Varistha Mediclaim

The Varistha Mediclaim Policy is a health insurance plan provided by the National Insurance Company. The policy acts as a security for senior citizens who are more prone to suffer from ailments and age-related illnesses. Senior citizens within the age of 60 to 80 years can benefit from such a policy. The tenor of the Varistha Mediclaim plan is one year, after which it can be renewed on a yearly basis. It covers hospitalisation and domiciliary hospitalisation for a fixed sum insured per person. So, let’s understand the medical policy for senior citizens offered by the National Insurance Company in detail.

Eligibility Criteria for Varistha Mediclaim Policy

Features of Varishta Mediclaim Policy

1. Sub-Limit:

Sub-limits are applied to certain treatments under this medical policy for senior citizens the details of which are given below:

• A sub-limit of Rs. 10,000 for cataract related treatments
• A sub-limit of Rs. 20,000 for benign prostatic hyperplasia related treatments
• Under domiciliary hospitalisation cover, a sub-limit of maximum 20% of the sum insured is applicable
• A sub-limit of ₹1,000 for ambulance charges

2. Copayment:

Details of the copayments applied to the medical treatment bills under the policy are as follows:

• 10% copayment is applied to all treatments except cataract and benign prostatic hyperplasia

• 20% copayment is applied wherever the policyholder has opted in

• 10% co-payment is applicable for pre-existing disease treatments for which additional premiums have been paid. This copayment is in addition to the previously mentioned copayment term

3. Pre-Policy Medical Screening:

Pre-Policy Medical Screening is not required for those insured under the health insurance policies offered by the National Insurance Company.

• Those not insured under the health insurance policies of the National Insurance Company have to get their health check-ups done at their own cost

• If the proposal is accepted by the insurance company, 50% of the medical expenses incurred on pre-insurance medical checkups are reimbursed

• The date on the medical reports should not be within 30 days of the date on policy proposal

4. Policy Renewal:

The policy can be renewed annually on timely payment of the renewal premium. The renewal premium must be paid within 30 days of the date of policy expiry.

5. Waiting Period:

Those insured under the policy have to serve a waiting period of one year for specific diseases, the details of which can be found in the policy document.

6. Initial Waiting Period:

An initial waiting period of 30 days has to be served to avail the benefits of the Varistha Mediclaim Policy

7. Loading:

A 10% loading on premiums up to 85 years of age and a 20% loading on premiums above 85 years is applied

8. Free Look Period:

A free look period of 15 days is provided to those insured under the policy to offer them a window for cancellation on grounds of dissatisfaction from coverage/terms/conditions of the policy. 

9. Policy Withdrawal:

The policy can be withdrawn from the insurance company’s side. The policy holders are informed by the National Insurance Company before the withdrawal of any health insurance plans and they are also given an opportunity to switch to any other similar health insurance plan under the company. 

10. Critical Illness Survival Period:

A 30-day long critical illness survival period is provided under the plan which means that the policy holder has to survive a minimum of 30 days after being diagnosed with a critical illness to be able to claim the policy. 

11. Number of Claims in a Policy Period:

Coverage is provided only once a policy year in case of critical illness. 

12. Restricted Cover:

Although coverage is provided for open-chest CABG treatment, the amount payable is limited to 20% of the sum insured 

Benefits of Varishta Mediclaim Policy

1. Hospitalisation Coverage

• Room rent charges are covered up to 1% of the sum insured per day

• Intensive Care Unit (ICU) charges (including IV fluids, nursing care, blood transfusion, etc.) are covered up to 2% of the sum insured per day

2. Domiciliary Hospitalisation

If the insured person is not in a condition to relocate to a hospital or in case of unavailability of hospital beds, they can get treatment at home. Domiciliary treatment is done under special recommendations of the doctor, however, it doesn't cover the following things:

• Any treatment for less than 3 days

• Pre-hospitalisation and post-hospitalisation medical expenses

• Medical expenses for certain diseases like Asthma, Bronchitis, Chronic Nephritis, etc.

3. Inpatient Hospitalisation

Inpatient hospitalisation facilities are provided on hospitalisation for 24 continuous hours or more.

4. Pre and Post Hospitalisation Cover

The pre-hospitalisation cover is provided for expenses incurred 30 days before the date of hospitalisation and post-hospitalisation cover is offered for 60 days after the date of discharge.

5. Pre-Existing Diseases Cover

A waiting period of 4 years applies to coverage of the treatment expenses for pre-existing diseases. In case of certain ailments having a waiting period of 1 year, that are mentioned in the policy, are pre-existing illnesses at the time of proposal, it will be covered after one claim-free year.

Varishta Mediclaim Policy Coverage

• Domiciliary hospitalisation expenses

• Room rent expenses up to a fixed limit

• Cost of Anesthesia, Blood, Oxygen, Surgical Appliances, Drugs, etc.

• Intensive Care Unit expenses covered up to a fixed limit

• Health check-up on every three claim-free years 

Exclusions of Varistha Mediclaim Policy

• Expenses arising owing to HIV/AIDS

• First 30 days waiting period for any disease

• Intentional self-injury, drug or alcohol abuse

• Sterility and venereal disease

• Treatment due to pregnancy, childbirth including caesarean section

• Congenital external disease or defects or anomalies

• Vaccinations of any kind

• Cosmetic or aesthetic treatment and plastic surgery

• Hospitalisation for the purpose of evaluation or diagnosis

• Dental treatment and naturopathy treatment

• Expenses incurred for vitamins or tonics

• Hearing aids, spectacles or contact lenses

Claim Notification Under National Insurance Varistha Mediclaim

In the event of a health insurance claim, the policyholder should inform the Third-Party Administrator (TPA in Health Insurance) regarding the treatment within the following prescribed time limit:

• Cashless Claim Notification

For planned hospitalisation: At least 72 hours before hospitalisation

For emergency hospitalisation: Within 24 hours of emergency hospitalisation

• Reimbursement Claim Notification

For planned hospitalisation: At least 72 hours before hospitalisation

For emergency hospitalisation: Within 24 hours of emergency hospitalisation

How to Claim Under Varistha Mediclaim Policy?

Here’s the procedure to claim under Varistha Mediclaim Policy for senior citizens:

• Cashless Claim Process

1. To avail cashless treatment at a network hospital, the health insurance TPA must be informed first. The policyholder must fill the cashless claim form and send it for approval to the TPA.

2. The TPA will then send a pre-authorisation letter to the hospital upon verification.

3. The policyholder needs to sign the discharge papers and pay for the non-medical expenses during discharge.

4. The TPA can reject the pre-authorisation for cashless treatment if relevant medical details aren’t provided.

5. In the event of rejection of pre-authorisation for cashless treatment, the policyholder can seek medical care and apply for a reimbursement claim.

• Reimbursement Claim Process

The policyholder must submit all necessary documents and original receipts to the TPA within the given time limit for reimbursement claim settlement.

Documents Required for Filing Claim Under Varistha Mediclaim

You can keep the following documents ready while filing your National Insurance Varistha Mediclaim policy claim:

• Claim application form

• Original cash memo from the chemist, hospital, etc.

• Original bills, receipts, discharge certificate, medical history of the patient, etc.

• Original investigation test reports and the prescription from the attending doctor

• Diagnosis certificate from the attending doctor

• Surgeon’s certificate regarding the diagnosis and the nature of the operation

Time Limit for Document Submission

Conclusion

Health care expenses can spoil the financial math for households very quickly. A safety net in the form of insurance has always been an integral part of healthcare. The current circumstances have made the requirement of insurance more prominent. The ongoing pandemic has seen senior citizens falling in a high-risk category.

Since the National Insurance Varistha Mediclaim caters to senior citizens within the age of 60 to 80 years, it is undoubtedly the most important financial instrument during these times. To avail one of the most ideal health insurance policies, visit Bajaj Markets, where you get swift claim settlements and an insurance cover of up to ₹50 lakh.

To estimate the premium you need to pay for enhanced coverage with Bajaj Markets, you can use our online health insurance premium calculator!

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