Mera Mediclaim Plan

Mera Mediclaim Plan is a health plus life insurance plan offered by PNB MetLife, in association with a health insurance company, Care Health Insurance Limited. Mera Mediclaim Plan also covers the health expenses of the family of the life assured.

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The plan aims to protect its buyers from financial difficulty arising due to any medical emergency or the death of the life insured. Mera Medical plan includes complimentary health check-ups for the policyholder and family to keep the beneficiaries' health in regular check.

Salient Features of Mera Mediclaim Plan

Sr. No.

Description 

Feature 

Premium discount

7.5% discount on combined premiums 

2

Medical treatments

Cashless medical treatments available at more than 7500 hospital networks.

3

Increments in health cover

The health cover increases to 250% in two claim-free years with NCB-super

Floaters

1 adult + 1 child or 1 adult + 2 children or 1 adult + 3 children or 1 adult + 4 children or 2 adults + 1 child or 2 adults + 2 childre or 2 adults + 3 children or 2 adults + 4 children

Automatic Recharge

Sum insured is automatically recharged for the next claim after availing the health claims with a specific layout

Benefits

There are several benefits related to the Mera Mediclaim Plan, which one can avail of during and at the end of the policy tenure. Some of the primary benefits relating to this plan are:

  1. Life Assurance

    The insurer will pay a death cover to the family of the life insured upon the untimely demise of the policyholder. This benefit will be provided to the beneficiaries smoothly and without causing any obstruction to the same.

    According to the policy option selected for the sum assured by the life insured under the Mera Mediclaim Plan, the amount provided upon death will be according to the payout option selected at the time of policy purchase.

  2. Health Check-Up

    The Life Insured, along with the family covered under the Mera Mediclaim Plan are provided with annual medical check-ups so that any uncertainty can be detected at the earliest.

  3. Hospitalization Expenses

    Medical bills are covered under this policy for more than 540 daycare treatments. In addition, cashless hospitalization is available for more than 7500 hospital networks across India.

  4. NCB Bonus

    If one is able to go for straight five years of the policy tenure without availing any claim whatsoever, the sum insured is increased up to 150% for the said 5 claim-free years.

  5. Tax Benefits

    Payable premium falls under Section 80C and 80D of the Income Tax Act of 1961. The rebate has a limit of Rs 1.5 lakhs.

    “Tax benefit is subject to changes in tax laws. Standard T&C apply.”

Premium Illustration

Premium payments under Mera Mediclaim Plan are calculated on an annual basis. An illustration with specific conditions is given below to understand the basic premium requirements.

Let’s say a 35 years old male wants to assure his life and health, so he buys the Mera Mediclaim Plan for a policy tenure of 30 years which makes him liable to pay the premiums up to 65 years of age. 

Policy term: 30 years

Sum assured for life: Rs. 25 lakhs

Sum assured for health: Rs. 10 lakhs

Annual premium (life): Rs. 7,600

Annual premium (health): Rs. 7,705 (lifelong renewable)

Combined discount: Rs. 1,148

Annual combined payable premium: Rs. 14,157

Notes:

  • Illustration is only applicable to the principal life
  • Premium may increase with entering a higher age group
  • The amount is given in exclusion with taxes
  • Refer to the policy brochure for detailed information regarding payment flexibilities

Rider Options

One can add numerous additional riders to the basic policy structure to avail of the extra benefits according to personalized needs.

Premium Returns

If one chooses the policy with the return of premium option and survives the entire policy tenure, then he or she can avail of the maturity benefit equal to the sum assured.

Along with this, several other riders are given in a list format below:

  • Global Coverage
  • Travel Plus
  • Unlimited Automatic Recharge
  • NCB Super
  • Deductible Premium Rider
  • Daily Allowance Plus

Eligibility Criteria

Indian nationals are eligible to apply for the Mera Mediclaim Plan. In addition to being an Indian national, one will need to fulfil some additional requirements.

There are two parts of the policy with different eligibility requirements, which are:

  • Minimum entry age: 18 years
  • Maximum entry age: 65 years
  • Minimum policy maturity age: 28 years
  • Maximum policy maturity age: 80 years
  • Minimum policy term: 10 years
  • Maximum policy term: 40 years

What Are the Documents Required To Buy the Plan?

As discussed earlier, all Indian nationals are eligible to buy the Mera Mediclaim Plan, so relative documents listed below can be shown to apply for this plan.

  • Filled up the application form
  • Passport size photographs
  • Address proof
  • Identity proof
  • Age proof
  • Bank details

How To Buy the Mera Mediclaim Plan Online?

One can follow a straightforward online procedure to purchase this plan from the comfort of their homes. And the procedure is similar to the primary method used to fill any online application.

The stepwise procedure is as below:

  • Go to the online portal that is equipped with the Mera Mediclaim Plan online buying option.
  • Read all the instructions laid down on the platform before proceeding.
  • Select the buy online option to proceed further.
  • An online application form will appear.
  • Fill the application form with authentic credentials
  • Click on next and proceed further.
  • Scan and upload all the mentioned documents.
  • Enter your health details that are asked on the platform.
  • Select the most suitable plan option in your premium payment capacity.
  • Proceed further for online payments.
  • Pay the specified amount to complete the online purchasing process.

Exclusions

There are certain exclusions under which the insurer is not liable to pay anything to the insured for specifically agreed reasons. 

Some of those reasons are:

  1. Medical expenses under the first 30 days of the policy

    The insurer shall not pay treatment costs relating to the first 30 days of the policy unless the claims are due to an accident.

  2. Treatment costs relating to gender changing surgeries

    The expenses arising due to surgery to alter the gender characteristics to that of an opposite-sex can not be claimed under any circumstances.

  3. Overdose of drugs or alcohol

    If a medical emergency is caused due to the insured person overdosing on drugs or alcohol, then such medical bills are not claimable. Even if a person dies due to the said reasons, the beneficiaries can’t make the claims to cover death benefits.

  4. Death due to Suicide

    In case of the life assured committing suicide within the first 12 months from commencement of the policy tenure, 80% of the sum assured up to the suicide date or surrender value available at the time of death due to suicide will be paid to the family considering the higher value among both. This sum shall not include any interest rates whatsoever.

  5. Treatments relating pregnancy and infertility

    Medical bills caused while treating pregnancy or childbirth, abortion, miscarriage, infertility, etc., are not covered under the Mera Mediclaim Plan. However, one can ask the insurer if these facilities are available as a rider option.

  6. Medical conditions present from birth

    A person suffering from a congenital disease cannot claim any medical expenses related to that condition.

FAQ's

  • Q. Can you claim a medical expense for plastic surgery under this policy?

    Ans: No, this policy doesn't cover cosmetic plastic surgery expenses, but if the surgery is essentially needed to treat an accident, burn, or cancer, and it becomes a medical necessity, then one can claim for the same.
  • Q. What are the premium payment intervals I can opt for under this plan?

    Ans: One can go for three different payment modes yearly, half-yearly, and monthly according to your convenience. One can also request to change the existing mode on every annual completion of the policy.
  • Q. What are the treatment methods other than allopathic that are covered under this policy?

    Ans: The insurer understands that sometimes treatments can only be effective when done in combination with allopathic and other medical fields to ease the condition. So, this policy covers the medical disciplines named Ayurveda, Unani, Sudha, and Homeopathy for a specific limit and varies for different plans. But you can only claim these expenses for treatment from any government-recognized facility rather than private hospitals.
  • Q. What are the documents required to make a medical claim?

    Ans: The complete list of documents is as follows:
    • Duly filled claim form signed by the insured
    • Photo ID copy of the insured
    • Doctor's referral letter in which he has advised hospitalization
    • Original medical bills, receipts, and discharge letter from the hospital
    • Original pharmacy bills
    • Operation theatre letters, if any
    • Ambulance receipt
    • Any other document relating to claim assessment
  • Q. Can I cancel the policy from my end?

    Ans: Yes, the policy can be cancelled from one's end by giving a 15 day written notice to the insurer. There will be some refund for the unexpired policy period, the details of which one can find on the policy brochure.

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