National Senior Citizen Mediclaim Policy

With advancing age, people tend to be more exposed to health issues and require wide medical coverage. Health plans for senior citizens aim to provide financial assistance and ease the burden of healthcare expenses for them. This blog will explore the types of plans, key features, and the cashless claim process of the National Senior Citizen Mediclaim Policy. This will help you make an informed decision when choosing a suitable plan for yourself or your loved ones.

Understanding Senior Citizen Mediclaim Policy

The National Senior Citizen Mediclaim Policy (NSCMP) is a health insurance policy for senior citizens offered by the National Insurance Company Limited (NICL). The policy covers expenses, including inpatient treatment (allopathy, ayurveda, and homeopathy), domiciliary hospitalisation, and any treatment of a disease or an injury sustained during the policy period.

Eligibility criteria for this policy are divided into two grounds: individual basis and floater basis.

On Individual Basis

• Senior citizens aged 60 to 80 years (self only)
• Senior citizens aged 60 to 80 years and their spouses (both aged 60 to 80 years)

Floater Basis

• Senior citizens aged 60 to 80 years and their spouses (aged 50 to 80 years)
• Senior citizen's parents (one or both parents aged 60 to 80 years)

Types of Plans Under the National Senior Citizen Mediclaim Policy

There are two plans offered under the National Senior Citizen Mediclaim Policy.

Plan A covers expenses up to the sum insured for inpatient treatment, pre-hospitalisation, post-hospitalisation, domiciliary hospitalisation, and daycare procedures. Plan B covers all the expenses covered in Plan A, as well as additional expenses for hospital cash, ambulance charges, doctor's home visits, nursing, aya, attendant charges during post-hospitalisation, funeral expenses, and regular medical consultation charges.

The policy also offers a variety of sum insured options from ₹1 lakh to ₹10 lakhs. It also has a variety of optional covers available, such as pre-existing diabetes and/or hypertension, outpatient treatment, critical illness, and personal accident.

Benefits of the National Senior Citizen Mediclaim Policy

There are a number of advantages that you can avail of from the National Senior Citizen Mediclaim Policy. Let us take a look at a few of them:

Hospitalisation Coverage and Cashless Facility

One of the advantages of this policy is the hospitalisation coverage it offers. This means that if you or your family needs to be hospitalised, the policy will help cover the expenses. For added convenience, many insurers offer a cashless facility wherein you can avail of treatment without shelling out any dough upfront.

Pre Hospitalisation Expenses

We all know that medical expenses don't start and end with a hospital stay. There are often costs involved before and after the main event, and thankfully, NSCP has your back. Suppose you have a medical condition that requires hospitalisation, and you incur medical expenses related to that condition within 30 days of your hospitalisation. In that case, the insurance company will refund you for those expenses. This is applicable even if you are not hospitalised for the full 30 days.

Ambulance Services and Emergency Medical Assistance

Speaking of ambulances, did you know that some policies also cover the cost of ambulance services? The policy offers to pay for your ambulance ride to and from the hospital, as well as to and from any diagnostic centres you need to visit during your hospitalisation. It will pay up to ₹2,500 for ambulance charges per illness for each person insured under the policy.

Procedure for Cashless Claims

Cashless claims can be made if you have opted for TPA (Third-party Assistance) service and are treated at a network provider. You need to follow certain steps for your cashless claim:

• You must take treatment at a network hospital and get pre-authorisation from the TPA. A list of network hospitals is available on the website of the insurance company and the TPA.
• You must complete and submit the cashless request form to the TPA for authorisation. The form is available with the network hospital and the TPA.
• Once the TPA receives the cashless request form and related medical information, it will issue a pre-authorisation letter to the hospital after verification.
• At the time of discharge, you must verify and sign the release papers and pay for any non-medical and inadmissible expenses.
• The TPA can deny pre-authorisation if the insured person or the network hospital cannot provide any required details.
• If the TPA denies pre-authorisation, you can still obtain treatment per your doctor's advice and submit the necessary documents to the TPA to reimburse your claim.

Way Forward

In these uncertain times, the National Senior Citizen Mediclaim Policy is a reliable option, providing financial security to senior citizens and their families. By embracing this policy, individuals can secure a healthier, more confident future in their golden years.