National Health Insurance Mediclaim Plus Policy: Overview 2025

The National Health Insurance Mediclaim Plus Policy is a complete health insurance cover that targets individuals and families in India. This policy provided by National Insurance Company covers a vast amount of medical costs, including simple hospitalization and complicated treatments. With healthcare expenses increasing in 2025, such a strong mediclaim policy is more applicable to Indian families that want to ensure financial stability in case of any medical emergency.

Over the past few years, the Indian consumers have been expressing a greater inclination toward policies that extend beyond simple hospitalization. The Mediclaim Plus Policy is in line with this trend as it offers a variety of add-on covers, increased sum insured, and covers modern treatments, which makes it a good competitor in the comparison of health insurance in India.

Other questions asked by people are:

Will the National Health Insurance Mediclaim Plus Policy be appropriate to the senior citizens in 2025?
Yes, the policy has entry age of up to 65 years and is renewable throughout life and is therefore appropriate to senior citizens who are subject to underwriting rules.

Mediclaim Plus Policy in 2025 Why Choose?

Mediclaim Plus plan is especially applicable in 2025 as there is inflation in medical expenses and the rising demand of specialized treatment. It is unlike many of the basic plans as it is able to cover modern medical procedures and can be expanded to cover a broader age range. The flexibility and customization of coverage options allow the families to customize the plan to their needs and budget which makes it an appealing option to new buyers and those who are planning to change providers this year.

And you know? In 2025, more than 30 percent of the urban households in India reported at least one significant hospitalization, which is why quality health insurance is important.

What are the Main Characteristics or the Highlights of This Policy?

The following are the good points to consider when considering the National Health Insurance Mediclaim Plus Policy:

• Coverage: Hospitalization (inpatient), day care procedures, pre and post hospitalization costs.
• Sum Insured Options: The Sum Insured options start as low as Rs 2 Lakhs and go up to Rs 50 Lakhs, which is attractive to small as well as large families.
• Family Floater: A single plan can cover the policy holder, spouse, dependent children and parents.
• Modern Treatments: Covers advanced treatment such as robotic operations, oral chemotherapy, immunotherapy, etc.
• No Claim Bonus: Increase in sum insured by up to 50 percent in claim free years.
• Alternative Treatment: AYUSH cover of Ayurveda, Yoga, Unani, Siddha and Homeopathy.
• Room Rent Limit: Elastic capping based on plan, out of pocket expenses is minimized.
• Renewable: Lifetime renewability.
• Daycare Coverage: More than 140 daycare procedures covered.
• Restoration Benefit: An automatic replacement of sum insured occurs when it is exhausted by a claim.

Other questions people ask are:

Does Mediclaim Plus Policy cover preexisting diseases?
The preexisting diseases are covered after a waiting period of say four years depending on the terms and conditions of the policy.

Pros and Cons of National Health Mediclaim Plus Policy.

Knowing the benefits and the drawbacks will allow you to make a wise decision:

Pros

• Available wide sum insured that can fit most families
• Large amount of covered daycare and advanced treatment
• Floater benefits enable the family members to claim against the same sum insured
• Reinstatement of sum insured on unrelated sickness during policy period
• Includes alternative treatment, addressing holistic healthcare requirements

Cons

• Waiting time on preexisting conditions and some specialized treatment
• Certain plans can limit room rent and certain surgeries coverages
• There could be sub limits and deductibles on some of the treatments depending on the plan chosen
• High sum insured or senior citizen premiums are more than basic plans
• Non-allopathic treatment with a percentage of sum insured

Did you know? The 2025 guidelines provided by IRDAI have motivated the insurers to provide their customers with easier claim procedures and broader coverage, which has led to improved customer experience of the Mediclaim Plus subscribers.

What is the Workings of the Mediclaim Plus Policy with a Family?

This policy is available in the form of an individual or a family floater policy. In a family floater, the total sum insured is shared by all covered family members, however, each member can claim independently, and this increases utility. As an illustration, suppose a child incurs a hospitalization bill of Rs 1 lakh and the family cover is Rs 10 lakh, then the rest of Rs 9 lakh is still left to other people in that policy year. This is a cost-effective structure as compared to purchasing individual plans per member.

• Family members between the ages of three months and sixty-five years are all eligible to be covered at entry.
• Policy is renewable on a life basis and medical screening is necessary on those who join after the age of 50.
• Section 80D of Income Tax Act tax benefits.

The other question people ask is:

What is the premium of a family under Mediclaim Plus?
Premium depends on the age of the oldest member of the family, family size, sum insured, location and add-ons.

What Does the Policy Omit in 2025?

As with most health plans, there are some things that are not covered, including:

• Initial thirty days exclusion not including accidents
• Unless the waiting period is observed, preexisting illnesses
• Non-medically necessary cosmetic surgeries
• Self-inflicted injuries, war or substance abuse
• Maternity and newborn coverage as outlined in policy documents only
• OPD consultations and dental treatment unless in connection with a covered condition

The policy brochure or the web site should always be consulted to see the detailed and up to date exclusions.

Did you know? Since 2025, the Insurance Regulatory and Development Authority of India mandates that all health policies should have transparency in exclusions and waiting periods.

Does Mediclaim Plus have Cashless Hospitalization?

Yes, Mediclaim Plus Policy has cashless treatment in over 6000 hospitals across the country. When you are hospitalized, you may show your National Insurance health card at a network hospital and covered costs are paid directly to the insurer.

Important procedures to follow cashless facility:

• Before admission, call the insurance desk at contact network hospital.
• Complete and send in claim intimation and preauthorization forms.
• Eligible expenses are reviewed and approved by insurer.
• Expenses not covered, in case any, that the policyholder would pay at discharge.

In 2025, the insurer is still increasing its network of specialty hospitals and clinics, making it even more accessible.

What is the Comparison of National Mediclaim Plus Policy with other Popular Health Plans?

This comparison indicates that National Mediclaim Plus has higher sum insured options than some competitors, but other features such as broad daycare coverage and cashless network size are different.

What are the Sub Limits and Waiting Periods?

The majority of critical illnesses and preexisting diseases have a four-year waiting period, and listed specific illnesses may have two years. Depending on the variant you select, sub limits may be applied to such treatments as cataract surgery, joint replacements, and room rent.

• Cataract: Rs 40,000/- per eye, SI subject to
• Maternity: Some high sum insured policies cover after a waiting period
• ICU Charges: In some plans capped at twice the normal room rate

What is the way of purchasing or renewing the Mediclaim Plus policy in 2025?

In 2025, purchasing or renewing this plan is easy and has a strong online support. Steps include:

• Go to National Insurance official web site or reputable aggregators
• Fill in application form and choose necessary sum insured and members
• Provide KYC, health statements and medical reports where necessary
• Pay the premium through online banking, UPI or cards
• Get policy documents via email and hard copy through courier should you wish

To renew, the person does not need new medical tests unless there are any noticeable changes in health.

Other questions people ask are:

Is it possible to transfer to Mediclaim Plus Policy of another insurer?
Yes, it is possible to be ported as per the IRDAI guidelines at the time of renewal provided that the benefits are continued.

Which Additional Covers or Riders are there in 2025?

Mediclaim Plus Policy has a variety of add-on riders, including:

• Critical Illness Rider: A lump sum benefit is paid when any of the listed severe illnesses happens.
• Personal Accident Rider: An accidental death/permanent disability cover.
• Maternity and Newborn Cover: It is an add-on premium to some plans.
• Outpatient Treatment Rider: The reimbursement of planned OPD consultations, certain medications and diagnostics.
• Hospital Cash Benefit: Additional cash per day of hospitalization in excess of 24-hours.

Such customization will enable the policyholders to align their coverage with family needs in 2025.

Did you know? In 2025, more than 40 percent of Indian purchasers wanted plans with inbuilt or optional critical illness covers because the risk of non-communicable diseases has been on the rise.

What is the Claim Settlement Ratio and the Customer Service Performance?

In the 2024 to 2025 period, National Insurance Company registered a health insurance claim settlement ratio of more than 90 percent. The insurer has also been rated highly in terms of helpline support, grievance redressal and online claim filing process.

• Cashless approval turn around time is four hours in metro cities, and marginally higher in smaller centres.

Among the policyholders, it is common to hear:

• Immediate help in large hospitals
• Claim reimbursement through smooth uploading of documents online
• Emergency 24x7 toll free helpline
• Claim tracking and status update online

Which Documents Are Needed in Claims?

In cashless claims:

• Copy of health card
• Photo identity proof
• Hospital discharge and admission summary
• Bills and diagnostic reports

In reimbursement claims:

• Original bills and receipts
• Prescription and diagnosis of doctor
• Payment bank details

Make copies to refer to and file within thirty days of discharge.

What are the things you should know before purchasing National Health Insurance Mediclaim Plus in 2025?

These are some tips on decisions:

• Evaluate your healthcare history, family, and future medical requirements.
• Select a sufficient amount of sum insured according to the cost of healthcare in the area.
• Look out for sub limits and exclusions particularly when you have certain healthcare issues.
• Compare to other plans on premium and feature sets.
• Check on claim experience and hospital network in your city.

Like any insurance, the more coverage, the more the premium, so strike a balance between features and cost.

Other questions people ask are:

What are the ways to get the maximum tax benefits under my Mediclaim Plus Policy?
Remit premiums through banking and retain receipts; you can claim deduction of up to Rs 25000 on self and family and additional Rs 50000 on senior citizen parents under section 80D.

Rapid Recall: Mediclaim Plus Policy 2025

• Provides wide coverage on hospitalization, daycare and new medical procedures.
• Portable to individuals, families and senior citizens with lifelong renewability.
• The wide range of sum insured is Rs 2 lakh to Rs 50 lakh, and there are restoration benefits.
• Good cashless hospital network and digital claim.
• Add-on covers that can be taken according to individual needs.
• To maximize the plan, read all of the terms, waiting periods, and exclusions.

People also ask

Where can I find out the premium of National Health Insurance Mediclaim Plus?
Go to the insurer site and use the online premium calculator, enter family details and sum insured and get an estimate in a moment.

Can sum insured be changed at time of policy renewal?
Yes, you can increase or decrease the sum insured at renewal, with underwriting and current claims history.

How much is the grace period of policy renewal?
The policy provides a thirty-day grace period after the expiry date within which renewal can be done without the loss of continuity benefits.

Do medical tests preceding the policy have to be compulsory?
Medical tests are usually required at age 50 or higher sum insured options, but can be waived at lower age and sum options.

Does COVID 19 and vector borne diseases come under National Mediclaim Plus Policy?
Yes, according to the IRDAI rules all new health policies should include treatment of infectious diseases such as COVID 19 and dengue, as per policy terms.

Sources:

• The official site of National Insurance Company.
• Mint: Health Insurance Claim Ratios India 2025