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National Varistha Mediclaim Senior Citizens Prospectus


                          VARISTHA MEDICLAIM FOR SENIOR CITIZENS

This policy has been designed to cater to the needs of our Senior Citizens. It covers Hospitalization and Domiciliary Hospitalization Expenses under Section I as well as expenses for treatment of Critical Illnesses, if opted for, under Section II Disease covered under Critical illnesses are as under.

Coronary Artery Surgery

Cancer


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Renal Failure i.e. Failure for both Kidneys

Stroke

Multiple Sclerosis

Major Organ Transplants like kidney, Lung, Pancreas or Bone marrow

Paralysis and blindness at extra premium

Critical Illness cover is an optional cover under the policy. Person who will not opt for critical illness cover are entitled to hospitalization and Domiciliary hospitalization expenses cover for those diseases categorized above as critical illness but up to the limit of Sum Insured under Section I i.e. under

Hospitalization and Domiciliary hospitalization expenses and the claim for those diseases will be paid on reimbursement basis or as cashless hospitalization. Person opting for critical Illness cover may opt for claim either under Section I or Section II(if not hospitalized) or under both sections for those diseases categorized above as Critical Illnesses but claim under section I will be paid either on reimbursement basis or as cashless hospitalization if it is otherwise admissible If in any policy year a critical illness is diagnosed and claim paid thereafter, in subsequent renewals the person may avail cover both under Section I & II but with the exclusion, both under section I & II, of that particular critical illness which has been diagnosed and claim paid in the preceding policy year.

SUM INSURED: Sum Insured is fixed per person

Under Hospitalization & Domiciliary Hospitalization cover sum Insured is Rs.1,00,000/- and under Critical Illness cover Sum Insured is Rs.2,00,000/-.

Age Group: For fresh entry in to the scheme – 60 years to 80 years. However, for 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.

Pre-acceptance Medical Checkup: No Medical Checkup is required if the insured was covered under any Health Insurance Policy of National Insurance Company or other Insurance companies uninterruptedly for preceding three years. Other persons have to undergo medical check up at their own cost for Blood/ Urine Sugar, Blood Pressure, Echo- cardiography and eye check up including retinoscopy. 

Scope of Cover: 

Section I- Hospitalization and Domiciliary Hospitalization Expenses Cover:

1.0 In the event of any claim becoming admissible under this scheme, the company will pay to the Insured person the amount of such expenses as would fall under different heads mentioned below, and as are reasonable and necessarily incurred thereof by or on behalf of such Insured person, but not exceeding the Sum Insured in aggregate in any one period of Insurance stated in the schedule here to.

Hospitalisation Benefits Limits
A

(i) Room, Boarding expenses as provided by the Hospital/Nursing Home


(ii) If admitted in IC Unit

i) up to 1% of Sum  nsured per day


ii) up to 2% of Sum Insured per day overall limit : 25 % of the S.I per illness / injury

B

Surgeon, Anesthetist Medical practitioner, Consultants specials Fees, Nursing Expenses

Up to 25 % of Sum Insured per Illness/ Injury
C Anesthesia, Blood, Oxygen, OT Charges,
Surgical appliances ( any disposable surgical
consumables subject to upper limit of 10% of Sum Insured), Medicines, drugs, Diagnostic Material & X-RAY, Dialysis ,chemotherapy,
Radiotherapy, cost of pacemaker, artificial
limbs and cost of stent and implants.
Up to 50 % of Sum  nsured per Illness/ Injury.

1) Company’s overall liability in respect of claims arising due to Cataract is Rs 10,000/- and that of Benign Prostatic Hyperplasia is Rs 20,000/- Only.

2) Company’s liability in respect of all claims admitted during the period of Insurance shall not exceed the Sum Insured for the person as mentioned in the schedule.

3) Liability of the company under Domiciliary Hospitalization clause is limited to 20 % of the Sum Insured under Section I and within the overall limit of sum Insured under section I.

4) Hospitalization expenses of person donating an organ during the course of organ transplant will also be payable subject to the sub limits UNDER “C” above applicable to the insured person within the overall sum insured of the insured person.

5) Ambulance charges up to a maximum limit of Rs.1000/- in a policy year will be reimbursed.

2 DEFINITIONS:

2.1 Hospital / Nursing Home, means any institution in India established for indoor care and treatment of sickness and injuries and which

Either

(a) Has been registered either as a hospital or Nursing Home with the local authorities and is under the supervision of the registered and qualified medical practitioner

Or

(b) Should comply with minimum criteria as under:

i. It should have at least 15 inpatient beds. In class “C” towns condition of number of beds may be reduced to 10.

ii. Fully equipped Operation Theatre of its own wherever surgical operations are carried out.

iii. Fully qualified nursing staff under its employment round the clock.

iv. Fully qualified Doctor(s) should be in charge round the clock.

2.2.1 The term, Hospital/ Nursing Home shall not include an establishment which is a place of for the rest, a place for the aged, a place for drug addition or place of alcoholics, a hotel or similar place.

2.2 Surgical Operation means manual and/or operative procedures for correction of deformities and defects, repair of injuries, diagnosis and cure of disease, relief of suffering and prolongation of life.

2.3 Expenses of Hospitalization for minimum period of 24 hours are admissible. However, this time limit is not applied to specific treatments i.e. day care treatment for stitching of wound/s, close reduction/s and application of POP casts, Dialysis, Chemotherapy, Radiotherapy, Arthroscopy, Eye Surgery, ENT surgery, Laparoscopic surgery, Angiography, Endoscopies, Lithotripsy (Kidney stone removal), D & C ,Tonsillectomy taken in the Hospital / Nursing Home and the Insured is discharged on the same day. The treatment will be considered to be taken under Hospitalization benefit. This condition will also not apply in case of stay in Hospital of less than 24 hours provided-

(a ) the treatment is such that it necessitates hospitalization and the procedure involves specialized infrastructural facilities available in Hospitals.

And

(b) due to technological advances hospitalization is required for less than 24 hours only.

2.4 Domiciliary Hospitalization benefit means medical treatment for a period exceeding three days for such illness/ disease/ injury which in the normal course would require care and treatment at a Hospital /Nursing Home but actually taken whilst confined at home in India under any of the following circumstances, namely :

i) The condition of the patient is such that he/she cannot be removed to the Hospital/Nursing Home or

ii) The patient cannot be removed to Hospital/ Nursing Home for lack of accommodation therein

Subject to however that domiciliary hospitalization benefit shall not cover:

i) Expenses incurred for pre and post hospital treatment and

ii) Expenses incurred for any of the following diseases;

1. Asthma

2. Bronchitis

3. Chronic Nephritis and Nephritic Syndrome

4. Diarrhea and all type of dysenteries including Gastroenteritis

5. Diabetes Mellitus and Insipidus

6. Epilepsy

7. Hypertension

8. Influenza, cough and cold

9. All psychiatric or psychosomatic Disorders

10. Pyrexia of unknown Origin for less than 10 days

11. Tonsillitis and Upper Respiratory Tract Infection including Laryngitis and Pharyngitis

12. Arthritis, Gout and Rheumatism

Note: When treatment such as Dialysis, Chemotherapy, Radiotherapy is taken in the Hospital/ Nursing Home and the Insured is discharged on the same day, the treatment will be considered to be taken under Hospitalization benefit section Liability of the Company under this clause is restricted as stated in the schedule attached hereto.

3.0 Any One Illness will be deemed to mean continuous period of the illness for which treatment is undergone and includes relapse within 105 days from the date of last consultation with the Hospital/Nursing Home where treatment was taken. Occurrence of same illness after a lapse of 105 days stated above will be considered as fresh illness for the purpose of this policy.

3.1 Pre-Hospitalization:

Relevant Medical Expenses incurred during period up to 15 days prior to hospitalization/domiciliary hospitalization on disease/illness/injury sustained will be considered as a part of claim under the item 1.0 above.

3.2 Post-Hospitalization

Relevant Medical Expenses incurred during period up to 30 days after hospitalization/domiciliary hospitalization on disease/illness/injury sustained will be considered as a part of claim under the item 1.0 above.

3.3 Medical Practitioner means a person who holds a degree/diploma as a recognized institution and is registered by Medical Council or respective State of India. The term Medical Practitioner would Include Physician, Specialist and Surgeon.

3.4 Qualified Nurse means a person who holds a certificate of a recognized Nursing Council and is who is employed on recommendations of the attending Medical Practitioner.

3.5 TPA means a Third Party Administrator who is licensed by the Insurance Regulatory and Development Authority, and is engaged for a fee or remuneration, by what ever name as may be specified in the agreement with the Company, for the provision of health services


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By Dr J P Hajra on Nov 15, 2014 11:15 AM

My wife and I wish to insure under your medical policy At the moment we are isured under Star Health and Allied Insurance Co Ltd for last 5 years Our ages for my wife and I are67 respectively. Kindly let us know the procedural details of pay ment for insuring us at the rate of 1lac for each of us. I am looking forward to your response Dr J P Hajra, Retd Professor of Metallurgy, IISC, Bangalore-560012 Present Adress: Kendriya Vihar, B15, /239VIP Road, Calcutta-700052
By trigunatita bandyopadhyay on Sep 16, 2014 2:04 PM

We want to make a policy for age between 60-70 years. total no. of persons around 30. If any medical checkup is required for the above policy ? and can it be group policy?
By k.hameed on Sep 12, 2014 5:44 AM

i wud like to know about a full cover insurance policy for senior citizen above 65 yrs now in good health.the policy shud cover all expenses in medical and hospital expenses of all types.a package for spouse of age 61 also will b helpful.pl send me full details.if u have attractive policy for only covering major hospital bills with economy premium pl let me know .am looking for both.rgds
By savita on Sep 4, 2014 5:08 PM

I want to purchase health insurance for my mother. she is 60 years old.Her dob is 1/1/1954. Kindly suggest me best plan which covers pre existing desease i.e. Diabetes
By Team Medimanage on Sep 3, 2014 10:00 AM

Dear Mr.Roy, Hope you are doing well !!! Thank you for writing to us. If you are opting for critical illness benefit under a policy then it will pay a lump sum amount to you which will be helpful to overcome financial crisis in event of hospitalization. Health Insurance policy will only cover your actual medical expenses done during hospitalization. But it will not provide any lump sum amount which will support you financially. For getting more information on critical illness and health Insurance kindly share your contact details with us. Looking forward to serve you.
By Debashish Roy on Aug 30, 2014 3:39 PM

What additional benefits do we get by opting for critical illness benefits?
By Srividhya on Aug 19, 2014 3:50 PM

Hi,I need to to take health cover for my parents of age 66 and 60.Please call me on 9840237818
By Raju Iyer on Aug 19, 2014 12:27 PM

I want health cover for self and wife aged 75 and 74 respectively. There are no pre existing known diseases. Please let me premium for mediclaim and critical illness cover for Rs 100000 & 200000.
By Kevin Correa on Aug 12, 2014 2:07 PM

I need a health cover for self and wife. Ages 66 and 64.Pre existing diabetes and hypertension. my phone number 9167 939888. please contact urgently.
By Praveen Keshari on Aug 11, 2014 11:14 AM

I would like to take a medical policy for my parents-father aged 71 and mother 62. Need complete details. Please contact on my contact number:9313274222
By Shivanand Swami on Jul 23, 2014 10:00 PM

I would like to take a medical policy for my parents-father aged 68 and mother 60. Need complete details. My contact number:9916102507
By rahul nagwan on Jul 23, 2014 5:56 PM

intrested in policy for my mother who's present age is 58 pls contant me at this no; 8447485260
By DAMODAR V PATIL on Jul 5, 2014 9:33 PM

I am 78 years old and wish to know about the policy and the premium
By Geeta on May 12, 2014 4:16 PM

Intersted for my mother health ins.No health problems 70 yrs. my no. Is 9873190615
By vijay gosavi on May 8, 2014 11:34 AM

I 64 years old having B P sugar and piles. I have purchased star health sr. citizen red carpet policy last year getting expired in next month. I would like to port my policy.l advice mob 09920017351 (thane-Mumbai)
By Paradkar Madhukar Kanhoji on Mar 13, 2014 11:08 AM

my BOD is 3/5/1949 . My BOD is 3/5/1949, pl suggest the mediclaim policy
By ANTARYAMI DOBAI on Feb 12, 2014 4:08 PM

I want to take mediclaim for my parent .Father-66+ & Mother 61+
By gautam bandopadhyay on Jan 23, 2014 11:08 PM

What is rs. 200,000 for critical illness ? If illness continues for years together is it payable for every year?
By Dr Abu Sayeed Galib on Jan 15, 2014 9:16 PM

Need healthcare insurance for dad(1939) and mom(1950). Which company gives best policy?
By dinesh prasad sinha on Jan 12, 2014 2:53 PM

I am 64 yrs n 9 months old and my wife 58 yrs 6 months.Shall like to have more details for our joint or severemedical/heath insurance for @10 lacs.
By Provanjan Halder on Oct 1, 2013 3:44 PM

I am 65 yrs old retired Govt. employee wanted to start a policy of Rs 100000 each for me and in the name of my Wife with age of 56yrs.pls send me details with premium.
By John S Lestourgeon on Oct 1, 2013 9:20 AM

Kindly advice in regards to this Policy I am from Pune.
By John S Lestourgeon on Oct 1, 2013 9:18 AM

Dear Sir, I wish to take this Policy for myself and my wife as details given below. I am 66 years old...had an angioplasty done in 2008 at present in good health under mediacation. My wife 61 years old.. has Type2 Diabetics since 2004 ..at present in good health under proper mediacation. Kindly advice ... the policy details as to yearly premimum etc. Thanking you in anticipation. John Lestourgeon
By S R TAMBE on Jul 30, 2013 11:38 AM

I am senior citizen 0f 68 year old residing in Mumbai. I WISH TO PURCHASE VARISHA MEDICLAIM FOR SENIOR CITIZEN POLIY.Pl send detals. mobile 9820487498
By subbalakshmi on Jul 19, 2013 9:42 AM

Iam 70yrs old. Want to know more abt this policy
By r k jain on Jul 9, 2013 9:41 PM

pl contact me on 9752776242 . we want take policy
By Sunil Anikhindi on Jul 2, 2013 8:46 PM

I am in urgent need to take the mediclaim policy for my parents who are residing in kolhapur. My contact no. is 7738228056. Thanks.
By kishore on Feb 4, 2013 11:47 AM

can some one contact me regd medicliam policy , i have one from from new india , need addiitional cover my contact i s9820930273
By Manisha on Oct 26, 2012 10:30 PM

Please contact me....on my email id. I want to take this policy for my parents 63 and 75 years resp.
By Sudhir Chandra on Apr 22, 2012 8:51 AM

I have received details about Star Medical Red carpet. I understand that National Varishta is offering Medical insurance for age group 60-80. This means that both myself and my wife can go for this policy. Please suggest whether it is safe to take National Varishta policy.
By saumitra on Apr 12, 2012 11:49 AM

i m interested in this policy for my parents. pls contact me on 9764048698.
By Sudhir Chandra on Apr 8, 2012 8:13 PM

I need nedical insurance cover for myself and my wife.We are both senior citizens.I am 75 plus and my wife is 65
By sunilkumardutta on Mar 24, 2012 8:53 PM

Inform me the procedure for having the above Mediclaim for Undersigned aged 78years
By sunilkumardutta on Mar 22, 2012 3:27 PM

plz. advice how to get this policy. I am 78 years old. I had my Sail Group mediclaim for retired person. This was invalidated from 2006 due some reason not known. However after knowing this facility i got interested to obtain the same. SKDutta
By Sheeja ANish on Mar 20, 2012 12:01 PM

Please contact me number 9496252991, 04712507050 want a policy for my father
By Sudha on Oct 1, 2011 5:25 PM

i want to know clear information about mediclime & personal accident benefits and rates. we want to make insurance to employees in my organization.
By vijay gunjal on Sep 22, 2011 2:42 PM

open heart surgery are covered
By vijay gunjal on Sep 22, 2011 2:42 PM

open heart surgery are covered
By Dr C S Gokhale on Aug 23, 2011 1:18 PM

Can some body from your company personally visit and discuss details ? My tel no. are 022-28570022, Mobile No.s 9322215479 and 9320215479
By ganesh on Apr 18, 2011 2:06 PM

plz contact me to tis no.7385582201 or 7385582219. i required mediclaim policy for my parents.
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