National Insurance Company Limited

CIN - U10200WB1906GOI001713 IRDAI Regn. No. – 58

Issuing Office
National Parivar Mediclaim Plus Policy
Whereas the Proposer designated in the schedule hereto has by a Proposal together with Declaration, which shall be the basis of
this contract and is deemed to be incorporated herein, has applied to National Insurance Company Ltd. (hereinafter called the
Company), for the insurance hereinafter set forth, in respect of person(s)/ family members named in the schedule hereto
(hereinafter called the Insured Persons) and has paid the premium as consideration for such insurance.

1 PREAMBLE
The Company undertakes that if during the Policy Period, any Insured Person shall suffer any illness or disease (hereinafter called
Illness) or sustain any bodily injury due to an Accident (hereinafter called Injury) requiring Hospitalisation of such Insured
Person(s) for In-Patient Care at any hospital/nursing home (hereinafter called Hospital) or for Day Care Treatment at any Day
Care Center or to undergo treatment under Domiciliary Hospitalisation, following the Medical Advice of a duly qualified Medical
Practitioner, the Company shall indemnify the Hospital or the Insured, Reasonable and Customary Charges incurred for Medically
Necessary Treatment towards the Coverage mentioned herein.
Provided further that, the amount payable under the Policy in respect of all such claims during each Policy Year of the Policy
Period shall be subject to the Definitions, Terms, Exclusions, Conditions contained herein and limits as shown in the Table of
Benefits, and shall not exceed the Floater Sum Insured in respect of the Insured family.

2 DEFINITIONS
2.1 Accident means a sudden, unforeseen and involuntary event caused by external, visible and violent means.

2.2 Age / Aged means completed years on last birthday as on Policy commencement date.

2.3 AIDS means Acquired Immune Deficiency Syndrome, a condition characterised by a combination of signs and symptoms,
caused by Human Immunodeficiency Virus (HIV), which attacks and weakens the body’s immune system making the HIV-
positive person susceptible to life threatening conditions or other conditions, as may be specified from time to time.

2.4 Any One Illness means continuous period of illness and it includes relapse within forty five days from the date of last
consultation with the hospital where treatment has been taken.

2.5 AYUSH Day Care Centre means and includes Community Health Centre (CHC), Primary Health Centre (PHC), Dispensary,
Clinic, Polyclinic or any such health centre which is registered with the local authorities, wherever applicable and having
facilities for carrying out treatment procedures and medical or surgical / para-surgical interventions or both under the
supervision of registered AYUSH Medical Practitioner(s) on day care basis without in-patient services and must comply with
all the following criterion:
i. Having qualified registered AYUSH Medical Practitioner in charge round the clock;
ii. Having dedicated AYUSH therapy sections as required and/or has equipped operation theatre where surgical procedures
are to be carried out;
iii. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized
representative.

2.6 AYUSH Treatment refers to the medical and / or Hospitalisation treatments given Ayurveda, Yoga and Naturopathy, Unani,
Siddha and Homeopathy systems.

2.7 AYUSH Hospital is a healthcare facility wherein medical/surgical/para-surgical treatment procedures and interventions are
carried out by AYUSH Medical Practitioner(s) comprising of any of the following:
a. Central or State Government AYUSH Hospital or
b. Teaching hospital attached to AYUSH College recognized by the Central Government/ Central Council of Indian
Medicine/ Central Council for Homeopathy; or
c. AYUSH Hospital, standalone or co-located with in-patient healthcare facility of any recognized system of medicine,
registered with the local authorities, wherever applicable, and is under the supervision of a qualified registered
AYUSH Medical Practitioner and must comply with all the following criterion:
i. Having at least 5 in-patient beds;
ii. Having qualified AYUSH Medical Practitioner in charge round the clock;
iii. Having dedicated AYUSH therapy sections as required;
iv. Maintaining daily records of the patients and making them accessible to the insurance company’s authorized
representative

2.8 Break in policy means the period of gap that occurs at the end of the existing Policy Period due date, when the premium due
for renewal on a given policy or instalment premium due is not paid on or before the premium renewal date or grace period.

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 1 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
2.9 Cashless Facility means a facility extended by the Company to the Insured where the payments of the costs of treatment
undergone by the Insured in accordance with the Policy terms and conditions, are directly made to the Network Provider or a
Non Network Provider to the extent pre-authorization approved.

2.10 Condition Precedent means a Policy term or condition upon which the Company’s liability by the Policy is conditional upon.

2.11 Contract means prospectus, proposal, Policy, and the policy schedule. Any alteration with the mutual consent of the insured
person and the insurer can be made only by a duly signed and sealed endorsement on the Policy.

2.12 Congenital anomaly refers to a condition(s) which is present since birth, and which is abnormal with reference to form,
structure or position:
a) Internal Congenital Anomaly
Congenital anomaly which is not in the visible and accessible parts of the body.
b) External Congenital Anomaly
Congenital anomaly which is in the visible and accessible parts of the body.

2.13 Co-payment means a cost-sharing requirement by the Policy that provides that the insured shall bear a specified percentage of
the admissible claim amount. A co-payment does not reduce the Sum Insured.

2.14 Day Care Centre means any institution established for day care treatment of disease/ injuries or a medical setup within a
hospital and which has been registered with the local authorities, wherever applicable, and is under the supervision of a
registered and qualified medical practitioner AND must comply with all minimum criteria as under:
i. has qualified nursing staff under its employment;
ii. has qualified medical practitioner (s) in charge;
iii. has a fully equipped operation theatre of its own where surgical procedures are carried out
iv. maintains daily records of patients and shall make these accessible to the Company’s authorized personnel.

2.15 Day Care Treatment means medical treatment, and/or surgical procedure which is:
i. undertaken under general or local anesthesia in a hospital/day care centre in less than twenty-four hrs because of
technological advancement, and
ii. which would have otherwise required a hospitalisation of more than twenty-four hours.
Treatment normally taken on an out-patient basis is not included in the scope of this definition.

2.16 Dental Treatment means a treatment carried out by a dental practitioner including examinations, fillings (where appropriate),
crowns, extractions and surgery excluding any form of cosmetic surgery/implants.

2.17 Diagnosis means diagnosis by a medical practitioner, supported by clinical, radiological, histological and laboratory evidence,
acceptable to the Company.

2.18 Domiciliary Hospitalisation means medical treatment for an illness /injury which in the normal course would require care
and treatment at a hospital but is actually taken while confined at home under any of the following circumstances.
i. the condition of the patient is such that he/she is not in a condition to be removed to a hospital, or
ii. the patient takes treatment at home on account of non availability of bed/ room in a hospital.

2.19 Family members means spouse, children and parents of the insured, covered by the Policy.

2.20 Floater Sum Insured means the sum insured, as mentioned in the Schedule, available to all the insured persons, for any and
all claims made in the aggregate during each policy year.

2.21 Grace Period means the specified period of time, immediately following the premium due date during which premium
payment can be made to renew or continue a policy in force without loss of continuity benefits pertaining to Waiting Periods
and coverage of Pre-Existing Diseases. The Grace Period for payment of the premium shall be thirty days.
Coverage shall not be available during the period for which no premium is received.

2.22 Hospital means any institution established for in-patient care and day care treatment of disease/ injuries and which has been
registered as a hospital with the local authorities under the Clinical Establishments (Registration and Regulation) Act, 2010 or
under the enactments specified under Schedule of Section 56(1) of the said Act, OR complies with all minimum criteria as
under:
i. has qualified nursing staff under its employment round the clock;
ii. has at least ten inpatient beds, in those towns having a population of less than ten lacs and fifteen inpatient beds in
all other places;
iii. has qualified medical practitioner (s) in charge round the clock;
iv. has a fully equipped operation theatre of its own where surgical procedures are carried out
v. maintains daily records of patients and shall make these accessible to the Company’s authorized personnel.

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 2 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
2.23 Hospitalisation means admission in a Hospital or mental health establishment for a minimum period of twenty four (24)
consecutive ‘Inpatient care’ hours except for procedures/ treatments, where such admission could be for a period of less than
twenty four (24) consecutive hours.

2.24 ICU (Intensive Care Unit) Charges means the amount charged by a Hospital towards ICU expenses which shall include the
expenses for ICU bed, general medical support services provided to any ICU patient including monitoring devices, critical care
nursing and intensivist charges.

2.25 ID Card means the card issued to the insured person by the TPA for availing Cashless Facility.

2.26 Illness means a sickness or a disease or pathological condition leading to the impairment of normal physiological function
which manifests itself during the policy period and requires medical treatment.
i. Acute Condition means a disease, illness or injury that is likely to response quickly to treatment which aims to return
the person to his or her state of health immediately before suffering the disease/ illness/ injury which leads to full
recovery.
ii. Chronic Condition means a disease, illness, or injury that has one or more of the following characteristics
a) it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and / or tests
b) it needs ongoing or long-term control or relief of symptoms
c) it requires your rehabilitation or for you to be specially trained to cope with it
d) it continues indefinitely
e) it comes back or is likely to come back.

2.27 In-patient Care means treatment for which the insured person has to stay in a hospital for more than 24 hours for a covered
event.

2.28 Insured / Insured Person means person(s) named in the schedule of the Policy.

2.29 Intensive Care Unit means an identified section, ward or wing of a hospital which is under the constant supervision of a
dedicated medical practitioner(s), and which is specially equipped for the continuous monitoring and treatment of patients who
are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more
sophisticated and intensive than in the ordinary and other wards.

2.30 Injury means accidental physical bodily harm excluding disease solely and directly caused by external, violent and visible and
evident means which is verified and certified by a medical practitioner.

2.31 Medical Advice means any consultation or advice from a Medical Practitioner including the issue of any prescription or repeat
prescription.

2.32 Medical Expenses means those expenses that an insured person has necessarily and actually incurred for medical treatment
on account of disease/ injury on the advice of a medical practitioner, as long as these are no more than would have been payable
if the insured person had not been insured and no more than other hospitals or doctors in the same locality would have charged
for the same medical treatment.

2.33 Medically Necessary Treatment means any treatment, tests, medication, or stay in hospital or part of a stay in hospital which:
i. is required for the medical management of the disease/ injuries suffered by the insured person;
ii. must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration,
or intensity;
iii. must have been prescribed by a medical practitioner;
iv. must conform to the professional standards widely accepted in international medical practice or by the medical
community in India.

2.34 Medical Practitioner means a person who holds a valid registration from the medical council of any state or Medical Council
of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Government and is
thereby entitled to practice medicine within its jurisdiction; and is acting within the scope and jurisdiction of the licence.

2.35 Migration means a facility provided to policyholders (including all members under family cover and group policies), to
transfer the credits gained for pre-existing diseases and specific waiting periods from one health insurance policy to another
with the same insurer.

2.36 Network Provider means Hospitals or Day Care Centres enlisted by the Company or jointly by the Company and a TPA to
provide medical services to an insured person on payment by a cashless facility.

2.37 New Born Baby means baby born during the policy period and is aged upto 90 days.

2.38 Non- Network means any Hospital, Day Care Centre that is not part of the network.

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 3 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
2.39 Notification of Claim means the process of intimating a claim to the Company or TPA through any of the recognized modes
of communication.

2.40 Out-Patient Treatment means treatment in which the insured person visits a clinic / hospital or associated facility like a
consultation room for diagnosis and treatment based on the advise of a medical practitioner and the insured person is not
admitted as a day care patient or in-patient.

2.41 Policy Period means period of one policy year/ two policy years/ three policy years as mentioned in the schedule for which
the Policy is issued.

2.42 Policy Year means a period of twelve months beginning from the date of commencement of the policy period and ending on
the last day of such twelve month period. For the purpose of subsequent years, policy year shall mean a period of twelve months
commencing from the end of the previous policy year and lapsing on the last day of such twelve-month period, till the policy
period, as mentioned in the schedule.

2.43 Preferred Provider Network (PPN) means a network of hospitals which have agreed to a cashless packaged pricing for listed
procedures for the insured person. The list is available on the website of the Company/TPA and subject to amendment from
time to time. For the updated list please visit the website of the Company/TPA. Reimbursement of expenses incurred in PPN
for the procedures (as listed under PPN package) shall be subject to the rates applicable to PPN package pricing.

2.44 Pre existing disease means any condition, ailment, injury or disease
a) That is/are diagnosed by a physician within 36 months prior to the effective date of the Policy issued by the Company or
its reinstatement, or
b) For which Medical Advice or treatment was recommended by, or received from, a physician within 36 months prior
to the effective date of the Policy issued by the Company or its reinstatement.

2.45 Portability means a facility provided to the policyholders (including all members under family cover), to transfer the credits
gained for, Pre-Existing Diseases and Specific Waiting Periods from one insurer to another insurer.

2.46 Psychiatrist means a medical practitioner possessing a post-graduate degree or diploma in psychiatry awarded by an university
recognised by the University Grants Commission established under the University Grants Commission Act, 1956, or awarded
or recognised by the National Board of Examinations and included in the First Schedule to the Indian Medical Council Act,
1956, or recognised by the Medical Council of India, constituted under the Indian Medical Council Act, 1956, and includes, in
relation to any State, any medical officer who having regard to his knowledge and experience in psychiatry, has been declared
by the Government of that State to be a psychiatrist.

2.47 Qualified Nurse means a person who holds a valid registration from the Nursing Council of India or the Nursing Council of
any state in India.

2.48 Reasonable and Customary Charges means the charges for services or supplies, which are the standard charges for the
specific provider and consistent with the prevailing charges in the geographical area for identical or similar services, taking into
account the nature of the disease/ injury involved.

2.49 Room Rent means the amount charged by a Hospital towards Room and boarding expenses and shall include the associated
charges.

2.50 Schedule means a document forming part of the Policy, containing details including name of the insured person, age, relation
of the insured person, sum insured, premium paid and the policy period.

2.51 Surgery or Surgical Procedure means manual and / or operative procedure (s) required for treatment of a disease or injury,
correction of deformities and defects, diagnosis and cure of diseases, relief of suffering or prolongation of life, performed in a
hospital or day care centre by a medical practitioner.

2.52 Third Party Administrator (TPA) means any entity, licenced under the IRDA (Third Party Administrators - Health Services)
Regulations, 2001 by the Authority, and is engaged, for a fee by the Company for the purpose of providing health services.

2.53 Unproven/ Experimental Treatment means treatment, including drug therapy, which is not based on established medical
practice in India, is experimental or unproven.

2.54 Waiting Period means a period from the inception of this Policy during which specified diseases/treatment is not covered. On
completion of the period, diseases/treatment shall be covered provided the Policy has been continuously renewed without any
break.

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 4 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
3 BENEFITS COVERED UNDER THE POLICY
3.1COVERAGE
3.1.1 In-patient Treatment
The Company shall indemnify the medical expenses for:
i. Room charges and intensive care unit charges (including diet charges, nursing care by qualified nurse, RMO charges,
administration charges for IV fluids/blood transfusion/injection), subject to limit as per Section 3.1.1.1
ii. Medical practitioner(s)
iii. Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances
iv. Medicines and drugs
v. Diagnostic procedures
vi. Prosthetics and other devices or equipment if implanted internally during a surgical procedure.
vii. Dental treatment, necessitated due to an injury
viii. Plastic surgery, necessitated due to disease or injury
ix. Hormone replacement therapy, if medically necessary
x. Vitamins and tonics, forming part of treatment for disease/injury as certified by the attending medical practitioner
xi. Circumcision, necessitated for treatment of a disease or injury

3.1.1.1 Limit for Room Charges and Intensive Care Unit Charges
Room charges and intensive care unit charges per day shall be payable up to the limit as shown in the Table of Benefits, for Plan A
only. However, the limit shall not apply if the treatment is undergone for a listed procedure in a Preferred Provider Network (PPN)
as a package.

Note:
Listed procedures and Preferred Provider Network list are dynamic in nature, and will be updated in the Company’s website from
time to time.

3.1.1.2 Limit for Cataract Surgery

The Company’s liability for cataract surgery shall be up to the limit as shown in the Table of Benefits, for Plan A only. However,
the limit shall not apply if the treatment is undergone for a listed procedure in a Preferred Provider Network (PPN) as a package.

3.1.1.3 Treatment related to participation as a non-professional in hazardous or adventure sports

Expenses related to treatment necessitated due to participation as a non-professional in hazardous or adventure sports, subject to
Maximum amount admissible for Any One Illness shall be lower of 25% of Sum Insured.

3.1.2 Pre Hospitalisation

The Company shall indemnify the medical expenses incurred up to thirty days immediately before the insured person is hospitalised,
provided that:
i. such medical expenses are incurred for the same condition for which the insured person’s hospitalisation was required, and
ii. the in-patient hospitalisation claim for such hospitalisation is admissible by the Company
Pre hospitalisation shall be considered as part of the Hospitalisation claim.

3.1.3 Post Hospitalisation

The Company shall indemnify the medical expenses incurred up to sixty days immediately after the insured person is discharged
from hospital, provided that:
i. such medical expenses are incurred for the same condition for which the insured person’s hospitalisation was required, and
ii. the in-patient hospitalisation claim for such hospitalisation is admissible by the Company
Post hospitalisation shall be considered as part of the hospitalisation claim.

3.1.4 Domiciliary Hospitalisation

The Company shall Company shall indemnify the medical expenses incurred under domiciliary hospitalization, including Pre
Hospitalisation expenses and Post Hospitalisation expenses, up to the limit as shown in the Table of Benefits.

Exclusions
Domiciliary hospitalisation shall not cover:
i. Treatment of less than three days
ii. Expenses incurred for alternative treatment
iii. Expenses incurred for maternity or infertility
iv. Expenses incurred for any of the following diseases;
a) Asthma f) Influenza, cough and cold
b) Bronchitis g) All psychiatric or psychosomatic disorders
c) Chronic nephritis and nephritic syndrome h) Pyrexia of unknown origin for less than ten days
d) Diarrhoea and all type of dysenteries including i) Tonsillitis and upper respiratory tract infection
gastroenteritis including laryngitis and pharingitis
e) Epilepsy j) Arthritis, gout and rheumatism

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 5 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
3.1.5 Day Care Procedure
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.

3.1.6 AYUSH Treatment

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.

3.1.7 Organ Donor’s Medical Expenses

Organ Donor's Hospitalisation Expenses
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:
i. The organ donation confirms to the Transplantation of Human Organs Act 1994 (and its amendments from time to time)
ii. The organ is used for an Insured Person and the Insured Person has been medically advised to undergo an organ transplant
iii. The Medical Expenses shall be incurred in respect of the organ donor as an in-patient in a Hospital.
iv. Claim has been admitted under In-patient Treatment Section in respect of the Insured Person undergoing the organ
transplant.

Exclusions
The Company shall not be liable to make payment for any claim under this Cover which arises for or in connection with any of the
following:
i. Pre-hospitalization Medical Expenses or Post- Hospitalization Medical Expenses of the organ donor.
ii. Costs directly or indirectly associated with the acquisition of the donor’s organ.
iii. Medical Expenses where the organ transplant is experimental or investigational.
iv. Any medical treatment or complication in respect of the donor, consequent to harvesting.
v. Any expenses related to organ transportation or preservation.

3.1.8 Hospital Cash

The Company shall pay the insured a daily hospital cash allowance up to the limit as shown in the Table of Benefits for a maximum
of five days, provided:
i. the hospitalisation exceeds three days.
ii. a claim has been admitted under In-patient Treatment Section
Hospital Cash shall be payable for each day from the 4th day of Hospitalisation up to the 8th day of Hospitalisation only.
Hospitalisation of less than 24 hours shall not be considered for the purpose of payment of Hospital Cash

3.1.9 Ambulance
The Company shall reimburse the insured the expenses incurred for ambulance charges for transportation to the hospital, or from
one hospital to another hospital, up to the limit as shown in the Table of Benefits, provided a claim has been admitted under In-
patient Treatment Section.

3.1.10 Air Ambulance

The Company shall reimburse the insured the expenses incurred for medical evacuation of the insured person by air ambulance to
the nearest hospital or from one hospital to another hospital following an emergency up to the limit as per the Table of Benefits,
provided prior intimation is given to the Company/TPA, and a claim has been admitted under In-patient Treatment Section.

3.1.11 Medical Emergency Reunion

In the event of the insured person being hospitalised in a place away from the place of residence for more than five continuous days
in an intensive care unit for any life threatening condition, the Company after obtaining confirmation from the attending medical
practitioner, of the need of a ‘family member’ to be present, shall reimburse the expenses of a round trip economy class air ticket
for Plan B and Plan C to allow a family member, provided a claim has been admitted under In-patient Treatment Section.
For the purpose of the Section, ‘family member’ shall mean spouse, children and parents of the insured person.

3.1.12 Doctor’s Home Visit and Nursing Care during Post Hospitalisation
The Company shall reimburse the insured, for medically necessary expenses incurred for doctor’s home visit charges, nursing care
by qualified nurse during post hospitalisation up to the limit as shown in the Table of Benefits.

3.1.13 Anti Rabies Vaccination

The Company shall reimburse the insured medically necessary expenses incurred for anti-rabies vaccination up to the limit as shown
in the Table of Benefits. Hospitalisation is not required for vaccination.

3.1.14 Maternity
The Company shall indemnify Maternity Expenses as described below for any female Insured Person, and also Pre-Natal and Post-
Natal Hospitalisation expenses per delivery, including expenses for necessary vaccination for New Born Baby, subject to the limit

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 6 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
as shown in the Table of Benefits. The female Insured Person should have been continuously covered for at least 24 months before
availing this benefit.
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.

Cover
Maternity Expenses means;
a) Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during
Hospitalization);
b) Expenses towards lawful medical termination of pregnancy during the Policy Period.
Note: Ectopic pregnancy is covered under ‘In-patient treatment’, provided such pregnancy is established by medical reports.

Exclusions
The Company shall not be liable to make any payment under the cover in respect of Maternity Expenses incurred in connection with
or in respect of:
1. Covered female Insured Person below eighteen (18) years and above forty-five (45) years of age.
2. Delivery or termination within a Waiting Period of twenty-four (24) months. However, the Waiting Period may be waived
only in the case of delivery, miscarriage or abortion induced by accident.
3. Delivery or lawful medical termination of pregnancy limited to two deliveries or terminations or either has been paid under
the Policy and its Renewals.
4. More than one delivery or lawful medical termination of pregnancy during a single Policy Period.
5. Maternity Expenses of Surrogate Mother, unless claim is admitted under Section 3.1.15 (Infertility)
6. Ectopic pregnancy
7. Pre and post hospitalisation expenses, other than pre and post natal treatment.

3.1.15 Infertility
The Company shall pay to the hospital or reimburse the insured, in respect of the medical expenses of the insured and his spouse,
if covered by the Policy, for treatment undergone as an in-patient or as a day care treatment, for procedures and/ or treatment of
infertility, provided the Policy has been continuously in force for twenty four (24) months from the inception of the Policy or from
the date of inclusion of the insured person, whichever is later. The medical expenses for either or both the insured person shall be
subject to the limit as shown in the Table of Benefits.

Exclusions
The Company shall not be liable to make any payment in respect of any expenses incurred in connection with or in respect of
1. Insured and insured persons above forty five years of age.
2. Diagnostic tests related to infertility
3. Reversing a tubal ligation or vasectomy
4. Preserving and storing sperms, eggs and embryos
5. An egg donor or sperm donor
6. Experimental treatments
7. Any disease/ injury, other than traceable to maternity, of the surrogate mother.

Conditions
1. Expenses for advanced procedures, including IVF, GIFT, ZIFT or ICSI, shall be payable only if the Insured person has been
unable to attain or sustain a successful pregnancy through reasonable, and medically necessary infertility treatment.
2. Maternity expenses of the surrogate mother shall be payable under Section 3.1.14 (Maternity). Legal affidavit regarding
intimation of surrogacy shall be submitted to the Company.
3. Maximum of two claims shall be admissible by the Policy during the lifetime of the insured person if he has no living child
and one claim if the insured has one living child.
4. Any one illness limit shall not apply.

Definitions for the purpose of the Section

1. Donor means an oocyte donor or sperm donor.
2. Embryo means a fertilized egg where cell division has commenced/ under the process and has completed the pre-embryonic
stage.
3. Gamete Intra-Fallopian Transfer (GIFT) means a procedure where the sperm and egg are placed inside a catheter separated
by an air bubble and then transferred to the fallopian tube. Fertilization takes place naturally.
4. Infertility means the inability to conceive after one year of unprotected sexual intercourse or the inability to sustain a
successful pregnancy. However the one year period may be waived, provided a medical practitioner determines existence of a
medical condition rendering conception impossible through unprotected sexual intercourse, including but not limited to
congenital absence of the uterus or ovaries, absence of the uterus or ovaries due to surgical removal due to a medical condition,
or involuntary sterilization due to chemotherapy or radiation treatments.
5. Intra-Cytoplasmic Sperm Injection (ICSI) means an injection of sperm into an egg for fertilisation.
6. In Vitro Fertilization (IVF) means a process in which an egg and sperm are combined in a laboratory dish where fertilization
occurs. The fertilized and dividing egg is transferred into the uterus of the woman.
National Insurance Co. Ltd.
National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 7 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
7. Surrogate means a woman who carries a pregnancy for the insured person.
8. Zygote Intra-Fallopian Transfer (ZIFT) means a procedure where the egg is fertilized in vitro and transferred to the
fallopian tube before dividing.

3.1.16 Vaccination for Children

The Company shall reimburse the insured, the expenses incurred for vaccinations of children (up to twelve years for male child and
up to fourteen years for female child), as listed in Annexure I, up to the limit as shown in the Table of Benefits, provided the children
are covered by the Policy. Hospitalisation is not required for this benefit.

3.1.17 HIV/ AIDS Cover

The Company shall indemnify the Hospital or the Insured the Medical Expenses (including Pre and Post Hospitalisation Expenses)
related to following stages of HIV infection:
i. Acute HIV infection – acute flu-like symptoms
ii. Clinical latency – usually asymptomatic or mild symptoms
iii. AIDS – full-blown disease; CD4 < 200

3.1.18 Mental Illness Cover

The Company shall indemnify the Hospital or the Insured 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 or a post-graduate degree (Unani) in Moalijat
(Nafasiyatt) or a post-graduate degree (Siddha) in Sirappu Maruthuvam.

Exclusions
Any kind of Psychological counselling, cognitive/ family/ group/ behavior/ palliative therapy or other kinds of psychotherapy for
which Hospitalisation is not necessary shall not be covered.

3.1.19 Modern Treatment

The Company shall indemnify the Medical Expenses for In-Patient Care, Domiciliary Hospitalisation 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.

Modern Treatment Coverage

UAE & HIFU Limit is for Procedure cost only
Balloon Sinuplasty Limit is for Balloon cost only
Deep Brain Stimulation Limit is for implants including batteries only
Only cost of medicines payable under this limit, other incidental charges like investigations and consultation
Oral Chemotherapy
charges not payable.
Immunotherapy Limit is for cost of injections only.
Intravitreal injections Limit is for complete treatment, including Pre & Post Hospitalization
Robotic Surgery Limit is for robotic component only.
Stereotactic Radio
surgeries Limit is for radiation procedure.
Bronchial Thermoplasty Limit is for complete treatment, including Pre & Post Hospitalization
Vaporization of the
prostrate Limit is for LASER component only.
IONM Limit is for IONM procedure only.
Stem cell therapy Limit is for complete treatment, including Pre & Post Hospitalization

3.1.20 Morbid Obesity Treatment

The Company shall indemnify the Hospital or the Insured the Medical Expenses, including Pre Hospitalisation expenses and Post
Hospitalisation expenses incurred for surgical treatment of obesity that fulfils all the following conditions and subject to Waiting
Period of three (03) years as per Section 4.2.f.iv:
1. Treatment has been conducted is upon the advice of the Medical Practitioner, and
2. The surgery/Procedure conducted should be supported by clinical protocols, and
3. The Insured Person is 18 years of age or older, and
4. Body Mass Index (BMI) is;
a) greater than or equal to 40 or
b) greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less invasive
methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type 2 Diabetes

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 8 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
3.1.21 Correction of Refractive Error
The Company shall indemnify the Hospital or the Insured the Medical Expenses, including Pre Hospitalisation expenses and Post
Hospitalisation expenses incurred for expenses related to the treatment for correction of eye sight due to refractive error equal to or
more than 7.5 dioptres, subject to Waiting Period of two (02) years as per Section 4.2.f.iii.

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
Aggregate of all the benefits under 3.1.1 to 3.1.21 are subject to the Floater Sum Insured opted.

3.1.22 Reinstatement of Sum Insured due to Road Traffic Accident

In the event of the sum insured being exhausted on account of claims arising out of any injury due to road traffic accident during a
policy year, if the Insured and/or Insured Person (s) has to subsequently incur any expenses on hospitalisation due to any other
disease/ injury, the Company shall reinstate the sum insured as mentioned in the schedule. Reinstatement shall be allowed only once
during the policy year and the maximum amount payable under a single claim shall not exceed the sum insured as mentioned in the
schedule.

3.2 GOOD HEALTH INCENTIVES

3.2.1 No Claim Discount (NCD)
On renewal of policies with a term of one year, a NCD of flat 5% shall be allowed on the * base premium, provided claims are not
reported in the expiring Policy.
On renewal of policies with a term exceeding one year, the NCD amount with respect to each claim free policy year shall be
aggregated and allowed on renewal. Aggregate amount of NCD allowed shall not exceed flat 5% of the total base premium for the
term of the policy.
* Base premium depends on the zone and sum insured and is the aggregate of the premium for senior most insured person and other insured
persons for a year.

3.2.2 Health Check Up

Expenses of health check up shall be reimbursed (irrespective of past claims) at the end of a block of two continuous policy years,
provided the Policy has been continuously renewed with the Company without a break. Expenses payable are subject to the limit
stated in the Table of Benefits.

4 EXCLUSIONS
The Company shall not be liable to make any payment by the Policy, in respect of any expenses incurred in connection with or in
respect of:

4.1. Pre-Existing Diseases (Excl 01)

a) 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.
b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase.
c) If the Insured Person is continuously covered without any break as defined under the portability norms of the extant IRDAI
(Health Insurance) Regulations then waiting period for the same would be reduced to the extent of prior coverage.
d) Coverage under the policy after the expiry of thirty six (36) months for any pre-existing disease is subject to the same being
declared at the time of application and accepted by us.

4.2. Specified disease/procedure waiting period (Excl 02)

a) 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. This exclusion shall not be applicable for claims arising due to an accident
b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase.
c) If any of the specified disease/procedure falls under the waiting period specified for Pre-Existing Diseases, then the longer
of the two waiting periods shall apply.
d) The waiting period for listed conditions shall apply even if contracted after the policy or declared and accepted without a
specific exclusion.
e) If the Insured Person is continuously covered without any break as defined under the applicable norms on portability
stipulated by IRDAI, then waiting period for the same would be reduced to the extent of prior coverage.
f) List of specific diseases/procedures
i. 90 Days Waiting Period (Life style conditions)
a. Hypertension and related complications
b. Diabetes and related complications
c. Cardiac conditions
ii. One year waiting period
a. Benign ENT disorders d. Mastoidectomy
b. Tonsillectomy e. Tympanoplasty
c. Adenoidectomy

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 9 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
iii. Two years waiting period
a. Cataract m. Surgery of gall bladder and bile duct excluding
b. Benign prostatic hypertrophy malignancy
c. Hernia n. Surgery of genito-urinary system excluding
d. Hydrocele malignancy
e. Fissure/Fistula in anus o. Surgery for prolapsed intervertebral disc unless
f. Piles (Haemorrhoids) arising from accident
g. Sinusitis and related disorders p. Surgery of varicose vein
h. Polycystic ovarian disease q. Hysterectomy
i. Non-infective arthritis r. Refractive error of the eye more than 7.5 dioptres
j. Pilonidal sinus s. Congenital Internal Anomaly (not applicable for
k. Gout and Rheumatism new born baby)
l. Calculus diseases
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.

iv. Three years waiting period

Following diseases shall be covered after three years of continuous cover from the inception of the policy:
a. Treatment for joint replacement unless arising from accident
b. Osteoarthritis and osteoporosis
c. Morbid Obesity and its complications
d. Stem Cell Therapy: Hematopoietic stem cells for bone marrow transplant for haematological conditions to be covered.

4.3. First 30 days waiting period (Excl 03)

a) 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.
b) This exclusion shall not, however, apply if the Insured Person has Continuous Coverage for more than twelve (12) months.
c) The within referred waiting period is made applicable to the enhanced sum insured in the event of granting higher sum
insured subsequently.

4.4. Investigation & Evaluation (Excl 04)

a) Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
b) Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.

4.5. Rest Cure, Rehabilitation and Respite Care (Excl 05)

a) Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
i. Custodial care either at home or in a nursing facility for personal care such as help with activities of daily living such as
bathing, dressing, moving around either by skilled nurses or assistant or non-skilled persons.
ii. Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.

4.6. Obesity/ Weight Control (Excl 06)

Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
1) Surgery to be conducted is upon the advice of the Doctor
2) The surgery/Procedure conducted should be supported by clinical protocols
3) The member has to be 18 years of age or older and
4) Body Mass Index (BMI):
a. greater than or equal to 40, or
b. greater than or equal to 35 in conjunction with any of the following severe co-morbidities following failure of less
invasive methods of weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnea
iv. Uncontrolled Type2 Diabetes
4.7. Change-of-Gender Treatments (Excl 07)
Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite
sex.

4.8. Cosmetic or Plastic Surgery (Excl 08)

Expenses for cosmetic or plastic surgery or any treatment to change appearance unless for reconstruction following an Accident,
Burn(s) or Cancer or as part of medically necessary treatment to remove a direct and immediate health risk to the insured. For this
to be considered a medical necessity, it must be certified by the attending Medical Practitioner.

4.9. Hazardous or Adventure Sports (Excl 09)

Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports, including
but not limited to, para-jumping, rock climbing, mountaineering, rafting, motor racing, horse racing or scuba diving, hand gliding,
sky diving, deep-sea diving.
National Insurance Co. Ltd.
National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 10 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
4.10. Breach of Law (Excl 10)
Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach
of law with criminal intent.

4.11. Excluded Providers (Excl11)

Expenses incurred towards treatment in any hospital or by any Medical Practitioner or any other provider specifically excluded by
the Company and disclosed in its website / notified to the policyholders are not admissible. However, in case of life threatening
situations following an accident, expenses up to the stage of stabilization are payable but not the complete claim.

4.12. Drug/Alcohol Abuse (Excl 12)

Treatment for, Alcoholism, drug or substance abuse or any addictive condition and consequences thereof (Excl 12)

4.13. Non Medical Admissions (Excl 13)

Treatments received in health hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing
home attached to such establishments or where admission is arranged wholly or partly for domestic reasons (Excl 13)

4.14. Vitamins, Tonics (Excl 14)

Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals
and organic substances unless prescribed by a medical practitioners part of hospitalization claim or day care procedure

4.15. Refractive Error (Excl 15)

Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.

4.16. Unproven Treatments (Excl16)

Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. Unproven treatments
are treatments, procedures or supplies that lack significant medical documentation to support their effectiveness.

4.17. Hormone Replacement Therapy

Expenses for hormone replacement therapy, unless part of Medically Necessary Treatment, except for Puberty and Menopause
related Disorders

4.18. General Debility, Congenital External Anomaly

General debility, Congenital external anomaly.

4.19. Self Inflicted Injury

Treatment for intentional self-inflicted injury, attempted suicide.

4.20. Stem Cell Surgery

Stem Cell Surgery (except Hematopoietic stem cells for bone marrow transplant for haematological conditions).

4.21. Circumcision
Circumcision unless necessary for treatment of a disease (if not excluded otherwise) or necessitated due to an accident.

4.22. Vaccination or Inoculation.

Vaccination or inoculation unless forming part of treatment and requires Hospitalisation, except as and to the extent provided for
under Section 3.1.13 (Anti Rabies Vaccination), Section 3.1.14.iv and Section 3.1.16 (Vaccination for Children).

4.23. Massages, Steam Bath, Alternative Treatment (Other than AYUSH treatment)
Massages, steam bath, expenses for alternative treatments (other than AYUSH treatment), acupuncture, acupressure, magneto-
therapy and similar treatment.

4.24. Dental treatment

Dental treatment, unless necessitated due to an Injury.

4.25. Out Patient Department (OPD)

Any expenses incurred on OPD.

4.26. Stay in Hospital which is not Medically Necessary.

Stay in hospital which is not medically necessary.

4.27. Spectacles, Contact Lens, Hearing Aid, Cochlear Implants

Spectacles, contact lens, hearing aid, cochlear implants.

4.28. Non Prescription Drug

Drugs not supported by a prescription, private nursing charges, referral fee to family physician, outstation
doctor/surgeon/consultants’ fees and similar expenses.
National Insurance Co. Ltd.
National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 11 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
4.29. Treatment not Related to Disease for which Claim is Made
Treatment which the insured person was on before Hospitalisation for the Illness/Injury, different from the one for which claim for
Hospitalisation has been made.

4.30. Equipments
External/durable medical/non-medical equipments/instruments of any kind used for diagnosis/ treatment including CPAP, CAPD,
infusion pump, ambulatory devices such as walker, crutches, belts, collars, caps, splints, slings, braces, stockings, diabetic foot-
wear, glucometer, thermometer and similar related items and any medical equipment which could be used at home subsequently.

4.31. Items of personal comfort

Items of personal comfort and convenience including telephone, television, aya, barber, beauty services, baby food, cosmetics,
napkins, toiletries, guest services.

4.32. Service charge/ registration fee

Any kind of service charges including surcharges, admission fees, registration charges and similar charges levied by the hospital.

4.33. Home visit charges

Home visit charges during Pre and Post Hospitalisation of doctor, attendant and nurse, except as and to the extent provided for under
Section 3.1.12 (Doctor’s Home Visit and Nursing Care during Post Hospitalisation).

4.34. War
War (whether declared or not) and war like occurrence or invasion, acts of foreign enemies, hostilities, civil war, rebellion,
revolutions, insurrections, mutiny, military or usurped power, seizure, capture, arrest, restraints and detainment of all kinds.

4.35. Radioactivity
Nuclear, chemical or biological attack or weapons, contributed to, caused by, resulting from or from any other cause or event
contributing concurrently or in any other sequence to the loss, claim or expense. For the purpose of this exclusion:
a) Nuclear attack or weapons means the use of any nuclear weapon or device or waste or combustion of nuclear fuel or the
emission, discharge, dispersal, release or escape of fissile/ fusion material emitting a level of radioactivity capable of causing
any Illness, incapacitating disablement or death.
b) Chemical attack or weapons means the emission, discharge, dispersal, release or escape of any solid, liquid or gaseous
chemical compound which, when suitably distributed, is capable of causing any Illness, incapacitating disablement or death.
c) Biological attack or weapons means the emission, discharge, dispersal, release or escape of any pathogenic (disease
producing) micro-organisms and/or biologically produced toxins (including genetically modified organisms and chemically
synthesized toxins) which are capable of causing any Illness, incapacitating disablement or death.

4.36. Treatment taken outside the geographical limits of India

5 CONDITIONS

5.1 Disclosure of Information

The policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of misrepresentation, mis
description or non-disclosure of any material fact by the policyholder.
(Explanation: "Material facts" for the purpose of this policy shall mean all relevant information sought by the company in the
proposal form and other connected documents to enable it to take informed decision in the context of underwriting the risk)

5.2 Condition Precedent to Admission of Liability

The terms and conditions of the policy must be fulfilled by the insured person for the Company to make any payment for claim(s)
arising under the policy.

5.3 Communication
i. All communication should be made in writing.
ii. For policies serviced by TPA, ID card, PPN/network provider related issues to be communicated to the TPA at the address
mentioned in the schedule. For claim serviced by the Company, the Policy related issues to be communicated to the Policy
issuing office of the Company at the address mentioned in the schedule.
iii. Any change of address, state of health or any other change affecting any of the insured person, shall be communicated to the
Policy issuing office of the Company at the address mentioned in the schedule
iv. The Company or TPA shall communicate to the insured at the address mentioned in the schedule.

5.4 Physical Examination

Any medical practitioner authorised by the Company shall be allowed to examine the insured person in the event of any alleged
injury or disease requiring hospitalisation when and as often as the same may reasonably be required on behalf of the Company.

5.5 Claim Procedure

5.5.1 Notification of Claim

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 12 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
In the event of hospitalisation/ domiciliary hospitalisation, the insured person/insured person’s representative shall notify the TPA
(if claim is processed by TPA)/Company (if claim is processed by the Company) in writing by letter, e-mail, fax providing all
relevant information relating to claim including plan of treatment, policy number etc. within the prescribed time limit.

Notification of claim for Cashless facility TPA must be informed:

In the event of planned hospitalization At least seventy two hours prior to the insured person’s
admission
In the event of emergency hospitalization Within twenty four hours of the insured person’s admission

Notification of claim for Reimbursement Company/TPA must be informed:

In the event of planned hospitalisation/ domiciliary At least seventy two hours prior to the insured person’s
hospitalistion/ admission to hospital/ inception of domiciliary hospitalisation
In the event of emergency hospitalisation/ domiciliary Within twenty four hours of the insured person’s admission to
hospitalistion hospital/ inception of domiciliary hospitalisation

Notification of claim for vaccination Company/TPA must be informed:

In the event of Anti Rabies Vaccination/ Vaccination for At least twenty four hours prior to the vaccination
Children

5.5.2 Procedure for Cashless Claims

i. Cashless facility can be availed, if TPA service is opted.
ii. 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.
iii. Cashless request form available with the network provider/PPN and TPA shall be completed and sent to the TPA for
authorization.
iv. The TPA upon getting cashless request form and related medical information from the insured person/ network provider/PPN
shall issue a pre-authorization letter within an hour to the hospital after verification.
v. At the time of discharge, the insured person has to verify and sign the discharge papers, pay for non-medical and inadmissible
expenses.
vi. The TPA shall grant the final authorization within three hours of the receipt of discharge authorization request from the
Hospital
vii. The TPA reserves the right to deny pre-authorization in case the insured person is unable to provide the relevant medical details.
viii. In case of denial of cashless access, the insured person may obtain the treatment as per treating doctor’s advice and submit the
claim documents to the TPA for processing.

5.5.3 Procedure for Reimbursement of Claims

For reimbursement of claims the insured may submit the necessary documents to TPA (if claim is processed by TPA)/Company (if
claim is processed by the Company) within the prescribed time limit.

5.5.3.1 Procedure for Reimbursement of Claims under Domiciliary Hospitalisation

For reimbursement of claims under domiciliary hospitalisation, the insured may submit the necessary documents to TPA (if claim
is processed by TPA)/Company (if claim is processed by the Company) within the prescribed time limit.

5.5.4 Documents
The claim is to be supported by the following documents in original and submitted within the prescribed time limit.
i. Completed claim form
ii. Bills, payment receipts, medical history of the patient recorded, discharge certificate/ summary from the hospital etc.
iii. Cash-memo from the hospital (s)/chemist (s) supported by proper prescription
iv. Payment receipt, investigation test reports etc. supported by the prescription from the attending medical practitioner
v. Attending medical practitioner’s certificate regarding diagnosis along with date of diagnosis and bill receipts etc.
vi. Certificate from the surgeon stating diagnosis and nature of operation and bills/receipts etc.
vii. For claim under Domiciliary Hospitalisation in addition to documents listed above (as applicable), medical certificate stating
the circumstances requiring for Domiciliary hospitalisation and fitness certificate from treating medical practitioner.
viii. For claim under Maternity for surrogacy under Infertility in addition to documents listed above (as applicable), legal affidavit
regarding intimation of surrogacy.
ix. For claim under Medical Emergency Reunion in addition to documents listed above (as applicable), confirmation of the need
of family member from attending medical practitioner
x. For claim under Reinstatement of Sum Insured due to Road Traffic Accident in addition to documents listed above (as
applicable), police investigation report, confirming the road traffic accident.
xi. Any other document required by Company/TPA

Note
In the event of a claim lodged as per condition 5.8 and the original documents having been submitted to the other insurer, the
Company may accept the documents listed under condition 5.5.4 and claim settlement advice duly certified by the other insurer
subject to satisfaction of the Company.

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 13 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
Type of claim Time limit for submission of documents to Company/TPA
Reimbursement of hospitalization, pre hospitalisation Within fifteen days from date of discharge from hospital
expenses and ambulance charges, air ambulance charges and
medical emergency reunion charges
Reimbursement of post hospitalisation expenses and Within fifteen days from completion of post hospitalisation
doctor’s home visit and nursing care during post treatment
hospitalization
Reimbursement of domiciliary hospitalisation expenses Within fifteen days from issuance of fitness certificate
Reimbursement of anti rabies vaccination, new born baby Within fifteen days from date of vaccination
vaccination and vaccination of children
Reimbursement of expenses for infertility treatment Within fifteen days of completion of treatment or fifteen days
of expiry of Policy period, whichever is earlier, once during the
policy year
Reimbursement of health check up expenses (to be At least forty five (45) days before the expiry of the third Policy
submitted to the office only) Year.

5.5.5 Claim Settlement

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.
ii. In the case of delay in the payment of a claim, the Company shall be liable to pay interest to the policyholder from the date of
receipt of last necessary document to the date of payment of claim at a rate 2% above the bank rate.
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.
(Explanation: “Bank rate” shall mean the rate fixed by the Reserve Bank of India (RBI) at the beginning of the financial year in
which claim has fallen due)

5.5.6 Services Offered by TPA

The TPA shall render health care services covered by the Policy including issuance of ID cards & guide book, hospitalization &
pre-authorization services, call centre, acceptance of claim related documents, claim processing and other related services
The services offered by a TPA shall not include
i. Claim settlement and claim rejection; however, TPA may handle claims admission and recommend to the Company for
settlement of the claim
ii. Any services directly to any insured person or to any other person unless such service is in accordance with the terms and
conditions of the Agreement entered into with the Company.

Waiver
Time limit for notification of claim and submission of documents may be waived in cases where it is proved to the satisfaction of
the Company, that the physical circumstances under which insured person was placed, it was not possible to intimate the
claim/submit the documents within the prescribed time limit.

5.5.7 Classification of * Zone and Co-payment

The amount of claim admissible will depend upon the zone for which premium has been paid and the zone where treatment has
been taken.
* The country has been divided into four zones.
Zone I - Greater Mumbai Metropolitan area, entire state of Gujarat
Zone II – National Capital Territory (NCT) Delhi and National Capital Region (# NCR), Chandigarh, Pune
Zone III - Chennai, Hyderabad, Bangalore, Kolkata
Zone IV - Rest of India
# NCR includes Gurgaon-Manesar, Alwar-Bhiwadi, Faridabad-Ballabgarh, Ghaziabad-Loni, Noida, Greater Noida, Bahadurgarh, Sonepat-
Kundli, Charkhi Dadri, Bhiwani, Narnaul

Where treatment has been taken in a zone, other than the one for which ** premium has been paid, the claim shall be subject to co-
payment.
a. Insured paying premium as per Zone I can avail treatment in Zone I, Zone II, Zone III and Zone IV without co-payment
b. Insured paying premium as per Zone II
a. Can avail treatment in Zone II, Zone III and Zone IV without any co-payment
b. Availing treatment in Zone I will be subject to a co-payment of 5%
c. Insured paying premium as per Zone III
a. Can avail treatment in Zone III and Zone IV without any co-payment
b. Availing treatment in Zone I will be subject to a co-payment of 12.5%
c. Availing treatment in Zone II will be subject to a co-payment of 7.5%
d. Insured paying premium as per Zone IV

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 14 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
 a. Can avail treatment in Zone IV without any co-payment
b. Availing treatment in Zone I will be subject to a co-payment of 22.5%
c. Availing treatment in Zone II will be subject to a co-payment of 17.5%
d. Availing treatment in Zone III will be subject to a co-payment of 10%
** For premium rates please refer to the Prospectus/ Brochure

5.5.8 Optional Co-payment

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:
• 20% Co-payment on each admissible claim under the Policy, with a 25% discount in total premium.
• 10% Co-payment on each admissible claim under the Policy, with a 12.5% discount in total premium.

Above co-payments shall not be applicable on Critical illness & Outpatient treatment optional covers, but shall apply on Pre-existing
diabetes and/ or hypertension optional cover.

5.6 Moratorium Period

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. The moratorium would be applicable for the Basic Sums Insured of the first policy.
Wherever, the Basic Sum Insured is enhanced, completion of sixty continuous months would be applicable from the date of
enhancement of Basic Sums Insured only on the enhanced limits.

5.7 Payment of Claim

All claims by the Policy shall be payable in Indian currency and through NEFT/ RTGS only.

5.8 Territorial Limit

All medical treatment for the purpose of this insurance will have to be taken in India only.

5.9 Multiple Policies

i. In case of multiple policies taken by an insured person during a period from one or more insurers to indemnify treatment costs,
the insured person shall have the right to require a settlement of his/her claim in terms of any of his/her policies. In all such
cases the insurer chosen by the insured person shall be obliged to settle the claim as long as the claim is within the limits of and
according to the terms of the chosen policy.
ii. Insured person having multiple policies shall also have the right to prefer claims under this policy for the amounts disallowed
under any other policy / policies. Then the insurer shall independently settle the claim subject to the terms and conditions of
this policy.
iii. If the amount to be claimed exceeds the sum insured under a single policy, the insured person shall have the right to choose
insurer from whom he/she wants to claim the balance amount.
iv. Where an insured person has policies from more than one insurer to cover the same risk on indemnity basis, the insured person
shall only be indemnified the treatment costs in accordance with the terms and conditions of the chosen policy.
v. On occurrence of an insured event under specified critical illnesses, the policyholders can claim from all Insurers under all
policies.

5.10 Fraud
If any claim made by the insured person, is in any respect fraudulent, or if any false statement, or declaration is made or used in
support thereof, or if any fraudulent means or devices are used by the insured person or anyone acting on his/her behalf to obtain
any benefit under this policy, all benefits under this policy and the premium paid shall be forfeited.
Any amount already paid against claims made under this policy but which are found fraudulent later shall be repaid by all
recipient(s)/policyholder(s), who has made that particular claim, who shall be jointly and severally liable for such repayment to the
insurer.
For the purpose of this clause, the expression "fraud" means any of the following acts committed by the insured person or by his
agent or the hospital/doctor/any other party acting on behalf of the insured person, with intent to deceive the insurer or to induce the
insurer to issue an insurance policy:
a) the suggestion, as a fact of that which is not true and which the insured person does not believe to be true;
b) the active concealment of a fact by the insured person having knowledge or belief of the fact;
c) any other act fitted to deceive; and
d) any such act or omission as the law specially declares to be fraudulent
The Company shall not repudiate the claim and / or forfeit the policy benefits on the ground of Fraud, if the insured person /
beneficiary can prove that the misstatement was true to the best of his knowledge and there was no deliberate intention to suppress
the fact or that such misstatement of or suppression of material fact are within the knowledge of the insurer.

5.11 Cancellation
i. The Company may cancel the policy at any time, on grounds of misrepresentation, non-disclosure of material facts or
established fraud by the insured person by giving 15 days’ written notice. There would be no refund of premium on
cancellation on grounds of misrepresentation, non-disclosure of material facts or fraud.
National Insurance Co. Ltd.
National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 15 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
ii. The policyholder may cancel his/her policy at any time during the term, by giving 7 days’ notice in writing. The Insurer shall:
a) refund proportionate premium for unexpired policy period, if the term of policy upto one year and there is no claim (s)
made during the policy period.
b) refund premium for the unexpired policy period, in respect of policies with term more than 1 year and risk coverage for
such policy years has not commenced and refund proportionate premium for unexpired policy period for the current
policy year.
There shall be no refund for the completed policy year elapsed.
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.

5.12 Territorial Jurisdiction

All disputes or differences under or in relation to the Policy shall be determined by an Indian court in accordance to Indian law.

5.13 Arbitration
i. If any dispute or difference shall arise as to the quantum to be paid by the Policy, (liability being otherwise admitted) such
difference shall independently of all other questions, be referred for arbitration as per Arbitration and Conciliation Act 1996,
as amended from time to time.
ii. It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, if the
Company has disputed or not accepted liability under or in respect of the Policy.
iii. It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon the Policy
that award by such arbitrator/arbitrators of the amount of expenses shall be first obtained.

5.14 Disclaimer
If the Company shall disclaim liability for a claim hereunder and if the insured person shall not within twelve calendar months from
the date of receipt of the notice of such disclaimer notify the Company in writing that he/ she does not accept such disclaimer and
intends to recover his/ her claim from the Company, then the claim shall for all purposes be deemed to have been abandoned and
shall not thereafter be recoverable hereunder.

5.15 Renewal of Policy

i. The policy shall be renewable provided the product is not withdrawn, except in case of established fraud or non-disclosure or
misrepresentation by the Insured. If the product is withdrawn, the policyholder shall be provided with suitable options to migrate
to other similar health insurance products/plans offered by the Company.
ii. The Company shall endeavor to give notice for renewal. However, the Company is not under obligation to give any notice for
renewal.
iii. Renewal shall not be denied on the ground that the insured person had made a claim or claims in the preceding policy years.
iv. Request for renewal along with requisite premium shall be received by the Company before the end of the policy period.
v. At the end of the policy period, the policy shall terminate and can be renewed within the Grace Period of 30 days to maintain
continuity of benefits without break in policy. Coverage is not available during the grace period.
vi. No loading shall apply on renewals based on individual claims experience.
vii. In case of non-continuance of the Policy by the insured (due to death or any other valid and acceptable reason)
a. The Policy may be renewed by any insured person above eighteen years of age, as the insured
b. If only children (less than eighteen years of age) are covered, the Policy shall be allowed till the expiry of the policy
period. The grandparents may be allowed to renew the Policy as Proposer, covering the grandchildren.
viii. In case of death of the eldest insured person:
• The base premium may be calculated based on the age of the next eldest insured person.

5.16 Enhancement of Sum Insured

Sum insured can be enhanced only at the time of renewal. Sum insured may be enhanced subject to the availability of the higher
slabs in the Policy and at the discretion of the Company. For the incremental portion of the sum insured, the waiting periods and
conditions as mentioned in exclusion 4.1, 4.2, 4.3 shall apply. Coverage on enhanced sum insured shall be available after the
completion of waiting periods.

5.17 Adjustment of Premium for Overseas Travel Insurance Policy

If during the policy period any of the insured person is also covered by an Overseas Travel Insurance Policy of any non life insurance
company, the Policy shall be inoperative in respect of the insured persons for the number of days the Overseas Travel Insurance
Policy is in force and proportionate premium for such number of days shall be adjusted against the renewal premium. The insured
person must inform the Company in writing before leaving India and may submit an application, stating the details of visit(s) abroad,
along with copies of the Overseas Travel Insurance Policy, within seven days of return or expiry of the Policy, whichever is earlier.

5.18 Migration
The Insured Person will have the option to migrate the Policy to an alternative health insurance product offered by the Company by
applying for Migration of the policy at least 30 days before the policy renewal date as per extant Guidelines related to Migration. If
such person is presently covered and has been continuously covered without any lapses under this Policy offered by the Company,
i. The Insured Person will get all the accrued continuity benefits for credits gained to the extent of the specific waiting periods,
waiting period for pre-existing diseases and Moratorium period of the Insured Person.

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 16 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
 ii. Migration benefit will be offered to the extent of Sum Insured of the previous policy. Migration benefit shall not apply to
any other additional increased Sum Insured.
The Proposal may be subject to fresh Underwriting as per terms of conditions of the migrated product, if the insured is not
continuously covered for at least 36 months under the previous product.

5.19 Portability
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, as per
IRDAI guidelines related to Portability. If such person is presently covered and has been continuously covered without any lapses
under this Policy offered by the Company,
i. 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.
ii. Portability benefit will be offered to the extent of Sum Insured of the previous policy. Portability benefit shall not apply to
any other additional increased Sum Insured.

5.20 Withdrawal of Product

i. In the likelihood of this product being withdrawn in future, the Company will intimate the insured person about the same 90
days prior to expiry of the policy.
ii. Insured Person will have the option to migrate to similar health insurance product available with the Company at the time of
renewal with all the accrued continuity benefits such as cumulative bonus, waiver of waiting period as per IRDAI guidelines,
provided the policy has been maintained without a break.

5.21 Revision of Terms of the Policy Including the Premium Rates

The Company, with prior approval of IRDAI, may revise or modify the terms of the policy including the premium rates. The insured
person shall be notified before the changes are effected.

5.22 Free Look Period

The Free Look Period shall be applicable on new individual health insurance policies and not on renewals or at the time of
porting/migrating the policy.
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. If he/she is not satisfied with any of the terms and conditions, he/she has the option to cancel his/her
policy. This option is available in case of policies with a term of one year or more.
If the insured has not made any claim during the Free Look Period, the insured shall be entitled to:
i. a refund of the premium paid less any expenses incurred by the Company on medical examination of the insured person and
the stamp duty charges or
ii. where the risk has already commenced and the option of return of the policy is exercised by the insured person, a deduction
towards the proportionate risk premium for period of cover or
iii. Where only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance
coverage during such period.

5.23 Nomination
The policyholder is required at the inception of the policy to make a nomination for the purpose of payment of claims under the
policy in the event of death of the policyholder. Any change of nomination shall be communicated to the company in writing and
such change shall be effective only when an endorsement on the policy is made. In the event of death of the policyholder, the
Company will pay the nominee {as named in the Policy Schedule/Policy Certificate/Endorsement (if any)} and in case there is no
subsisting nominee, to the legal heirs or legal representatives of the policyholder whose discharge shall be treated as full and final
discharge of its liability under the policy.

6. REDRESSAL OF GRIEVANCE
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:
Customer 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
For more information on grievance mechanism, and to download grievance form, visit our
website https://nationalinsurance.nic.co.in
Bima Bharosa (an Integrated Grievance Management System earlier known as IGMS) - https://bimabharosa.irdai.gov.in/
Insurance Ombudsman – The Insured person can also approach the office of Insurance Ombudsman of the respective area/region
for redressal of grievance as listed in Annexure -III. The updated list of Office of Insurance Ombudsman are available on IRDAI
website: https://irdai.gov.in/ and on the website of Council for Insurance Ombudsman: https://www.cioins.co.in/
Helpline Number: 1800 345 0330
Dedicated Email ID for Senior Citizens: health.srcitizens@nic.co.in

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 17 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
7. OPTIONAL COVERS
7.1 Pre-existing Diabetes / Hypertension
Subject otherwise to the terms, definitions, exclusions, and conditions of the Policy and on payment of additional premium, the
Company shall pay expenses for treatment of diabetes and/ or hypertension, if pre-existing, from the inception of the Policy. On
completion of continuous thirty six months of insurance, the additional premium and sub limits shall not apply.

Eligibility
As per the Policy.

Limit of Cover
Sum Insured opted under the policy shall apply.

Policy period
The policy period for the Policy, and the cover should be identical, as mentioned in the schedule.

Tax rebate
The insured can avail tax benefits for the premium paid, under Section 80D of Income Tax Act 1961.

Renewal
The cover can be renewed annually till Exclusion 4.1 applies on diabetes and/or hypertension, with respect to the insured persons.

7.1.1 Condition
Claim Amount
Any amount payable shall be subject to
i. The sum insured applicable to Section 3.1,
ii. Co-payment mentioned under Classification of Zone and Co-payment, Optional Copayment, and
iii. Sub limits mentioned below.
First year Up to a maximum of 25% of SI
Second year Up to a maximum of 50% of SI
Third year Up to a maximum of 75% of SI

7.2 Out-patient Treatment

Subject otherwise to the terms, definitions, conditions and Exclusions 4.7, 4.8, 4.17, 4.16, 4.23, 4.12, 4.9, 4.10, 4.34 and 4.35, the
Company shall pay up to the limit, as stated in the schedule with respect of
i. Out-patient consultations by a medical practitioner
ii. Diagnostic tests prescribed by a medical practitioner
iii. Medicines/drugs prescribed by a medical practitioner
iv. Out patient dental treatment

Eligibility
The cover can be availed by all insured persons as a floater.

Limit of Cover
Limit of cover, available under Out-patient Treatment are INR 2,000/ 3,000/ 4,000/ 5,000/ 10,000/ 15,000/ 20,000/ 25,000, in
addition to the sum insured opted.

Policy Period
The policy period for the Policy, and the cover should be identical, as mentioned in the schedule.

Tax Rebate
The insured person can avail tax benefits for the premium paid, under Section 80D of Income Tax Act 1961.

Renewal
The Outpatient Treatment cover can be renewed annually throughout the lifetime of the insured person.

7.2.1 Exclusions
The Company shall not make any payment under the cover in respect of
i. Treatment other than Allopathy/ Modern medicine, AYUSH
ii. * Cosmetic dental treatment to straighten lightens, reshape and repair teeth.
* Cosmetic treatments include veneers, crowns, bridges, tooth-coloured fillings, implants and tooth whitening).

7.2.2 Condition
Claim Amount
i. Any amount payable shall not affect the sum insured applicable to Section 3.1 and entitlement to No Claim Discount.
ii. Any amount payable shall not be subject to co-payment.

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 18 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
Claims Procedure
Documents supporting all out-patient treatments shall be submitted to the TPA/ Company twice during the policy period, within
thirty days of completion of six month period.

Documents
The claim has to be supported by the following original documents
i. All bills, prescriptions from medical practitioner
ii. Diagnostic test bills, copy of reports
iii. Any other documents required by the Company

Enhancement of Limit of Cover

Limit of cover can be enhanced only at the time of renewal.

7.3 Critical Illness

Subject otherwise to the terms, definitions, exclusions, and conditions of the Policy the Company shall pay the benefit amount, as
stated in the schedule, provided that
i. the insured person is first diagnosed as suffering from a critical illness during the policy period as a first incidence, and
ii. the insured person survives at least thirty days following such diagnosis
iii. diagnosis of critical illness is supported by clinical, radiological, histological and laboratory evidence acceptable to the
Company.

Eligibility (entry age)

The cover can be availed by persons between the age of eighteen years and sixty five years.

Benefit Amount
Benefit amount available under Critical Illness cover shall be limited to the 50% of the sum insured by the Policy.
Benefit amount available per individual are INR 2,00,000/ 3,00,000/ 5,00,000/ 10,00,000/ 15,00,000/ 20,00,000/ 25,00,000, in
addition to the sum insured opted.

Policy Period
The policy period for the Policy, and the cover should be identical, as mentioned in the schedule.

Pre Policy checkup

Pre Policy checkup reports (as per Section 2.8.iii) are required for individual opting for Critical illness cover between the age of
eighteen years and sixty five years.

Tax Rebate
No tax benefit is allowed on the premium paid under Critical Illness cover (if opted)

Renewal
The Critical Illness cover can be renewed annually throughout the lifetime of the insured person.

7.3.1 Definition
Critical illness means stroke resulting in permanent symptoms, cancer of specified severity, kidney failure requiring regular
dialysis, major organ/ bone marrow transplant, multiple sclerosis with persisting symptoms an open chest CABG (Coronary Artery
Bypass Graft), permanent paralysis of limbs and blindness.

I. Stroke Resulting in Permanent Symptoms

Any cerebrovascular incident producing permanent neurological sequelae. This includes infarction of brain tissue, thrombosis in an
intracranial vessel, haemorrhage and embolisation from an extracranial source. Diagnosis has to be confirmed by a specialist medical
practitioner and evidenced by typical clinical symptoms as well as typical findings in CT Scan or MRI of the brain. Evidence of
permanent neurological deficit lasting for at least three months has to be produced.

The following are not covered:

i. transient ischemic attacks (TIA)
ii. traumatic injury of the brain
iii. vascular disease affecting only the eye or optic nerve or vestibular functions.

II. Cancer of Specified Severity

A malignant tumor characterised by the uncontrolled growth & spread of malignant cells with invasion & destruction of normal
tissues. This Diagnosis must be supported by histological evidence of malignancy. The term cancer includes leukemia, lymphoma
and sarcoma.
The following are excluded:
i. All tumors which are histologically described as carcinoma in situ, benign, pre-malignant, borderline malignant, low
malignant potential, neoplasm of unknown behavior, or non- invasive, including but not limited to:
Carcinoma in situ of breasts, Cervical dysplasia CIN-1, CIN -2 & CIN-3.
ii. Any non- melanoma skin carcinoma unless there is evidence of metastases to lymph nodes or beyond;
National Insurance Co. Ltd.
National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 19 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
iii. Malignant melanoma that has not caused invasion beyond the epidermis;
iv. All tumors of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at
least clinical TNM classification T2N0M0;
v. All Thyroid cancers histologically classified as T1N0M0 (TNM classification) or below;
vi. Chronic lymphocytic leukaemia less than RAI stage 3
vii. Non- invasive Papillary cancer of bladder histologically described as TaN0M0 (TNM Classification)or of a lesser
classification;
viii. All Gastro-intestinal Stromal Tumors histologically classified as T1N0M0 (TNM Classification) or below and with mitotic
count of less than or equal to 5/50 HPFs;

III Kidney Failure Requiring Regular Dialysis

End stage renal disease presenting as chronic irreversible failure of both kidneys to function, as a result of which either regular renal
dialysis (hemodialysis or peritoneal dialysis) is instituted or renal transplantation is carried out. Diagnosis has to be confirmed by a
specialist medical practitioner.

IV Major Organ/ Bone Marrow Transplant

The actual undergoing of a transplant of:
i. one of the following human organs: heart, lung, liver, kidney, pancreas, that resulted from irreversible end-stage failure of the
relevant organ, or
ii. human bone marrow using haematopoietic stem cells. The undergoing of a transplant has to be confirmed by a specialist medical
practitioner.

The following are not covered

i. other stem-cell transplants
ii. where only islets of langerhans are transplanted

V Multiple Sclerosis with Persisting Symptoms

The unequivocal Diagnosis of Definite Multiple Sclerosis confirmed and evidenced by all of the following
i. Investigations including typical MRI findings, which unequivocally confirm the Diagnosis to be multiple sclerosis and
ii. There must be current clinical impairment of motor or sensory function, which must have persisted for a continuous period of
at least 6 months
iii. Neurological damage due to SLE is excluded.

VI Open Chest CABG

The actual undergoing of open chest surgery for the correction of one or more coronary arteries, which is/are narrowed or blocked,
by coronary artery bypass graft (CABG). The diagnosis must be supported by a coronary angiography and the realization of surgery
has to be confirmed by a specialist medical practitioner.

The following are not covered

i. angioplasty and/or any other intra-arterial procedures
ii. any key-hole or laser surgery.

VII Permanent Paralysis of Limbs

Total and irreversible loss of use of two or more limbs as a result of injury or disease of the brain or spinal cord. A specialist medical
practitioner must be of the opinion that the paralysis will be permanent with no hope of recovery and must be present for more than
three months.

VIII Blindness
The total and permanent loss of all sight in both eyes.

7.3.2 Exclusions
The Company shall not be liable to make any payment by the Policy if: any critical illness and/or its symptoms (and/or the treatment)
which were present at any time before inception of the first Policy, or which manifest within a period of ninety days from inception
of the first Policy, whether or not the insured person had knowledge that the symptoms or treatment were related to such critical
illness. In the event of break in the Policy, the terms of this exclusion shall apply as new from recommencement of cover

7.3.3 Condition
Claim Amount
i. Any amount payable under the optional covers will not affect the sum insured applicable to Section 3.1 and entitlement to
No Claim Discount (Section 3.1).
ii. Any amount payable shall not be subject to co-payment.
Notification of Claim
In the event of a claim, the insured person/insured person’s representative shall intimate the Company in writing, providing all
relevant information within fifteen days of diagnosis of the illness.

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 20 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
Claims Procedure
Documents as mentioned above, supporting the diagnosis shall be submitted to the Company within sixty days from the date of
diagnosis of the critical illness.

Documents
The claim has to be supported by the following original documents
i. Doctor’s certificate confirming diagnosis of the critical illness along with date of diagnosis.
ii. Pathological/other diagnostic test reports confirming the diagnosis of the critical illness.
iii. Any other documents required by the Company

Cessation of Cover
1 upon payment of the benefit amount on the occurrence of a critical illness the cover shall cease and no further claim shall be paid
for any other critical illness during the policy year.
2 On renewal, no claim shall be paid for a critical illness for which a claim has already been made

Enhancement of Benefit Amount

i. Benefit amount can be enhanced only at the time of renewal.
ii. Benefit amount can be enhanced to the next slab subject to discretion of the Company.

Insurance is the subject matter of solicitation

Please preserve the Policy for all future reference.

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 21 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
Table of Benefits:
Features Plans
PLAN A PLAN B PLAN C
Sum insured (SI) (as Floater) INR 6/ 7/ 8/ 9 /10 Lac INR 15/ 20 /25 Lac INR 30/ 40/ 50 Lac
Treatment Allopathy, AYUSH
In built Covers (subject to the SI)
In patient Treatment (as Floater) Up to SI Up to SI Up to SI
Pre Hospitalisation 30 days 30 days 30 days
Post Hospitalisation 60 days 60 days 60 days
Pre-existing Disease (Only PEDs declared in the Proposal
Covered after 36 months of Covered after 36 months Covered after 36 months
Form and accepted for coverage by the Company shall be
continuous coverage of continuous coverage of continuous coverage
covered)
Room - Up to 1% of SI or actual,
whichever is lower
* Room/ ICU Charges (per day per insured person) Up to SI Up to SI
ICU – Up to 2% of SI or actual,
whichever is lower
** Limit for Cataract Surgery (For each eye per insured Up to 15% of SI or INR 60,000
Up to SI Up to SI
person) whichever is lower
Domiciliary Hospitalisation (as Floater) Up to INR 1,00,000 Up to INR 2,00,000 Up to INR 2,00,000
Day Care Procedures (as Floater) Up to SI Up to SI Up to SI
AYUSH Treatment (as Floater) Up to SI Up to SI Up to SI
Organ Donor’s Medical Expenses (as Floater) Up to SI Up to SI Up to SI
INR 1,000, max. of 5 INR 2,000, max. of 5
Hospital Cash (per insured person, per day) INR 500, max. of 5 days
days days
Ambulance (per insured person, in a policy year) Up to INR 2,500 Up to INR 4,000 Up to INR 5,000
Air Ambulance (per insured person, in a policy year) Not covered Up to 5% of SI Up to 5% of SI
Medical Emergency Reunion (per insured person, in a policy
Not covered No sublimit No sublimit
year)
Doctor’s Home Visit and Nursing Care during Post INR 1,000 per day, max. INR 2,000 per day, max.
Not covered
Hospitalisation (per insured person, in a policy year) of 10 days of 10 days
Anti Rabies Vaccination (per insured person, in a policy year) Up to INR 5,000 Up to INR 5,000 Up to INR 5,000
Up to INR 30,000 for normal
Maternity (including Baby from Birth Cover) (per insured
delivery and INR 50,000 for Up to SI Up to SI
person, in a policy year, waiting period of 2 years applies)
caesarean section
Vaccination for New Born Baby As part of Maternity As part of Maternity As part of Maternity
Infertility (per insured person, in a policy year, waiting
Up to INR 50,000 Up to INR 1,00,000 Up to INR 1,00,000
period of 2 years applies)
Vaccination for Children, for male child up to 12 years and
female child up to 14 years (per insured person, in a policy Up to INR 1,000 Up to SI Up to SI
year)
Modern Treatment (12 nos) Up to 25% of SI for each treatment Up to 25% of SI for each Up to 25% of SI for each
treatment treatment
Treatment due to participation in hazardous or adventure Up to 25% of SI Up to 25% of SI Up to 25% of SI
sports (non-professionals)
Morbid Obesity Covered after waiting period of 3 Covered after waiting Covered after waiting
years period of 3 years period of 3 years
Refractive Error (min 7.5D) Covered after waiting period of 2 Covered after waiting Covered after waiting
years period of 2 years period of 2 years
Other benefits
Reinstatement of sum insured due to road traffic accident Yes Yes Yes
Good Health Incentives
No Claim Discount 5% discount on base premium,
Every 2 yrs., up to INR Every 2 yrs., up to INR
Health Check Up (as Floater) Every 2 yrs., up to INR 5,000
7,500 10,000
Optional covers
First year Up to a maximum of 25% of SI
Pre-existing Diabetes/Hypertension (as Floater) Second year Up to a maximum of 50% of SI
Third year Up to a maximum of 75% of SI
Limit of cover per family - INR 2,000/ 3,000/ 4,000/ 5,000/ 10,000/ 15,000/ 20,000/ 25,000
Out-patient Treatment (as Floater in a policy year)
in addition to the SI
Benefit amount - INR 2,00,000/ 3,00,000/ 5,00,000/ 10,00,000/ 15,00,000/ 20,00,000/
***Critical Illness (per insured person in a policy year)
25,00,000 in addition to the SI
Discounts
Online Discount 10% discount in premium (for new and Renewal, ONLY where no intermediary is involved)
•20% Co-payment, with a 25% discount in total premium.
Co-payment discount (optional)
•10% Co-payment, with a 12.5% discount in total premium.
Long Term Discount Discount of 4% for 2 year policy and Discount of 7.5% for 3 year policy
No Maternity/ Infertility Discount Discount of 3%, above 45 years of age
Add-ons (cover available on payment of additional premium)
INR 10,000/ 15,000/ 20,000/ 25,000/ 30,000/ 35,000/ 40,000/ 45,000/ 50,000, subject to 10%
National Home Care Treatment Add-On
of Basic SI under base Policy.
National Non-Medical Expenses Add-on (available to SI 5 Up to 10% of Basic Sum Insured (excluding Cumulative Bonus, if any) of base Policy and
lacs & above) shall be part of the base Policy Basic Sum Insured (excluding Cumulative Bonus, if any).
* The limit shall not apply if the treatment is undergone for a listed procedure in a Preferred Provider Network (PPN) as a package.
** The limit shall not apply if the treatment is undergone for a listed procedure in a Preferred Provider Network (PPN) as a package
*** Critical Illness benefit amount should not be more than the sum insured opted under the Policy

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 22 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
 Annexure I
Vaccinations for Children
Time interval Type of vaccination Frequency

Vaccination for new born

0-3 months BCG (From birth to 2 weeks) 1
OPV (0‚6‚10 weeks) OR OPV + IPV1 (6,10 3 OR 4
weeks)
DPT (6 & 10 week) 2
Hepatitis-B (0 & 6 week) 2
Hib (6 & 10 week) 2
Vaccination for first year
3-6 months OPV (14 week) OR OPV + IPV2 1 OR 2
DPT (14 week) 1
Hepatitis-B (14 week) 1
Hib (14 week) 1
9 months Measles (+9 months) 1
12 months Chicken Pox (12 months) 1
Vaccinations for age 1 to 12 years
1-2 years OPV (15 &18 months) OR OPV + IPV3 1 OR 2
DPT (15-18 months) 1
Hib (15-18 months) 1
MMR (15- 18 months) 1
Meningococcal vaccine (24 months) 1
2-3 years Typhoid (+2 years) 1
10-12 years TT 1
14 years (girl child only) HPV 1

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 23 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
 Annexure II
List I – List of which coverage is not available in the policy 14 BED PAN
Sl Item 15 FACE MASK
1 BABY FOOD 16 FLEXI MASK
2 BABY UTILITIES CHARGES 17 HAND HOLDER
3 BEAUTY SERVICES 18 SPUTUM CUP
4 BELTS/ BRACES 19 DISINFECTANT LOTIONS
5 BUDS 20 LUXURY TAX
6 COLD PACK/HOT PACK 21 HVAC
7 CARRY BAGS 22 HOUSE KEEPING CHARGES
8 EMAIL / INTERNET CHARGES 23 AIR CONDITIONER CHARGES
9 FOOD CHARGES (OTHER THAN PATIENT's DIET PROVIDED BY 24 IM IV INJECTION CHARGES
HOSPITAL) 25 CLEAN SHEET
10 LEGGINGS 26 BLANKET/WARMER BLANKET
11 LAUNDRY CHARGES 27 ADMISSION KIT
12 MINERAL WATER 28 DIABETIC CHART CHARGES
13 SANITARY PAD 29 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES
14 TELEPHONE CHARGES 30 DISCHARGE PROCEDURE CHARGES
15 GUEST SERVICES 31 DAILY CHART CHARGES
16 CREPE BANDAGE 32 ENTRANCE PASS / VISITORS PASS CHARGES
17 DIAPER OF ANY TYPE 33 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE
18 EYELET COLLAR 34 FILE OPENING CHARGES
19 SLINGS 35 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)
20 BLOOD GROUPING AND CROSS MATCHING OF DONORS SAMPLES 36 PATIENT IDENTIFICATION BAND / NAME TAG
21 SERVICE CHARGES WHERE NURSING CHARGE ALSO CHARGED 37 PULSEOXYMETER CHARGES
22 Television Charges List III – Items that are to be subsumed into Procedure Charges
23 SURCHARGES Sl Item
24 ATTENDANT CHARGES 1 HAIR REMOVAL CREAM
25 EXTRA DIET OF PATIENT (OTHER THAN THAT WHICH FORMS 2 DISPOSABLES RAZORS CHARGES (for site preparations)
PART OF BED CHARGE) 3 EYE PAD
26 BIRTH CERTIFICATE 4 EYE SHEILD
27 CERTIFICATE CHARGES 5 CAMERA COVER
28 COURIER CHARGES 6 DVD, CD CHARGES
29 CONVEYANCE CHARGES 7 GAUSE SOFT
30 MEDICAL CERTIFICATE 8 GAUZE
31 MEDICAL RECORDS 9 WARD AND THEATRE BOOKING CHARGES
32 PHOTOCOPIES CHARGES 10 ARTHROSCOPY AND ENDOSCOPY INSTRUMENTS
33 MORTUARY CHARGES 11 MICROSCOPE COVER
34 WALKING AIDS CHARGES 12 SURGICAL BLADES, HARMONICSCALPEL,SHAVER
35 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE HOSPITAL) 13 SURGICAL DRILL
36 SPACER 14 EYE KIT
37 SPIROMETRE 15 EYE DRAPE
38 NEBULIZER KIT 16 X-RAY FILM
39 STEAM INHALER 17 BOYLES APPARATUS CHARGES
40 ARMSLING 18 COTTON
41 THERMOMETER 19 COTTON BANDAGE
42 CERVICAL COLLAR 20 SURGICAL TAPE
43 SPLINT 21 APRON
44 DIABETIC FOOT WEAR 22 TORNIQUET
45 KNEE BRACES (LONG/ SHORT/ HINGED) 23 ORTHOBUNDLE, GYNAEC BUNDLE
46 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER List IV – Items that are to be subsumed into costs of treatment
47 LUMBO SACRAL BELT Sl Item
48 NIMBUS BED OR WATER OR AIR BED CHARGES 1 ADMISSION/REGISTRATION CHARGES
49 AMBULANCE COLLAR 2 HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC PURPOSE
50 AMBULANCE EQUIPMENT 3 URINE CONTAINER
51 ABDOMINAL BINDER 4 BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING
52 PRIVATE NURSES CHARGES- SPECIAL NURSING CHARGES CHARGES
53 SUGAR FREE Tablets 5 BIPAP MACHINE
54 CREAMS POWDERS LOTIONS (Toiletries are not payable, only prescribed 6 CPAP/ CAPD EQUIPMENTS
medical pharmaceuticals payable) 7 INFUSION PUMP– COST
55 ECG ELECTRODES 8 HYDROGEN PEROXIDE\SPIRIT\ DISINFECTANTS ETC
56 GLOVES 9 NUTRITION PLANNING CHARGES - DIETICIAN CHARGES- DIET
57 NEBULISATION KIT CHARGES
58 ANY KIT WITH NO DETAILS MENTIONED [DELIVERY KIT, 10 HIV KIT
ORTHOKIT, RECOVERY KIT, ETC] 11 ANTISEPTIC MOUTHWASH
59 KIDNEY TRAY 12 LOZENGES
60 MASK 13 MOUTH PAINT
61 OUNCE GLASS 14 VACCINATION CHARGES
62 OXYGEN MASK 15 ALCOHOL SWABES
63 PELVIC TRACTION BELT 16 SCRUB SOLUTION/STERILLIUM
64 PAN CAN 17 Glucometer & Strips
65 TROLLY COVER 18 URINE BAG
66 UROMETER, URINE JUG
67 VASOFIX SAFETY
List II – Items that are to be subsumed into Room Charges
Sl Item
1 BABY CHARGES (UNLESS SPECIFIED/INDICATED)
2 HAND WASH
3 SHOE COVER
4 CAPS
5 CRADLE CHARGES
6 COMB
7 EAU-DE-COLOGNE / ROOM FRESHNERS
8 FOOT COVER
9 GOWN
10 SLIPPERS
11 TISSUE PAPER
12 TOOTH PASTE
13 TOOTH BRUSH
National Insurance Co. Ltd.
National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page 24 of 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156
 Annexure III
The contact details of the Insurance Ombudsman offices are as below:
Areas of Jurisdiction Office of the Insurance Ombudsman Tel.: 0141- 2740363
Email: bimalokpal.jaipur@cioins.co.in
Office of the Insurance Ombudsman, Kerala , UT of (a) Office of the Insurance Ombudsman,
Gujarat , UT of Dadra and Lakshadweep, (b) Mahe – a Kochi
Ahmedabad
Nagar Haveli, Daman and part of UT of Pondicherry 10th Floor, Jeevan Prakash,LIC Building,
Jeevan Prakash Building, 6th floor,
Diu Opp to Maharaja's College
Tilak Marg, Relief Road,
Ahmedabad – 380 001. Ground,M.G.Road,
Tel.: 079 - 25501201/02 Kochi - 682 011.
Email: Tel.: 0484 - 2358759
bimalokpal.ahmedabad@cioins.co.in Email:
Office of the Insurance Ombudsman, bimalokpal.ernakulam@cioins.co.in
Karnataka West Bengal, UT of Office of the Insurance Ombudsman,
Bengaluru
Jeevan Soudha Building,PID No. 57-27- Andaman and Nicobar Kolkata
N-19 Islands, Sikkim Hindustan Bldg. Annexe, 7th Floor,
Ground Floor, 19/19, 24th Main Road, 4, C.R. Avenue,
JP Nagar, Ist Phase, Bengaluru – 560 078. KOLKATA - 700 072.
Tel.: 080 - 26652048 / 26652049 Tel.: 033 - 22124339 / 22124341
Email: bimalokpal.bengaluru@cioins.co.in Email: bimalokpal.kolkata@cioins.co.in
Madhya Pradesh and Office of the Insurance Ombudsman, Districts of Uttar Pradesh : Office of the Insurance Ombudsman,
Chhattisgarh Bhopal Laitpur, Jhansi, Mahoba, Lucknow
1st floor,"Jeevan Shikha", 60-B, Hamirpur, Banda, 6th Floor, Jeevan Bhawan, Phase-II,
Hoshangabad Road, Opp. Gayatri Chitrakoot, Allahabad, Nawal Kishore Road, Hazratganj,
Mandir,Arera Hills Mirzapur, Sonbhabdra, Lucknow - 226 001.
Bhopal – 462 011. Fatehpur, Pratapgarh, Tel.: 0522 - 4002082 / 3500613
Tel.: 0755 - 2769201 / 2769202/ 2769203 Jaunpur,Varanasi, Gazipur, Email: bimalokpal.lucknow@cioins.co.in
Email: bimalokpal.bhopal@cioins.co.in Jalaun, Kanpur, Lucknow,
Orissa Office of the Insurance Ombudsman, Unnao, Sitapur, Lakhimpur,
Bhubaneswar Bahraich, Barabanki,
62, Forest park, Raebareli, Sravasti, Gonda,
Bhubneshwar – 751 009. Faizabad, Amethi,
Tel.: 0674 - 2596461 /2596455 Kaushambi, Balrampur,
Email: Basti, Ambedkarnagar,
bimalokpal.bhubaneswar@cioins.co.in Sultanpur, Maharajgang,
Punjab, Haryana (excluding Office of the Insurance Ombudsman, Santkabirnagar, Azamgarh,
Gurugram, Faridabad, Chandigarh Kushinagar, Gorkhpur,
Sonepat and Bahadurgarh), Jeevan Deep Building SCO 20-27, Deoria, Mau, Ghazipur,
Himachal Pradesh, Union Ground Floor Sector- 17 A, Chandauli, Ballia,
Territories of Jammu & Chandigarh – 160 017. Sidharathnagar.
Kashmir,Ladakh & Tel.: 0172-2706468 Mumbai Metropolitan Office of the Insurance Ombudsman,
Chandigarh. Email: Region excluding wards in Mumbai
bimalokpal.chandigarh@cioins.co.in Mumbai – i.e M/E, M/W, N , 3rd Floor, Jeevan Seva Annexe,
Tamil Nadu, UT– Office of the Insurance Ombudsman, S and T covered under Office S. V. Road, Santacruz (W),
Pondicherry Town and Chennai of Insurance Ombudsman Mumbai - 400 054.
Karaikal (which are part of Fatima Akhtar Court, 4th Floor, 453, Thane and areas of Navi Tel.: 022 - 69038800/27/29/31/32/33
UT of Pondicherry) Anna Salai, Teynampet, Mumbai. Email: bimalokpal.mumbai@cioins.co.in
CHENNAI – 600 018. State of Uttaranchal and the Office of the Insurance Ombudsman,
Tel.: 044 - 24333668 / 24333678 following Districts of Uttar Noida
Email: bimalokpal.chennai@cioins.co.in Pradesh: Bhagwan Sahai Palace
Delhi & following Districts Office of the Insurance Ombudsman, Agra, Aligarh, Bagpat, 4th Floor, Main Road, Naya Bans, Sector
of Haryana - Gurugram, Delhi Bareilly, Bijnor, Budaun, 15,
Faridabad, Sonepat & 2/2 A, Universal Insurance Building, Bulandshehar, Etah, Kanooj, Distt: Gautam Buddh Nagar, U.P-201301.
Bahadurgarh. Asaf Ali Road, Mainpuri, Mathura, Meerut, Tel.: 0120-2514252 / 2514253
New Delhi – 110 002. Moradabad, Muzaffarnagar, Email: bimalokpal.noida@cioins.co.in
Tel.: 011 - 46013992/23213504/23232481 Oraiyya, Pilibhit, Etawah,
Email: bimalokpal.delhi@cioins.co.in Farrukhabad, Firozbad,
Assam , Meghalaya, Office of the Insurance Ombudsman, Gautambodhanagar,
Manipur, Mizoram, Guwahati Ghaziabad, Hardoi,
Arunachal Pradesh, Nagaland Jeevan Nivesh, 5th Floor, Shahjahanpur, Hapur,
and Tripura Near Pan Bazar , S.S. Road, Shamli, Rampur, Kashganj,
Guwahati – 781001(ASSAM). Sambhal, Amroha, Hathras,
Tel.: 0361 - 2632204 / 2602205 / 2631307 Kanshiramnagar, Saharanpur
Email: bimalokpal.guwahati@cioins.co.in Bihar, Office of the Insurance Ombudsman,
Andhra Pradesh, Telangana Office of the Insurance Ombudsman, Jharkhand. Patna
and UT of Yanam – a part of Hyderabad 2nd Floor, Lalit Bhawan, Bailey Road,
the UT of Pondicherry 6-2-46, 1st floor, "Moin Court", Lane Patna 800 001.
Opp.Hyundai Showroom , A. C. Guards, Tel.: 0612-2547068
Lakdi-Ka-Pool, Hyderabad - 500 004. Email: bimalokpal.patna@cioins.co.in
Tel.: 040 - 23312122 / 23376991 / State of Goa and State of Office of the Insurance Ombudsman, Pune
23376599 / 23328709 / 23325325 Maharashtra excluding areas Jeevan Darshan Bldg., 3rd Floor,
Email: of Navi Mumbai, Thane C.T.S. No.s. 195 to 198, N.C. Kelkar
bimalokpal.hyderabad@cioins.co.in district,Palghar District, Road,
Rajasthan Office of the Insurance Ombudsman, Raigad district & Mumbai Narayan Peth, Pune – 411 030.
Jaipur Metropolitan Region Tel.: 020-24471175
Jeevan Nidhi – II Bldg., Gr. Floor, Email: bimalokpal.pune@cioins.co.in
Bhawani Singh Marg, Jaipur - 302 005.

National Insurance Co. Ltd.

National Parivar Mediclaim Plus Policy
Premises No. 18-0374, Plot no. CBD-81, Page | 25
UIN: NICHLIP25039V032425
New Town, Kolkata - 700156