Varistha – Medi-Claim For Senior Citizens

National Insurance Company Limited

Apart from offering health insurance policies for individuals, families and students, National Insurance Company Limited also has a health insurance policy for the senior citizens called the “Varistha – medi-claim for senior citizens” policy. TheSALIENT FEATURES of this policy are:

· This policy caters to the needs of senior citizens by covering their hospitalization and domiciliary hospitalization expenses as well as expenses for treatment of Critical illnesses

· The diseases covered under critical illness are coronary artery surgery, cancer, renal failure of failure of both kidneys, stroke, multiple sclerosis, major organ transplants like kidney, lung, pancreas or bone marrow, paralysis and blindness at extra premium

· Fixed sum insured for each policyholder

· Under hospitalization and domiciliary hospitalization cover the sum insured is Rs.1 lac

· Under critical illness cover the sum insured is Rs.2 lacs

· If the applicant did not have an insurance policy in her/his name then s/he will have to undergo medical check up at her/his own cost for blood/urine sugar, blood pressure, echo-cardiography and eye check up including retinoscopy

· Company’s overall liability in respect of claims arising due to cataract is Rs.10000 and that of benign prostatic hyperplasia is Rs.20000

· Company’s liability in respect of claims admitted during the period of insurance shall not exceed sum insured

· Liability of the company under domiciliary hospitalization clause is limited to 20% of sum insured

· Ambulance charges up to a maximum limit of Rs.1000 in a policy year will be reimbursed

· Expenses of hospitalization for minimum period of 24 hours are admissible

· The above time limit is not applicable to specific treatments such as day care treatment for stitching of wounds, close reduction and application of POP casts, dialysis, chemotherapy, radiotherapy, eye surgery, ENT surgery, laparoscopic surgery, angiographies, endoscopies, lithotripsy and tonsillectomy

· Domiciliary hospitalization benefit means medical treatment for a period exceeding 3 days for such illnesses/diseases/injury which in the normal course would require care and treatment at a hospital/nursing home but taken whilst at home

· When treatment such as Dialysis, Chemotherapy, Radiotherapy is taken in the hospital/nursing home and the insured is discharged the same day, the treatment will be considered to be taken under hospitalization benefit section

· Pre-hospitalization during period up to 30 days prior to the disease will be considered as part of claim

· Post-hospitalization during period up to 60 days prior to the disease will be considered as part of claim

· Two pre-existing diseases namely diabetes and hypertension will be covered from the inception of the policy on payment of additional premium

· Insured shall bear 10% of any admissible claim that is a part of Compulsory Excess

· Insured has to bear additional 10% of all admissible claims if the claim arises out of any pre-existing disease for which the insured opted cover and paid additional premium

· No claim will be paid if a critical illness incepts during the first 90 days of the inception of the policy

· The insured needs to survive for 30 successive days after the diagnosis of the critical illness in order to make the claim

AGE LIMITS:

· The age group for fresh entry in to the scheme is between 60 years and 80 years

· The renewal age limit will be extended up to 90 years in which case the premium of 76-80 age band will be loaded by 10% up to 85 years and 20% up to 90 years of age

SCOPE OF COVER UNDER VARISTHA:

	HOSPITALIZATION BENEFIT	LIMIT
A	1. Room, boarding expenses as provided by hospital/nursing home 2. If admitted in ICU	Up to 1% of sum insured per day Up to 2% of sum insured per day; overall limit of 25% of sum insured per illness/injury
B	Surgeon, anesthetist, medical practitioner, consultants, specialist’s fee, nursing expenses	Up to 25% of sum insured per illness/injury
C	Anesthesia, blood, oxygen, OT charges, surgical appliances subject to upper limit of 7% of sum insured, medicines, drugs, diagnostic material and X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs, cost of stent and implants	Up to 50% of sum insured per illness/injury

PREMIUM CHART:

	SUM INSURED	PREMIUM 60-65 YEARS	PREMIUM 66-70 YEARS	PREMIUM 71-75 YEARS	PREMIUM 76-80 YEARS
MEDICLAIM	Rs.1 lac	4180/-	5196/-	5568/-	6890/-
CRITICAL ILLNESS	Rs.2 lacs	2007/-	2130/-	2200/-	2288/-
TOTAL		6187/-	7326/-	7768/-	9178/-

ADDITIONAL POINTS TO THE PREMIUM CHART:

· For fresh entrants to National Insurance the above premium will be loaded by 10%

· If a person suffers from any of the terminal diseases referred under critical illness cover then s/he will never be covered for that in this policy even on payment of additional premium

· Cover for Paralysis and Blindness may be given under Critical Illness by loading the Critical Illness premium by 15% in each case or 25% in case of both covers together

EXCLUSIONS:

The company shall not pay any benefit to the insured that suffers an event-giving rise to a Critical Illness that is caused by any of the following:

· Indigestion of drugs other than those prescribed by a medical practitioner

· Indigestion of medicines, prescribed or not, for treatment of drug addiction and any related to it

· Any attempt to commit suicide or any self inflicted injury

· Where the insured at any time suffered from the condition known as AIDS or HIV

· The company will not be liable for a Critical Illness or its symptoms of which were present in the insured at any time before inception of the policy or that manifests within a period of 90 days from such date

· No claim will be payable if the insured smokes 40 or more cigarettes/cigars or equivalent tobacco intake in a day

· No claim will be payable if a critical illness is caused by ionizing radiations or contamination by radioactivity from any nuclear fuel or nuclear waste or any war/invasion

ADDITIONAL BENEFITSof taking this health insurance policy for senior citizens from National Insurance Company Limited are:

· It is a public sector company so it is perceived to be safer by quite a few people

· No medical check up is required if the insured was covered under any health insurance policy of National Insurance Company or any other insurance company uninterruptedly for preceding three years

· Sum insured shall be progressively increased by 5% in respect of each claim free year subject to a maximum of 10 claim free years of insurance

· The policyholder also has an option to take a 5% discount each year instead of increasing the sum insured each year

· The insured shall be entitled for reimbursement of the cost of medical check up once at the end of block of every 3 underwriting years provided there are no claims during that block. But the cost of reimbursement will not exceed amount equal to 2% of the amount of average sum insured excluding the cumulative bonus