| 7- (b) Family Floater Coverage - National Insurance Prospectus |
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| PARIVAR Mediclaim for Family - NATIONAL INSURANCE COMPANY LIMITED |
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| 7. |
SUM INSURED |
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Rs.2,00,000/- to Rs.5,00,000/- in multiples of Rs.50,000/- |
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| 8. |
Premium Chart : Annexure-A |
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| 9. |
Claims Minimization Clause : |
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The Insured will at all times cooperate with the TPA/Company to contain claims ratio by ensuring that the treatment charges and other expenses are reasonable and necessary and will be subject to further sub-limits as may be required. |
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| 10. |
Cancellation Clause : |
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The policy may be renewed by mutual consent. The Company shall not however be bound to give notice that it is due for renewal and the Company may at any time cancel this policy by sending the insured 30 days notice by registered letter at the insured’s last known address and in such event the Company shall refund to the insured a pro-rata premium for un-expired period of insurance. The Company shall, however, remain liable for any claim arose prior to the date of cancellation. The insured may at any time cancel this policy and in such event the Company shall allow refund of premium at Company’s Short Period Rate(Table given hereunder) provided NO CLAIM has occurred upto the date of cancellation. |
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| Period on risk |
Rate of premium to be charged |
| Upto 1 month |
¼ th of the annual rate |
| Upto 3 months |
½ of the annual rate |
| Upto 6 months |
¾ th of the annual rate |
| Exceeding 6 months |
Full annual rate |
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| 11. |
Contribution Clause: |
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If the proposer is having more than one health insurance policies he should mention it to the underwriter so that there is a reference of the additional policy No. on both policies and that in case of a claim, underwriters will ensure that both the policies would contribute proportionately. |
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Procedure for availing Cashless Access Services in Network Hospital / Nursing Home. |
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Claims in respect of Cashless Access Services will be through the list of the network of Hospitals/Nursing Homes and is subject to pre admission authorization. The TPA shall, upon getting the related medical information from the insured persons/ network provider, verify that the person is eligible to claim under the policy and after satisfying itself will issue a pre-authorisation letter/ guarantee of payment letter to the Hospital/Nursing Home mentioning the sum guaranteed as payable, also the ailment for which the person is seeking to be admitted as a patient. |
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The TPA reserves the right to deny pre-authorisation in case the insured person is unable to provide the relevant medical details as required by the TPA. The TPA will make it clear to the insured person that denial of Cashless Access is in no way construed to be denial of treatment. The insured person may obtain the treatment as per his/her treating doctor’s advice and later on submit the full claim papers to the TPA for reimbursement subject to admissibility of claim as per terms and conditions of policy. |
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The TPA may repudiate the claim, giving reasons, if not covered under the terms of the policy. The insured person shall have right of appeal to the insurance company if he/she feels that the claim is payable. The insurance company’s decision in this regard will be final and binding on TPA. |
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The prospectus shall form part of your proposal form hence please sign as you have noted the contents of this prospectus |
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Signature of the Proposer: |
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Name: |
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Place & Date: |
