National Insurance- Varishtha Mediclaim Policy for the Golden Years

Varistha Mediclaim for Senior Citizens Policy by The National Insurance Company is designed to help the senior citizens and ensure that they are never short of coverage for their medical expenses whenever it is required. They can rest assured that the medical expenses incurred will not dent their financial health even when some critical illness strikes. Varishtha Mediclaim for senior citizens has seniors covered for even pre-existing conditions, namely, diabetes and hypertension coverage paying an additional premium.  

Who can buy the Varishtha Mediclaim for Senior Citizens Policy?

The policy is meant for senior citizens between 60 and 80 years of age. They can buy National Insurance Company’s Varistha Mediclaim Policy online until they are 80 years of age, while they can continue to renew the Varistha Mediclaim Policy until 90 years. Policyholders need to renew the policy each year to stay covered as it gives a one-year fixed-term coverage.

What is the amount of Coverage Under the Policy?

The policy is offered in two options with Rs. 1 Lakh and Rs. 2 Lakhs as the sum insured.

What are the Benefits of the Policy?

• Cashless facility for treatment across the network hospitals.
• Reimbursement of expenses incurred in treatment in non-network hospitals.
• Hospitalization medical expenses coverage for 30 days before hospitalization and 60 days post-hospitalization.
• Room, boarding expenses up to 1% of the sum insured for each day, 2% for admission in ICU and the maximum overall coverage up to 25% of sum insured for every illness.
• Covers expenses towards nursing, surgeon’s fees, consultant, anesthetist, consultants, etc. up to 25% of the Sum Insured for every illness.
• Costs of surgical anesthesia, appliances, OT, oxygen charges up to 7% of Sum Insured are also covered.
• Costs of medicines, X-Ray, diagnostic material, pacemaker, dialysis, radiotherapy, artificial limbs, chemotherapy, stent and implants up to 50% of Sum Insured for every illness.
• Domiciliary treatment expenses covered up to 20% of the basic sum insured
• Ambulance charges up to Rs 1000 for each year.
• Health check-up costs on renewal up to 2% of Sum Insured after three claim-free years in a row
• Pre-existing diabetes and hypertension coverage from the policy start date
• Treatment of critical Illnesses like Coronary Artery Surgery, renal failure, cancer, multiple sclerosis, stroke and major organ transplants like bone marrow, kidney, pancreas, and lung.
• Paralysis and blindness can be covered with extra premium.
• Covers paralysis and blindness at an extra premium of 15% for either of them or 25% additional premium for both.

Does the policy Come with any No Claims Bonus?

No claim bonus can be availed at 5% up to a maximum of 50% for each free year without a claim on renewal. Alternatively, this bonus can also be added to the sum insured with policy renewal.

Is a Medical Check-up Required Before Buying the Policy?

The Varistha Mediclaim Policy does not require a prior medical check-up if the applicant is covered by any health insurance plan for the last three years. A prior medical check-up is, however, required for others.

Does the policy require co-payment of claims?

The policy requires 10% co-payment of all claims and an additional 10% co-pay for claims related to pre-existing diseases.

What are the no Claim Period Requirements of the Policy?

The coverage of pre-existing illnesses starts after one year. The one year period also applies to certain conditions like cataract, piles, and hernia. There are 30 days no claim period for general conditions and  90 days no claim period for critical illnesses.

What Tax Benefits Can be Claimed Under the Policy?

The policyholder can claim tax benefit under Section 80D of the Income Tax Act.

What Medical Expenses are Excluded Under the Policy?

The policy does not cover expenses incurred on dental expenses, cosmetic surgery, visual aid, vaccination, hearing aid, HIV/AIDS. Policyholders also cannot claim the expenses on diagnostic tests that are not related to any disease, vitamins and tonics, pregnancy, and naturopathy treatment.

What are the Requirements for Admissibility of Claims by Smokers?

If the insured person smokes more than 40 cigarettes/cigars a day or has equivalent tobacco intake, the claim will not be payable.

What are the Other Circumstances for Non-Payment of any Benefit to an Insured Individual?

Critical illness arising out of ingestion of drugs other than those prescribed, drug addiction treatment medicines prescribed or not, suicide attempt, or any self-inflicted injury. Also, AIDS, HIV will broadly be interpreted to include all mutants, derivatives, or variations for non-payment. Any illness or injury from nuclear weapons/materials, ionizing radiation, and conditions from war, invasion, hostilities, civil war, etc. will not be liable for benefits/payment under the policy.

How are Claims Settled?

The insured person or his/her representative shall inform the TPA (Third Party Administrator) in writing by letter, e-mail, or fax furnishing all relevant information relating pertaining the claim including a plan of treatment, policy number, etc. within the prescribed time limit. The TPA is a third party, which is licensed by the IRDA (Third Party Administrators - Health Services) Regulations, 2001. The TPA is engaged, by the company for a fee for providing health services.

Summing it Up

For most of us, the golden years are a time to relax and take it easy, and the last thing weighing on the mind should be the funds required to meet the increasing medical expenses. The National Insurance Company’s Varistha Mediclaim for Senior Citizens goes a long way in addressing the concerns around treatment, tests, hospitalization, and other medical procedures, interventions, etc. Though advances in medicine have made it possible to ensure that the snow on the roof does not extinguish the fire in the belly, the worth of a health insurance plan cannot be denied.