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| NATIONAL INSURANCE COMPANY LIMITED |
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Regd. Office : 3, Middleton Street, Post Box – 9229, Kolkata – 700 071. |
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PARIVAR Mediclaim for Family |
| PROSPECTUS |
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| 1.SALIENT FEATURES OF THE POLICY |
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| This is a Family Floater Health Insurance Policy wherein entire family will be covered under single Sum Insured. |
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The Policy covers reimbursement of Hospitalization expenses for illness/diseases contracted or injury sustained by the Insured Person. In the event of any claim becoming admissible under the policy, the Company either pay directly to the insured if TPA service is not availed by the insured or pay to the Hospital/Nursing Home through TPA the amount of such expenses subject to limits as would fall under different heads mentioned below, as are reasonably and necessarily incurred in respect thereof anywhere in India by or on behalf of such Insured Person but not exceeding Sum Insured (all claims in aggregate) for that family as stated in the Schedule in any one period of insurance. |
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| HOSPITALIZATION EXPENSES: |
| Hospitalization Benefits |
Limits |
| a. |
(i)Room, Boarding expenses as provided by the Hospital/Nursing Home which also include Nursing care, RMO charges, I V fluids/Blood transfusion/Injection administration charges
(ii)If admitted in IC /ICC Unit |
(i)Upto 1% of Sum Insured per day
(ii)Upto 2% of Sum Insured per day |
| b. |
Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees, Nursing Expenses | Actual. |
| c. |
Anesthesia, Blood, Oxygen, OT charges, Surgical appliances(any disposable surgical consumables subject to upper limit of 10% of the S.I), Medicines, Drugs, Diagnostic material & X-Ray, Dialysis, Chemotherapy, Radiotherapy, cost of Pacemaker, artificial Limbs. Cost of Stent and implants |
Actual. |
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| N.B |
(a) |
Total expenses incurred for any one illness is limited to 50% of the overall Sum
Insured per family. |
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(b) |
Company’s liability in respect of all claims admitted during the period of Insurance shall not exceed the Sum Insured per family as mentioned in the Schedule. |
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(c) |
Hospitalization expenses of person donating an organ during the course of organ transplant will also be payable subject to the sub limits applicable for any one illness within the overall sum insured of the insured family. |
2.DEFINITIONS : |
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| 2.1- |
Family means Self, Spouse & two dependant children up to an age of 25 years. Parents are not covered. |
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| 2.2- |
Hospital/Nursing Home, means any institution in India established for indoor care and treatment of disease and injuries & which |
EITHER |
| (a) |
Has been registered either as a Hospital or Nursing Home with the local authorities and is under the supervision of a registered and qualified medical practitioner of Allopathic system of medicine. |
OR |
| (b) |
Hospital/Nursing Home run by Government. |
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| (C) |
Should comply with minimum criteria as under : |
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(i) |
It should have at least 15 inpatient beds. In Class “C” town the number of beds be reduced to 10. |
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(ii) |
Fully equipped Operation Theatre of its own wherever surgical operations are carried out. |
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(iii) |
Fully qualified nursing staff under its employment round the clock. |
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(iv) |
Fully qualified doctor(s) should be in charge round the clock. |
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| 2.2.1- |
The term, ‘Hospital/Nursing Home’, shall not include an establishment which is a place of rest, a place for the aged, a place for drug addicts or place of alcoholics, a hotel or a similar place. |
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| 2.3 |
Surgical Operation means manual and/or operative procedures for correction of deformities and defects, repair of injuries, diagnosis and cure of diseases, relief or suffering and prolongation of life. |
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