National Mediclaim in one table
| Insurer | National Insurance Company Limited |
|---|---|
| Sum insured | ₹1 lakh to ₹10 lakh, in ₹1 lakh steps. Each insured person can hold a different sum insured on the same policy |
Claim settlement and complaint figures are IRDAI-published and held centrally by NYVO, not taken from the insurer's marketing.
What National Mediclaim covers
These are the terms that decide what you are actually paid when you claim. Room rent, co-pay and restoration do more to shape a settlement than the sum insured does, and they are read from National Insurance's own policy wording.
| Feature | This plan | What good looks like |
|---|---|---|
| Co-payment | None as standard. You can opt into a 10% or 20% co-payment to cut the premium | No Co-payment |
| Room Rent Limit | 1% of sum insured a day, capped at ₹10,000 · ICU 2%, capped at ₹20,000 | No room rent capping |
| Room charges per illness | Room charges for any one illness cannot exceed 25% of the sum insured | No aggregate room cap |
| Disease sub-limit | Doctors' fees capped at 25% of sum insured per illness, all other expenses at 50%. Dialysis, chemotherapy and radiotherapy are capped at 50% or the network package rate, whichever is lower | No sub-limit |
| Sub-limits waived on network treatment | None of the sub-limits apply to a listed procedure taken as a package in a Preferred Provider Network hospital | Caps waived on network care |
| No Claim Bonus | 5% of the basic sum insured for each claim-free year, up to 50%. It falls back 5% for any year you claim | 50% each year (Minimum upto 100%) |
| Restoration Benefit | Basic sum insured reinstated once a year, but only on a basic sum insured of ₹6 lakh or more, and not for a condition already claimed that year | 100% restoration once in a year |
| Pre-Hospitalization | 45 days | At least 60 days |
| Post-Hospitalization | 60 days | At least 120 days |
| Consumables | Not in the base cover. The Non-Medical Expenses add-on buys them back, up to 10% of the basic sum insured, on ₹5 lakh and above | Consumables covered |
| Day-Care Procedures | Covered, subject to the same sub-limits as an ordinary admission | Covered without a capped list |
| AYUSH Treatment | In-patient AYUSH treatment covered up to the sum insured | Included |
| Modern treatments | Twelve listed procedures covered, each capped at 25% of the sum insured | Covered |
| Road ambulance | 1% of the sum insured, up to ₹2,000 a policy period | Included |
| Health check-up | Once every four claim-free years, 1% of the average basic sum insured up to ₹5,000 | Included |
| Entry age | 18 to 65 for the proposer, 65 the maximum for any family member, children from 3 months | No maximum entry age |
National Mediclaim add-ons you can buy with it
Each of these costs extra and each has its own conditions. Some are genuinely worth it; several exist to patch a gap in the base plan. Ask what each one adds before it goes on your quote.
National Mediclaim discounts you can ask for
Published discounts on this plan. Most are applied at quote stage rather than offered, so it is worth naming the ones you qualify for. Every figure is a ceiling, not a promise - what you actually get depends on the case.
| Discount | Worth | When it applies |
|---|---|---|
| Optional co-payment | Up to 12.5% or 25% | 12.5% off the premium for a 10% co-payment on every claim, or 25% off for a 20% co-payment. It applies to every insured person on the policy. |
From the plan prospectus. The co-payment discount is a trade, not a giveaway – you are buying a lower premium with a share of every future claim.
National Mediclaim waiting periods: when each part of the cover starts
Waiting periods run from the day cover began, not from the day you fall ill, and they run in parallel rather than one after another.
| Initial Waiting Period | 30 days |
|---|---|
| Hypertension, diabetes and cardiac conditions | 90 days |
| Benign ENT conditions and their surgeries | 1 year |
| Named specific illnesses | 2 years |
| Joint replacement, osteoarthritis, obesity, stem cell therapy | 3 years |
| Pre-Existing Disease | 36 months |
The named illnesses that wait 90 days to 3 years, depending on the condition
This plan does not run one specific-illness clock. Hypertension, diabetes and cardiac conditions wait 90 days; benign ENT surgery waits a year; the list below waits two years; joint replacement, osteoarthritis, osteoporosis, obesity and stem cell therapy wait three. Any of these that is also a pre-existing disease waits the longer of the two periods. An accident is covered from day one. The list is indicative – the policy wording carries the full set.
National Mediclaim exclusions: what the plan will not pay for
Every policy carries exclusions, and they are the clauses people read for the first time at claim stage. These are the ones worth knowing before you buy.
Where National Mediclaim falls short
No plan is right for everyone, and a page that only lists strengths is not much use to you. These are the gaps we would raise on a call before recommending it.
National Mediclaim questions, answered
What are the sub-limits on National Mediclaim, and when do they stop applying?
For any one illness, room charges cannot exceed 25% of your sum insured, doctors' and specialists' fees cannot exceed 25%, and everything else is capped at 50%. Room rent itself is limited to 1% of the sum insured a day up to ₹10,000, and ICU to 2% up to ₹20,000. All of it falls away if you take a listed procedure as a package in a Preferred Provider Network hospital, which is where this plan is at its best. Check whether the hospital you would actually use is in that network before you buy, because it changes the economics of the policy completely.
Does the cover get restored if I use it up?
Only if your basic sum insured is ₹6 lakh or more. On that, the basic sum insured is reinstated once during the policy period, taking effect after you are discharged from the admission that exhausted it. Any illness or injury already claimed that year cannot be claimed again from the reinstated amount, and anything left over does not carry into the next year. Below ₹6 lakh there is no restoration.
How long do I have to wait before a condition is covered?
Four clocks run in parallel. Any illness other than an accident waits 30 days. Hypertension, diabetes and cardiac conditions wait 90 days. Benign ENT conditions and their surgeries wait a year. A named list including cataract, hernia, piles and stone disease waits two years, and joint replacement, osteoarthritis, osteoporosis, obesity and stem cell therapy wait three. Pre-existing disease waits 36 months, the maximum IRDAI allows, and where a listed condition is also pre-existing the longer wait applies.
What is the no-claim bonus worth on this plan?
5% of your basic sum insured is added for each claim-free year, accumulating to a maximum of 50%. A claim in any year pulls it back down by 5% at the next renewal, though the basic sum insured itself is never reduced. On ₹10 lakh that means five clean years takes you to ₹12.5 lakh of cover, which is modest against plans that add 50% or more a year.
Is maternity covered?
No. Maternity, childbirth and voluntary termination of pregnancy are permanently excluded under this plan, and no add-on brings them back. National Insurance puts maternity in its floater product, the New National Parivar Mediclaim Policy, where it is built in after a three-year wait. If maternity matters to you, this is the wrong plan in the range.
Can I bring the premium down?
Two ways, both in the prospectus. Buying direct, online or at a branch with no intermediary, takes 10% off. Accepting a co-payment takes 12.5% off for a 10% share of every claim, or 25% off for a 20% share. The second is worth the arithmetic: a 20% co-payment on a ₹6 lakh hospital bill is ₹1.2 lakh out of your own pocket, which is many years of the premium you saved.
Read it from the insurer
We summarise. The policy wording is the contract, and it is the only document that settles a dispute. These links go to the insurer's own pages.
Understand the terms before you commit
A plan page tells you what this policy does. These explain why each term matters and what it costs you when it is missing.
Other National Insurance plans we have read
National Insurance files these separately, and the terms differ between them. If you are choosing within the range, compare the waiting periods and the exclusions rather than the sum insured.