medicine | Up to 25% of SI for the related modern procedure/ component/ medicine | Up to 25% of SI for the related modern procedure/ component/ medicine\nTreatment due to Participation in Hazardous or Adventure Sports (Non-Professionals) | Up to 25% of SI | Up to 25% of SI | Up to 25% of SI","sources":[{"clause":null,"heading":"Table of Benefits","page":18,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-table-of-benefits"}],"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":30},"display":"30 days","note":"Expenses must be for the same condition and the inpatient hospitalisation claim must be admissible.","quote":"The Company shall indemnify the Medical Expenses incurred up to 30 (thirty) days immediately before the insured person is hospitalised","sources":[{"clause":"3.1.2","heading":"Pre Hospitalisation","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-1-2"}],"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":"60 days","note":"Expenses must be for the same condition and the inpatient hospitalisation claim must be admissible.","quote":"The Company shall indemnify the Medical Expenses incurred up to 60 (sixty) days immediately after the insured person is discharged from hospital","sources":[{"clause":"3.1.3","heading":"Post Hospitalisation","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-1-3"}],"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 are covered when they require hospitalisation as an inpatient for less than 24 hours in a hospital or day care centre, but not in the outpatient department.","display":"Covered for day care treatments needing less than 24 hours hospitalisation, 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":"3.1.4","heading":"Day Care Procedure","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-1-4"}],"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 under the base policy.","display":"Not covered","note":"Home Care is listed separately as an add-on cover.","quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment.","sources":[{"clause":null,"heading":"4.26. Domiciliary Hospitalization & Out Patient Department (OPD) treatment","page":10,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-4-26-domiciliary-hospitalization-out-patient-dep"}],"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 treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy is covered up to the Sum Insured in any 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":"3.1.5","heading":"AYUSH Treatment","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-1-5"}],"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":"Specified modern treatments are covered for inpatient care or day care with pre and post hospitalisation expenses, subject to 25% of the Sum Insured for the related modern procedure, component or medicine during the policy period.","display":"Covered up to 25% of Sum Insured for each related modern procedure/component/medicine","note":null,"quote":"The Company shall indemnify the Medical Expenses for In-Patient Care or Day Care Procedure along with pre hospitalisation expenses and post hospitalisation expenses incurred for following Modern Treatments (wherever medically indicated), subject to the limit of 25% of the Sum Insured for the related modern procedure/ component/ medicine of each Modern Treatment during the Policy Period.\nModern Treatment | Coverage\nUAE & HIFU | Limit is for Procedure cost only\nBalloon Sinuplasty | Limit is for Balloon cost only\nDeep Brain Stimulation | Limit is for implants including batteries only\nOral Chemotherapy | Only cost of medicines payable under this limit, other incidental charges like investigations and consultation charges not payable.\nImmunotherapy | Limit is for cost of injections only.\nIntravitreal injections | Limit is for complete treatment, including Pre & Post Hospitalization\nRobotic Surgery | Limit is for robotic component only.\nStereotactic Radio surgeries | Limit is for radiation procedure.\nBronchial Thermoplasty | Limit is for complete treatment, including Pre & Post Hospitalization\nVaporization of the prostrate | Limit is for LASER component only.\nIONM | Limit is for IONM procedure only.\nStem cell therapy | Limit is for complete treatment, including Pre & Post Hospitalization","sources":[{"clause":null,"heading":"3.1.16 Modern Treatment","page":7,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-1-16-modern-treatment"}],"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":"quote-verified","value":"The policy covers an organ donor's hospitalisation medical expenses during the policy period for harvesting the organ donated to an insured person, if the insured person's inpatient organ transplant claim is admitted.","display":"Covered for donor hospitalisation expenses for harvesting the organ","note":"Acquisition, experimental transplant, donor complications after harvesting, and organ transportation or preservation expenses are excluded.","quote":"The Company shall indemnify the Medical Expenses incurred in respect of an organ donor’s Hospitalisation during the Policy Period for harvesting of the organ donated to an Insured Person, provided that: ... Claim has been admitted under In-patient treatment Section in respect of the Insured Person undergoing the organ transplant.","sources":[{"clause":"3.1.6","heading":"Organ Donor’s Medical Expenses","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-1-6"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Road ambulance is covered up to INR 2,500 in Plan A, INR 4,000 in Plan B and INR 5,000 in Plan C per policy period. Air ambulance is not covered in Plan A and is covered up to 5% of SI per policy period in Plans B and C.","display":"Road ambulance: INR 2,500/4,000/5,000 by plan; air ambulance: not covered in Plan A, up to 5% of SI in Plans B and C","note":"Both require an admitted claim under the In-patient treatment Section; air ambulance also requires prior intimation.","quote":"Ambulance | Up to INR 2,500 in a policy period | Up to INR 4,000 in a policy period | Up to INR 5,000 in a policy period\nAir Ambulance | Not covered | Up to 5% of SI per policy period | Up to 5% of SI per policy period","sources":[{"clause":null,"heading":"Table of Benefits","page":18,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-table-of-benefits"}],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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":"At renewal, cumulative bonus increases by 5% of sum insured excluding CB if no claims were reported and admitted under the expiring policy. If a claim was reported, CB is reduced by 5% of sum insured excluding CB, and total CB is capped at 50% of sum insured excluding CB.","display":"5% increase per claim-free year, maximum 50%; reduced by 5% after a claim","note":null,"quote":"At the time of renewal, cumulative bonus allowed shall be an amount equal to 5% (five percent) of sum insured (excluding CB) of the expiring policy in respect of an insured person, provided no claims were reported and admitted under the expiring policy. In the event of a claim being reported under the expiring policy the cumulative bonus with respect to the insured person shall be reduced by an amount equal to 5% (five percent) of sum insured (excluding CB) of the expiring policy. However, the reduction of CB will not impact sum insured (excluding CB). Cumulative bonus shall be aggregated over the years and available, subject to maximum of 50% (fifty percent) of the sum insured (excluding CB) of the expiring policy.","sources":[{"clause":null,"heading":"3.2 GOOD HEALTH INCENTIVES","page":7,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-2-good-health-incentives"}],"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 policy says List I items have no coverage, while List II, List III and List IV items are subsumed into room charges, procedure charges or costs of treatment.","display":"List I not covered; List II, III and IV items are subsumed into room, procedure or treatment costs","note":"Non Medical Expenses is also listed as an add-on cover for SI 5 lacs and above.","quote":"Note: The expenses that are not covered in this policy are placed under List-l of Annexure-II of the Policy. The list of expenses that are to be subsumed into room charges, or procedure charges or costs of treatment are placed under List-II, List-III and List-IV of Annexure-II of the Policy respectively ... List I – List of which coverage is not available in the policy ... List IV – Items that are to be subsumed into costs of treatment ... 56 | GLOVES","sources":[{"clause":null,"heading":"3.1.18 Correction of Refractive Error","page":7,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-1-18-correction-of-refractive-error"},{"clause":"Annexure II","heading":null,"page":20,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-annexure-ii"}],"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 expenses are covered for a female insured person after 24 months of continuous cover. Limits are Plan A INR 30,000 for normal delivery and INR 50,000 for caesarean section, Plan B INR 60,000 and INR 75,000, and Plan C INR 80,000 and INR 100,000.","display":"Covered after 24 months; Plan A INR 30,000/50,000, Plan B INR 60,000/75,000, Plan C INR 80,000/100,000","note":"Exclusions include delivery or termination within the 24-month waiting period except accident-induced delivery, miscarriage or abortion, and limits on number of deliveries or terminations.","quote":"The female Insured Person should have been continuously covered for at least 24 months before availing this benefit. ... Maternity (Covered after waiting period of 2 years) | Up to INR 30,000 for normal delivery and INR 50,000 for caesarean section | Up to INR 60,000 for normal delivery and INR 75,000 for caesarean section | Up to INR 80,000 for normal delivery and INR 100,000 for caesarean section","sources":[{"clause":"3.1.7","heading":"Maternity","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-1-7"},{"clause":null,"heading":"Table of Benefits","page":18,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-table-of-benefits"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"quote-verified","value":"The newborn baby is automatically covered from birth under the Sum Insured available to the mother during the corresponding policy period, up to 3 months of age. After 3 months, the baby is covered only if specifically included mid-term and requisite premium is paid.","display":"Automatically covered from birth up to 3 months under mother's available Sum Insured","note":null,"quote":"The New Born Baby shall be automatically covered from birth under the Sum Insured available to the mother during the corresponding Policy Period, for up to 3 months of age. On attaining 3 months of age, the New Born Baby shall be covered only if specifically included in the Policy mid-term and requisite premium paid to the Company.","sources":[{"clause":"3.1.7","heading":"Maternity","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-1-7"}],"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 in a hospital with a specific department for mental illness and under a qualified psychiatrist or specified AYUSH mental health professional.","display":"Covered for hospital treatment of mental illnesses with qualified specialist","note":"Psychological counselling and psychotherapy not requiring hospitalisation are not covered.","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.","sources":[{"clause":null,"heading":"3.1.15 Mental Illness Cover","page":6,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-1-15-mental-illness-cover"}],"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":"Health check-up expenses are reimbursed irrespective of past claims at the end of a block of two continuous policy periods if the policy has been continuously renewed without a break. Limits are Plan A INR 1,000, Plan B INR 2,000 and Plan C INR 3,000 every 2 years.","display":"Every 2 years: Plan A INR 1,000, Plan B INR 2,000, Plan C INR 3,000","note":null,"quote":"Expenses of health check up shall be reimbursed (irrespective of past claims) at the end of a block of two continuous policy period, provided the policy has been continuously renewed with the company without a break. Expenses payable is subject to the limit as stated in the Table of Benefits. ... Health Checkup | Every 2 yrs., up to INR 1,000 | Every 2 yrs., up to INR 2,000 | Every 2 yrs., up to INR 3,000","sources":[{"clause":null,"heading":"3.2.2 Health Check Up","page":8,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-3-2-2-health-check-up"},{"clause":null,"heading":"Table of Benefits","page":18,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-table-of-benefits"}],"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 under the base policy. If the optional Out-patient treatment cover is bought, it covers outpatient consultations, prescribed diagnostic tests, prescribed medicines/drugs and outpatient dental treatment up to the selected limit.","display":"Base OPD excluded; optional Out-patient treatment cover available up to INR 2,000/3,000/4,000/5,000/10,000","note":"Optional OPD applies only if mentioned in the policy schedule and paid for.","quote":"Any expenses incurred on Domiciliary Hospitalization and OPD treatment. ... Subject otherwise to the terms, definitions, conditions and Exclusions 4.7, 4.8, 4.18, 4.16, 4.24, 4.12, 4.9, 4.10, 4.35 and 4.36, and subject to the terms, definitions, exclusions, and conditions contained herein, it is hereby understood and agreed that the company shall pay up to the limit, as stated in the schedule with respect of\ni) Out-patient consultations by a medical practitioner\nii) Diagnostic tests prescribed by a medical practitioner\niii) Medicines/drugs prescribed by a medical practitioner\niv) Out patient dental treatment ... Outpatient Treatment | Limit of cover per individual - INR 2,000/ 3,000/ 4,000/ 5,000/ 10,000.","sources":[{"clause":null,"heading":"4.26. Domiciliary Hospitalization & Out Patient Department (OPD) treatment","page":10,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-4-26-domiciliary-hospitalization-out-patient-dep"},{"clause":"7.2","heading":"Out-patient treatment","page":17,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-7-2"},{"clause":null,"heading":"Table of Benefits","page":18,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-table-of-benefits"}],"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 treatment can be availed if TPA service is opted. Treatment may be in a network provider, PPN or non-network provider and is subject to TPA pre-authorisation.","display":"Available if TPA service is opted, subject to pre-authorisation by the TPA","note":null,"quote":"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":null,"heading":"5.5.2 Procedure for Cashless claims","page":11,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-5-5-2-procedure-for-cashless-claims"}],"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":"The proposer may choose claims to be serviced by a TPA or by the company. If TPA is chosen, cashless and reimbursement are available; if the company is chosen, expenses are reimbursed, and the TPA may process and recommend but does not settle or reject claims.","display":"TPA if opted; otherwise the company","note":null,"quote":"The proposer has the option of claims being serviced by TPA (in which case cashless facility/reimbursement of expenses will be available) or the company (in which case expenses will be reimbursed). ... The services offered by a TPA shall not include\ni. Claim settlement and rejection with respect to the policy; However, TPA may handle claims admission and recommend to the company for the payment of the claim settlement","sources":[{"clause":"2.9","heading":"Payment of Premium","page":6,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13039#c-2-9"},{"clause":null,"heading":"5.5.6 Services offered by TPA","page":12,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945#c-5-5-6-services-offered-by-tpa"}],"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 sum insured basis","note":"The product document is for the Individual Plan and states individual sum insured basis.","quote":"Policy can be issued to individuals on individual sum insured basis.","sources":[{"clause":"2.2","heading":"Eligibility","page":5,"url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13039#c-2-2"}],"law":[]}],"documents":[{"kind":"wording","label":"NMPP Wordings","pages":21,"fetched_at":"2026-10-17 19:55:09+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMPP%20Wordings.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/12945"},{"kind":"prospectus","label":"NMPP Prospectus","pages":22,"fetched_at":"2026-10-17 19:57:49+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMPP%20Prospectus.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13039"},{"kind":"cis","label":"NMPP CIS","pages":9,"fetched_at":"2026-10-17 20:00:36+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMPP%20CIS.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/13128"},{"kind":"premium","label":"NMPP Rate Chart","pages":null,"fetched_at":"2026-10-17 19:51:07+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMPP%20Rate%20Chart.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/30360"},{"kind":"proposal","label":"NMPP Proposal","pages":null,"fetched_at":"2026-10-17 19:59:52+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMPP%20Proposal%20Form.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/30378"},{"kind":"claim-form","label":"NMPP Claim Form","pages":null,"fetched_at":"2026-10-17 20:01:01+00","source_url":"https://nationalinsurance.nic.co.in/sites/default/files/2026-04/NMPP%20Claim%20Form.pdf","url":"https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425/document/30395"}],"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 Plus Policy (Individual Plan) (UIN NICHLIP25038V032425), IndiaInsurances, https://indiainsurances.com/policy/national-insurance/national-mediclaim-plus-policy-individual-plan-nichlip25038v032425"}