National Health Insurance Mediclaim Policy: 2025 Guide

National Health Insurance Mediclaim Policy is one of the most popular health insurance plans that are taken by individuals and families in India. This plan is provided by the National Insurance Company Limited which is owned by the government and assists individuals to afford hospitalisation costs in case of illness or accidental injuries. As the cost of healthcare is increasing in 2025, this policy is a good financial safety net to many Indians.

Individuals seek a health insurance cover with a broad cover, low premiums, cashless treatment in network hospitals and family cover. Most of these boxes are checked by the National Health Insurance Mediclaim Policy, which is why it is an appropriate option in the eyes of individuals who want to have reliable medical insurance options.

Why the National Health Insurance Mediclaim Policy?

Health crises may occur any time and may drain your savings in a short period of time. Not only does the National Health Insurance Mediclaim Policy help you manage such untimely expenses, but also gives you peace of mind to your family. It is made to cover individuals and families with dependent children and elderly citizens.

The policy includes various medical expenses including in-patient hospitalisation, pre and post-hospitalisation expenses, daycare procedures and so on. The availability of cashless treatment has increased with more hospitals being empanelled in 2025, making the policy more convenient.

Did you know?
By 2025, the National Insurance Company has more than 10,000 hospitals in India, which enables quick claim settlement and easy access to health care.

What are the Major Characteristics or Exemplars of the Policy?

When you consider this plan, the following are the highlights of 2025:

• It is accessible to individuals between 18 years to 65 years. Dependent children aged 3 months and above can be covered by the families.
• Sum insured can be between Rs 1 lakh to Rs 10 lakh.
• The policy covers hospitalisation, pre and post-hospitalisation, surgery, ICU, room rent, medicines, tests and reimburses or pays directly (cashless) the expenses.
• Pre-hospitalisation costs were up to 30 days prior to admission and post-hospitalisation up to 60 days post-discharge.
• Both individual and family floater is offered to cover in a broader manner.
• The policy covers daycare treatment without the need of 24-hour hospitalisation.
• Healthy applicants do not need any medical check-up until the age of 40.
• It is renewable throughout life, and thus it can be used in long-term health planning.
• Many variants on exhaustion during the policy period with 100 percent sum insured restoration.
• Section 80D tax benefits on the premium paid under the Income Tax Act of India.

How Does It Work? What is the Eligibility and Coverage Information?

The National Health Insurance Mediclaim Policy can be bought by anybody within the age limit of entry. The family floater option allows multiple members of a family to be covered by a single sum insured. The policyholders are given the option of sum insured, premium and optional covers.

Coverage includes:

• Illness or accidental injury treatment by hospitalisation
• Doctor charges, nursing charges, pathology investigations and other in-patient expenses
• Waiting period (currently 48 months) coverage of pre-existing disease
• Maternity benefits (in some plans and on paying additional premium)
• Registered hospitals: AYUSH treatments (Ayurveda, Yoga, Unani, Siddha, Homoeopathy)
• Costs of organ donors, ambulance costs, etc.

What is not covered:
There are some exception like cosmetic surgery, dental treatment not involving accidents, accidents caused by risky activities and illnesses acquired during the first waiting period.

The question people also ask is:

Q: Is it possible to insure senior citizens?
A: Yes, until the age of 65 to join and those already enrolled may be renewed indefinitely.

Q: Does Covid19 treatment cover?
A: Yes, and Covid19 related treatment is covered like other illnesses, with normal terms.

What are the Advantages and Disadvantages of National Health Insurance Mediclaim Policy?

Pros:

• Broad acceptance and thousands of network hospitals in India.
• Low premiums, particularly family floater.
• Hassle-free medical care with cashless and reimbursement claim facilities.
• Permanent renewal of the policies, and maintenance of health protection.
• Clear claim settling track record (high claim settlement ratio of over 95 percent as per recent IRDAI data).

Cons:

• Pre-existing illnesses waiting period (48 months).
• Capping of room rent may limit the availability of higher hospital room in certain plans.
• There are added benefits of some advanced treatments and maternity benefits that are not the default.
• There may be sub-limits on some surgeries and procedures, and thus the amount of claims may not be reimbursed fully.
• Foreign treatments are only covered in special cases.

Did you know?
According to the 2025 insurance trends, National Insurance Company has served more than 20 lakh policyholders with its mediclaim plans especially in tier-two and rural areas.

How Does National Health Insurance Stack up with Other Insurers in 2025?

The other questions people pose are:

Q: Do government workers pay the same premium?
A: Group policies on government employees can be charged differently, but the retail policy can be charged at the standard rates with no special discount unless it is charged on a group.

Which Documents are Needed to Buy or File Claim?

At the time of purchasing the policy:

• Age and identity proof- Aadhaar, passport, PAN, or Voter ID
• Address proof
• Passport size picture
• Health declaration form proposal

For claims:

• Original hospital bills, prescription, reports
• Hospital discharge summary
• Copy of policy and claim form
• Any supplementary documents according to particular claim

Did you know?
By 2025, National Insurance Company will pay the majority of its cashless claims at network hospitals in seven business days, speeding up the delivery of financial aid to the patients.

Who will buy this policy in 2025?

• Those not covered by employer health cover
• Families with young children who want cheap comprehensive cover
• Elderly people that require lifetime renewability
• Shopkeepers, small businessmen and unorganised sector people
• The rural people, since National Insurance Company has a large presence beyond metro cities

The question people also ask is:

Q: Is it possible to raise the sum insured at renewal?
A: Yes, you can ask to increase cover at renewal but additional amount will have a new waiting period applicable to some illness.

What are the Common Claim Experiences? Does Customer Support Suck?

The process of cashless hospitalisation in empanelled hospitals is mostly smooth to the policyholders. The online submission of claims via the National Insurance portal saved time on reimbursement claims in 2025. But there are cases of delays at peak times or when incomplete documents are submitted by some claimants.

There has been an increase in customer care with an exclusive toll free helpline and online chat facilities. The resolution of grievances takes place within 7 to 14 days.

What are the New Developments or Changes of 2025?

The policy has been modified to meet the new IRDAI guidelines, customer feedback and health trends. Some of the changes are:

• Growth of daycare treatments with the modern medicine.
• More network hospitals especially in Tier 2 and Tier 3 towns.
• Digital-first policy servicing, such as smooth e-cards, claim upload, and tracking.
• More rapid pre-approval of scheduled surgeries.
• Special wellness packages and regular health check-ups of policyholders of age above 40, on policy term basis.

Insight: “In 2025, policyholders want health insurance companies to provide them with seamless and digital-first experiences. National Insurance Company has taken a great leap in this direction particularly in the case of family floaters and senior citizen plans, says Swati Menon, an insurance advisor based in Kolkata.

TL;DR or Pithy Summary

National Health Insurance Mediclaim Policy is a medical cover against illnesses and accidents and is available to individuals, families and senior citizens.
The major advantages are that it can be renewed throughout life, cashless hospitals in 10000 plus hospitals, low premiums, and tax exemptions.
Disadvantages are that it takes longer to wait in case of pre-existing diseases and certain sub-limits to cover.
In 2025, digitized and increased coverage.

FAQs are also asked by people.

Q1: Does this policy cover ayush treatment?
Yes, now even the treatments in approved Ayush hospitals are covered up to the sum insured limits.

Q2: How old can one purchase the policy?
Most plans have a limit of 65 years of age of entry. Current members are able to renew on a lifelong basis.

Q3: Do I have to tell the insurer before I am admitted in hospital?
In case of planned admissions, cashless treatment is advisable to be pre-approved. In case of emergencies, report to the insurer within 24 hrs.

Q4: When can I claim once I purchase the policy?
There is a 30 day waiting period with exceptions to accidents, which are immediately covered.

Q5: Will my premium rise on claim?
Claiming will normally have no impact on premium in the following year, unless the sum insured is raised or the policy terms altered.

Q6: Is the Mediclaim Policy of the National Health Insurance offered online?
Yes, in 2025, customers will be able to purchase, renew and manage this policy entirely online via the official National Insurance Company web-site or application.

Q7: Are there special benefits to women or children?
Add-on maternity and child cover is available, with specialised options, and is subject to additional premium and plan terms.

Q8: What are general exclusions in this policy?
Some of the major exclusions include self-inflicted injuries, cosmetic surgeries, dental treatment that is not caused by accidents, and congenital diseases.

Q9: Is it possible to transfer my current health policy to another firm to National Insurance?
Yes, it is portable as per the rules of IRDAI and waiting periods are not broken.

Q10: Is there an annual health check-up in the policy?
There are also variants and increased sum insured options which provide preventive health check-ups upon a claim free year.

Sources:

• National Insurance Company
• Health Insurance Survey of Industry 2025