Varistha mediclaim is a health insurance policy started by the ‘National Insurance Company’ for senior citizens in India. It covers hospitalization expenses of both domiciliary hospitalization as well as critical illness.
Domiciliary Hospitalization expenses means that the patient is given coverage for being treated for an illness at home which should have been done at a hospital or nursing home in India under the following circumstances:
1. The patient is not in a condition to be moved from home.
2. There is shortage of accommodation at the concerned hospital or nursing home.
There are of course some illnesses which are not covered under this scheme. They are:
Asthma, Bronchitis, Chronic Nephritis or Nephritis syndrome, Diarrhea, dysentery and gastroenteritis, Diabetes mellitus, Epilepsy, Hypertension, Influenza, cough and cold, All psychosomatic disorder, Respiratory tract infection and Arthritis or rheumatism.
However the expenses for ‘Chemotherapy, Dialysis and Radiotherapy’ shall be covered under the insurance policy. Consultation within a lapse of 45 days would be considered as fresh illness. Both pre and post hospitalization expenses shall be covered under the scheme.
Diseases covered under critical illness are: 1.Coronary artery surgery, 2. Cancer, 3. Renal failure or failure of both kidneys, 4.Stroke, 5.Multiple sclerosis, 6.Major organ transplantation like kidney, pancreas etc. 7.Paralysis and blindness at extra premium.
Critical illness cover is an option under this policy. Insured that have not opted for critical illness cover are entitled to hospitalization and domiciliary expenses for diseases under critical illness but only up to the sum insured according to the scope of the policy. The advantage of an insured availing critical illness cover the expenses for treatment of the illness are compensated in total provided the diagnostic reports are submitted within 15 days of diagnosis by a registered doctor of any hospital within the network of the insurance company.
The scope of Varistha mediclaim varies from 1% to 50% of the sum insured. The boarding and ICU expenses are 1% and 2% of the sum insured and that of surgeon, anesthetist and nursing expenses would be up to 25% of the sum insured. The expenses of oxygen, blood, anesthesia, medicines, X-ray, chemotherapy etc. can be reimbursed up to 50% of the sum insured.
Hospitals that would be recognized as eligible for treatment of the insured should specify some criteria. The hospital should have at least 15 beds, proper infrastructure and qualified doctors and nurses.