National Insurance Company Limited (A Gow. of India Undertaking) Aoga,Ofoe: 3, Mdeeton Stee, Kolkata. 700071 National Mediclaim Policy PROSPECTUS: 1.1 Product The poloy coves hasptlsaton expenses (cashlesseinbursemert) reasonably and necesstly incured for ueatment of iessisee66 oF inuy contacedssiined dung te poy ped. The poly lo covers 14 daycare poceduressurgeres, expenses for 30 cay of prehosptasaton and 60 daysct posthesptalsaton. 1.2Coverage Ab Miter tga bosptasaton morethan24hrssbjecttofolowingsublims Room, boaragincudng nung care, RMO charges, adrnieraton charges rl ful tleod rants ijton~26% of cum neue foranyoneiness| oom charges Lim: % of sum insured per day subeco maximum ot 85,000. ICU chargesLimt: 2:0! suminsuredper cay subjecttomaximumet %10,00 b-“Mesialpracttone’, surgeon anaesthetist consultants specials’ fees-25%4etsuminsuedtor ary neiiness Anaesthesia ood oxygen, OT charges, sujal applance, meine, cuss, ila, agnostic tests, organ donors expenses, ambulance |U~ Charges-£0%ofsuminsured for any oe less (Ambulance cnarges - 1% of sum insured subjeetto amaximum 22,000in a policy period) car procedures ~ Expenses for 140+ daycare procedures, std inte policy, which requ lessthan 24hourshosritalsaton {Fe ane post hospasaton— Expenses latedto meical agnosis or procedure tat resutednhospialstin an inced duing the patio po 20 ‘ays pert hosptalsation and up t 60 days ater diszrarge tom hespal Pre & post hosptalsaton expenses wil be considered as par of nospltalisaondam 1 -Arveta ant omeorany-20%otsumineterany oneness 1.3Goodhealthincentives 1.3 Cumulativebonus (8) Suminsurd (etcuing CB) wie nreased by Sein respect of each cam ee pole perio (ro clans are reported), povided he poy i contrucusy renewed vith he company thou break sbjcto maximumot 50% ofthe suninsued (exuding CB) under the cue poly peo. Incas faim under the poy in respect nsuedpersn who has eamed the CB, the increased percentage (CB) willbe reduced by 5% of suminswred (excusing (Bente next enewal However sun nsured exuding CB ibe tained ard not be reduced. pg }42Heatt checkup Eipensesotheath checiup willbe rimbursed once the endctaback af ourcantrucus poe pera provcedno isis are repoted dung he block andthe pelcy has been cofnuously renewed wi the company without a break Expenses payable is a maximum of 14 of the average sum insured (excluding CB) the Block. Climfor heath checkup benefits maybe lodged atleast 45 caysbefore the exp cfthetth poy period “Thepolcy proves forcaslssfacity ana orrsmbursementt hosptalcaton expenses veatentot seca loess eri. ‘astiess ey is avaiable on in netcrk roi, opted fr TPA service subjet pie approval bythe TPA. Prelered Provider Network (PP) is a hospital whichhas agreed aceshless paclaged acing lor ear procedes rte insuredperees, The isis avaiable wthihecompany/TPAardswojecttoamenerent ‘romtmetoime 2. Other bones *P 2:1. Famiyazcount Desa betes hve iy sbigtaancnotghehsepeaeand ay cnoro a lan antes mene 2 i, Spouse i. Depannthiren i, Dependentparets 2igTaxreate | insuredperson can availtaxbevaitsforthe premium, under Secon 600 of income TaxAct 1961 4 22aiity i, Polsycanbe avaledby personsbetween he age of 1 years and 6Syeas. i, Chierentbetneenthe age of months and 18 years maybe covered, provided parent) larecovered atin saretime i, Polgycan be avaledfoselfand th folowing family members & Spouse . _Dependentlegimat orlegaly adopted chidren Dependent chidupto 18 yearsofage ‘Dependent male chi above 18 yeas andupio2§, fabonaide student andnotemployed Dependent female chiinot employe, itmariage Parents tag semrie esse debe Bis WEP Pat exrrting decisis are rod4, Broterupto25yearsitabona ide studentandnotempoyed , Sistrinotemloye, mariage fParenviniaws iv, Miterminclsion cffemiymerbers atproatapremiumisalowedoniyincaseot . _nenbom between the age otSrmonns and months b. spousewithin 9daysofmariage (Family menbers tera aboveraybe included oly arerewal \.Thepoicyselsoavaabet senior ciizens coveredtor Sl between® 15 000and€ 45,000, optingfor higher Sibetween'*50,000 and 5,0, 000 23Suminsured(S}) |. TheSloptons avaiable range from? 50,0000 6,00,000inmutipleot% 25,000. ji The proposer has te opin of selecting same SI or each amily member or separate Sir cferent members, li, Senior otizens covered or SI between & 15,000 and €45,000in mute of 5,000 may conte wth the same sum nsuredon renewal ut subjecttothe revisedpreniumrates Iv. Slbetween® 15 000and®45,000isnctavaiableto seniorctizens whotake the poy ota ist ime. 24 Enhancementofsuminsured i. Suminsuredcanbe enhancedonlyetthetimeofrenewal. li, Suminsuredcanbe enhanced upto 5,00, 000, subjectto discretion ofthe Company. i Forthe incremental portion of the Si, the wating periods and conto as mentioned in excision 4.1, 4.2, 4.3 will apply. Coverage on enhanced sum insuredwillbe avaiable ater tre compton of wang pods, 25Policy period ‘Thepolicyisissuedforapecodotoneyear. 2.BuyingthePoicy ‘The policy can be bought i ‘nine rombitainicaninein/ for proposer andinsured person upto50 years of age i avaling Policy forthe fist time i, fremeuroties ii, ——Fomouragents 27 Completion of proposal form |. Treproposalfomis tobe completedin ll respects (ncluding persona detail, reticalhstor fingured person) and tobe submitedto the ofceortothe agent li a persons insured under heath insurance pacy of any oer non if insurance company and wants to pr (Svte) to National Medica Policy, the poriltyandroposaltorn wilhavetobe completedand submitiedtothe offeeortothe agent. li. Incase ot senior ettzens coveredtor Si between 15,000 and 45,000 opting or ahigher Sibetween® 50,000 and®5,00,000 he proposalformillhave ‘obecompleted and ubmitedtotheoffesortothe agent 2.8Prepolicy checkup |. Prepolicy checkup srequiradtor persons 50 years and above, avaling the ply fc theft ime, ncucing midterm inclusion. ii Pre policy checkups not required in case cf persons 50 years and above, ping om any nome insurance compary provided the previous policy has ‘beenmaintainedwinoutatreak. |i, Pre polity checkup isnot epplcabe to senior zens covered for SI between © 16,000 and % 45,000 opting fora higher SI between & 50,000 and & 5,00,000 |v. The Company wilreimburse 50% a the expenses incurred forpre policy checkup the proposal is accepted. v. Thereporsrequiredare- ‘)Physicalexaminaton(eporttobe signed the Doctor wih mirimum MD (adicne) qualfcaton) 1) Bloodsugar(asting postprandial) ©) Lipdprotie §) Senmereatnine ©) Usineoutneandicroscopic examination ) ES 9) Eyecheckup including retnoscopy) ‘Theat ofmedical repos shoud not exceed 30 days pir tothe date of proposal 2.9Payment of premium |. Premiumisbasedonageardsuminsured. |. The proposer has he option of clams being senicedby TPA (which case cashless facityeimbursementof expanses willbe available) orthe company (inwhich case expenses wi be reimbursed) cashless factys tobe aval, the premium payable isincusive of TPA charges. I cashless facts nt equied, he premium payableis witout TPA charges. li, _Premiumasperthe premiumtabeatachedistobepadinfullbefoe the commencementotthe poly. iv. Premium canbe pai onlineforbot, new poy andrenewals, 2.10 Renewal tf policy Policy canbe renewed annualy throughout the ifetime ofthe insured person, ‘Thepolicy maybe enewedby mutual sent before the exyofthepoliy. (21‘The company snotboundie sendrenewal notice. Renewal of plcy canbe denied on grounds fraud, moral hazard or misrepresertaion ornoncooperation Inthe eventot breakin the poe a grace period cf 0 daysisalowed. Coverageisnotavalabedurngthe grace period. ‘Policy Definition 3.1 Anyone iliness means continuous period ofiiness anit nudes relapse within 46 days om the date castconsuttion wihthahospitalnusinghome where ‘teatmenthasbeen taken. ‘32Hospitalisation means admission in ahspita as an inpatient for a minimum period cf 2¢ consecutive hours excep fox spectid procedures! treatments, where ‘suhacmission ould be foraperodetlessthan 24 consecutvehous. Relaxation o2¢hours minimum duration forhospitalsatin slowed in i Day care procedures/surgerie (as istedin Appencix~fthe policy) where such treatments taken by aninsuredpersonin ahospitalday care cenre (out ‘atthe outpatient deparmnentofahospitl) i ‘Any otnersurpeisiprocecures (nat istedin Appendix | he poley which veto advancementof metal science requirehospitalisationforless than ‘24 nous andferichprior approval om company/TPAismandatory. 4.3 Network provider means hospitals or heath care providers enlisted by the company or by @ TPA anc the company together to provide medical series to an insuredperson onpaymentby acashless city ‘3.4Prefered provider network (PPN) means a network of hospi which have agreed to a cashess packaged pricing forcertainproceduresfortheinsured person. ‘Thelstis avaable wih the company/TPA and subject to amencment fom tne to time. Reimbursement of expenses incurred in PPN forthe procedures (as fsted under PPN\ package) shallbe subject the rates appinable to PPN package pricing. ‘35 Preexisting disease means ary conden, liret rir ot rll concions for nich he insured person ad sins or symploms andor wascagncsed andor receved medica avice/teatnet win 4 montsprtothefrs otc ssuedby te compary. ‘3.6 Third Party Administrator (TPA) means any ently, censed under the IRDA, (hid Party Administrator - Heath Services) Regulation, 2001 bythe Authority ‘andis engages, forafeeby the company forte purpose ofprovidng hea services. 4 Exclusions ‘The company shal notbe lable torrake any paymentunerthe policy in respectof any expenses incurecinconnectionwthorinespectot 41 Pre-existing diseases Alipre-eising diseases when he caver incops forth rst time unt 48 months of continous coverage has elapsed. Any complication afsing from pre-existing aimentciseassirures witbe cosieredas apatothepeexisingheathcocionor disease ‘Toitusvatita person's suring ron eithertypertansioncr diabetes or both atthe time of taking he poly, then policy shal be subject folowing exclusions, Diabetes Hypertension Diabetes and Hypertension Diabetic Retnopathy Coronary Artery Disease Diabetic Retinopathy Diabetic Nephropathy Cerebro Vascular Accident Diabetic Nephropathy Diabetic Fockwound Hypertensive Nephropathy Diabetic Footwound Diabetic Anciopethy Internal Bleeding’ Haemorrhage | Diabetic Angiopathy Diabetic Neuropathy Diabetic Neuropathy yperHypogiycaemic shock HyperFypoglyeaemic shock Coronary Artery Disease ‘Coronary Artery Disease Cerebro Vascular Accident Hypertensive Nephropathy Internal BlezdingHaemorthage 4.2First30 days waiting period ‘Any cisease contracted the insured person curing the first 30 days rom the inception of theft poly. Tis shal ct ppl incase the insured persons hospalised forinjures suteredinan accident whch ccurtedater inception ofthefirst poly. 43Speeitic wating period Following cseasestreatments ae subjecttoa wating ptiod mentonedbelow. i ‘Oneyear waiting period 2. Benign ENT sorders . _Tonsilectomy/Adencidecomy/Mastoidecomy/Tympanoplasy [3]i Two years walting period & Cataract Pilon! sinus b. Benign prostatic hypertrophy |. Goutand Rheumatism Hemia ‘m. Hypertension and related complications 6 Hydrocele ‘Diabetes and related complications ©. Congertal intemal disease ©. Calculus diseases f. FissureFistua in anus P. Surgery of gal blader and bile duct exuding malignancy 9 Piles (Haemortoids) & Surgery of genito-uinary system excluding malignancy h. Sinusitis and related csorders ‘Surgery or prolapsed intervertebral dsc unless arising fom accident i. Polyystic ovarian disease Surgery of varicose vein |. Nonsinfecive atts Hysterectomy ji, Four years waiting period ‘Treatment iorjoint replacement due o degenerative conditions . Age related osteoarthritis and osteoporosis 4AHIY, AIDS, STD ‘Any condton direct or ndrectyca.sed to or associated wih Human immunodeficiency Virus (HIV), Acquired immunodefcency Syndrome (AIDS), complications ‘TADS andther Sexually Trarsmited Diseases (STO). 45 General debility, congenital external anomaly General debit, run down contin rrestcue,congental extemal disease or defects or anomaly, ‘4.5:teriliyinfertity assisted conception ‘Stent, infonity'sub fry, assisted conception procedures. 47 Pregnancy Treatment arising rom or traceable to pregnancy/chiebith including caesarean section, miscariage,surogateorvierious pregnancy, aberton or complications thereotincudng crangesin chronic condor arising otf pregnancy other than ectopic pregnancy which may be established by medical epors, ‘4.Retractiveerror ‘Surgery or correction ofeye sight duetoreractve errr, 490besiy ‘Treatment for obesty or condton arising there from inlucing morta obesty) and any other weight control and management programiserices/supplies or treatment 4.10Psyehiarecsorder, intentional sefinfctedinjury ‘Treatmentforal psyche ndpsychosratic sorerstiseasesintrtionalsalnltedinay, tempted suicide 4.11 Genetic disorders, stem cell surgery. 4.12 Circumcision unless necessary for treatment of disease (i notexcluded otherwise) ornecesstated due te an accident. 4.18 Veecination orinoculation unless forming partof treatment and requires hospitalisation, 4.14 Cosmeti, plastic surgery, sex change, hormone replacement (Cosmeticoraesthetireetrent of ny description, change of ie or sx change operation, hxmone replacement therapy. Expenses for plastic suger ther than as ‘may benecesstated duetoilness/ disease injury 4.15 Massages, spa, steambath, naturopathy, experimental treatment Massages, spa, steambath,shirochara, udhwartanam,abhyangam,keyasekhem and smiartreatment. Expenses for naturopatty, experimental medicinetveatment, unproven proceduretreatment, alerative medicine treatment other than ayurveda and homeopathy), acupuncture, acupressure, magneto therapy and similar teetmet. 4.16Dentaltreatment Dental teatmentunessarsingduetoan accident. 4.17 Vitamins tonies ‘itains an tonics unless forming patt veatmentforilessciseaceinjury as ceriiedby te attending medical practioner, 4.18 OutPatient Department treatment (OPD treatment) 4.19 Diagnostic and evaluaton purpose where such agnosis and evaluation canbe cared out as outpatient procedure and the condition of he patent doesnot requitehospitalisstio, (4)4420 Treatmentin convalescenthome,naturectinie ‘Treatmentinconvalescenthomelhespitl heath hycromnaturecarecinicandsmiarestabishmenis. 421 Druglalcoholabuse “reatmentarising outolinessiseasenjurydueto misuse or abuse of crugslalcoholor use ofitoxcating substances. 422Stay inhosptal wtichisnot medically necessary 4423 Spectacle, contactlens hearing i, coclearimplants, 4.24Equipments Exemaldvable maialnanmedcal equpmentsnstuners of ny kind used for degra aime ncutng CPAP, CAPD, sion pum, ambuloy aves ie wae ence bs, clas cap spins sings, braces, stoke, dabee ontwer, garter, hemmonetr ear ltd tems (sktain ‘Appendix Ilof the poliey} and any medical equipment which could be used athome subsequently, 4425 Irelevant invesgationsveatrent, drugstveatment not supported by a prescription, private nursing charges, refer fee to family physician, outsation |. Arefundotthepremiumpaidless any expensesincurtedby tne company on medical examination of heinsuredperson andthe stamp duychargesor i, where the skhas already commenced and the option of retum ofthe pac i exercised by the insured parson, 2 deduction towards the proportionate risk ‘Premium forperdencover. Redressalofgrievance Incase of any grievance relating he servicing the Policy, the insured person may approach the Grievance cel of the company se up atcvsional tices, regional ctees and head offce. Former infrmaton on grievance mechanism, andto download grievance form, tour webs, ‘The insured person may iso approach te ofice of insurance Ombudsman ofthe respective area/regionforredressalof grievance. Disclaimer ‘The prospectus contains salient feature ofthe Poly. For deta references tbe made tothe Poy. Incase o ay diference between the prospactus andthe Poly, the terms and condtons ofthe Poly shal reval ‘The prospects and proposal fom a par ofthe Policy. Hence please read the prospects carefully and sign the same, The proposal farmis tobe completedin all respec foreachinsured person. Bah the prospectus andthe proposalform are tobe submitiedtotheofesrtothe agent, Place Signature Date Name Insurance isthe Subject matter of Solitation I71Rate with TPA charges a EN Cc a 000 | vei _| tea | ise | tase | aes | ase | ast [sams [eames [aa oa wwoato_| vas] vat7_| 1s isso | soe [ama [ esto [remo | as | has | ea vasa [ta _|ise_| ua] onse [ava [sant _[ roms [esse [amet [ae [anne a vom [tess] soo_| ee | 2676 | ame | eso [ 7an0 [aera [tones [ao | rare ae wrsgoo_| axea_| eas] eae | aan | sexe | rare [ages | toa | ines tenet [tae [20 anon | aaa | ceo [are | ame [are [eae [ are [ise | aa] sm [ em [ae zasano [2006 | 2e0a [2am | aare | ezie [ars | ions | texe | vaoe | wnst [meat | beam 2sioo | ari_[ea_| ates [aos [reo mom [nee [az [ere | ae [pane [ae arom | zor |_ ones | ase | ame | ante | vise [rere | aa | aoe [nia [ase | toe oxen | ars | aeee_| are | s20 | ase | ene [eee | soe [eee | ee [ant | mar sasom [sa [aes [ay | sao [ane | eer [ame | so | tae | sere | ae et ssuom_|~aae | azs7_| az [ones | mom [ome [eas [asm | esa | aim | oie [aor arson | are] ases_[ ast | ome [ ow | vam | sis [tres] aise [ree [ste [soe scnome | ate [sen] soe |ese7 | as | eas [eee [mee | | mee | mee | Se emo [exe | ae | aso [ier | nat | ese eer ame | aes | mer | oe se EE ‘som | aes7_|_aaet_| ssi [7am | eae | anak ar} mae | mee | see | aa snore | are |aees_[ ss | eae | vam [react | uae aoe | me | sare | se | at ‘Service Tax extra Rate wihout TPA charges A saoot_| ese [esi [oer [sate [aos [aes [art [anes | aiet_[ ses] so To [soo | “ass |iner| 1220 | so | zee [“asee [ace | seis | aoe [tae [ete] taee wmoaoo [sae | 12@ | sae | 192 [aoe [eat [ers | asm] soa] nest [nse | oe sesoon_| sas [nasi] ssa [eae | aor [sant | eess [rate | aoe] ae [300s | ae enone |1ge7_|17es_[ zor | ars [ass | com] vser_|_ eam | tag [ete | tnom [tar sso |21ee | aiss | eom [sas [ao [78 | aos aa [ ie | tea [re | ese ono | 296 [aa [2600 [ars [se [aan arr | ores [erm [eam | ase [ase zsow | 20 | aze7 [oe [amr ses | tugs | g0r7_| vars | rues | sn azuow | ~zsss [2550 [00s [am waee_| vases | vase eae [560 [ast zioor_[ 276 _| aes | siee[ com swe [ tats | 7m | ouers | meee [st amon | 2a | 2508 [ase | a5 ‘eam | ez08 | a8 | zanis [pase [ore sasom [goa [ams [arse [se ‘zon | soa [eae | eases [erie mae asuoo_| ar | ajor | sess | sais waar | sore | ra_| ese [ss | soe reo | “sae | asee [azar | ea ea] tess vaiee [anne [stom |e ‘coon are |aees [aot [ oa coe_[ rae [ares [arse [ae [mee ‘eso | “seer [are] aor [ eee reo [ees | se [rer | some se 450,000 | 4189 | 4or1_| aga 6978 se2sa [9417 | 20783 | 30055 | s4ai7 | 97.094 ‘so | eon | axes [soe] 7a eee [ee | aise _[ aise] asad | sas sonoor_| —4ate [eset |e [7388 sis | meer | sae [wer | arses | ae ‘Service Tax extra Rate fr senior citizens covered for SI between & 15,000 and & 45,000, ate with TPA charges a | os wm [ne we isoor_|— aaa | —ta5F [ace | 13s zomoo| 1088 | “tae ast | tar zsao0_| 1380 | teat] 1007 | zon 30,000] 1.443 17% 1,928 2.408 ssg00_| aes | tat [ ane a “oo —a80 [20st | “ened [a8 so |_zar—[ ana [ ae] ace Serve Taxon Rate without TPA charges a | os | em | We | tee Teaet | re [wr | nee r 20m00_| 100 [sam | 8 | as 2s000—| ia | te | ios [a EX Eo [Fismo [a0] 1s [35] [[anoo|“2oee[~asto [anes | ast aeano_| 2275 | zon | aues_| ane ‘Service Tax otra PROSPECTUS FORM: Printed by DD Tracer, Kolkata. 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