National Mediclaim Policy: Coverage, Premium & Renewal

Overview

The National Mediclaim policy is National Insurance's entry-level individual hospitalization plan, offering sum insured options from ₹1 lakh to ₹10 lakh, with each family member covered under a separate limit. It covers hospitalization costs, though several sub-limits determine what's payable at claim time.

Key Features

Hospitalization Cover: Pays for in-patient expenses, but room rent, ICU charges, doctor's fees, and related costs carry their own daily and per-illness caps.
Pre-and Post-Hospitalization: Covers related medical costs for 45 days before admission and 60 days after discharge.
Bonus and Restoration: Sum insured rises 5% each claim-free year (up to 50%). SI restoration applies only for cover of ₹6 lakh and above.

Major Exclusions

Pre-Existing Diseases: Excluded for 36 months from policy inception.
Initial Waiting Period: 30 days, accidents are covered immediately.
Specific Treatments: Cosmetic surgery, self-inflicted injuries, and non-accident dental care aren't covered.

A ₹10 lakh sum insured may sound like reasonable cover today. But room-rent caps, per-illness expense limits, and fixed caps on several treatments mean the amount you actually recover at claim time can fall well short of that number. That’s a concern with the National Mediclaim policy.

This review covers what the policy offers, its premiums, waiting periods, how it stacks up on the insurer's claims and solvency metrics, and how to renew or file a claim.

What Is the National Mediclaim Policy?

National Mediclaim is National Insurance's entry-level individual hospitalization policy. Family members can be listed on one policy, but it is not a floater. Each insured person gets their own separate sum insured. Here are the plan's basic details.

Parameter	Details
Sum Insured (SI)	₹1 lakh to ₹10 lakh
Adult Entry Age	Minimum: 18 years, maximum: 65 years
Child Entry Age	From over 3 months, as per policy terms
Exit Age	No limits for both adults (children and siblings can renew only until marriage)
Policy Tenure	1 year
Renewability	Lifelong
Relationships Covered	Spouse, dependent or legally adopted children, parents, brother and sister (till marriage) and parent-in-laws

Key Insight

Don't confuse this with National Mediclaim Plus, a separate, higher-cover product (up to ₹50 lakh, with hospital cash and a second-opinion benefit), or the National Parivar Mediclaim Policy, which is an actual family floater.

Key Features & Benefits of National Mediclaim Policy

Hospitalization Cover and Sub-Limits

Room rent is capped at 1% of SI per day (max ₹10,000), ICU at 2% of SI per day (max ₹20,000). Room-related charges are further capped at 25% of SI per illness, doctor's fees at 25%, and other hospitalization expenses at 50%. Modern treatments like robotic surgery are capped at 25% of SI each.

Pre- and Post-Hospitalization Expenses

The plan covers medical expenses for 45 days before admission and 60 days after discharge, provided they relate to the condition being treated.

Daycare Procedures

Over 140 listed treatments, such as dialysis, chemotherapy, and cataract surgery, are covered even when hospitalization runs under 24 hours.

Bonus

Your SI grows by 5% for every claim-free year. The maximum bonus is capped at a maximum of 50% of SI. A claim year reduces the accumulated bonus by 5% of the expiring SI at renewal.

Restoration of Sum Insured

A refill of SI is available only for basic SI of ₹6 lakh and above. It reinstates 100% of the basic SI once per policy year and applies only to a subsequent hospitalization for a different illness. The available SI must first be fully exhausted.

Consumables

Non-medical items are covered only for SI ₹5 lakh and above through a paid add-on. This covers consumables up to 10% of the base SI, with no separate limit.

Health Checkups

One checkup can be reimbursed after every 4 continuous claim-free years. The coverage is capped at 1% of the basic SI, subject to a maximum of ₹5,000.

Waiting Periods, Sub-Limits and Exclusions

Waiting Period	Duration
Initial (Except Accidents, Covered from Day 1)	30 days
Pre-Existing Diseases (PED)	36 months (3 years)
Diabetes, Hypertension, Cardiac Conditions (If Not a PED)	90 days
Specific Illness	90 days, 1 year, 2 years, and 3 years, depending on the disease/procedure.

Other Limits to Note: Ambulance cover is just 1% of SI, capped at ₹2,000 per year. The base policy includes no domiciliary hospitalization or Outpatient Department (OPD) cover.

For the complete set of exclusions, check the official policy prospectus.

National Mediclaim Policy Sample Premium Illustration

See a snapshot of premiums for different age bands and sum insured options.

Please Note: Since this is an individual-SI product, a couple buying ₹10 lakh each pays the sum of both individual premiums, not one shared-pool rate. These are indicative values and can vary based on age, location, and medical underwriting. For exact quotes, you can check the National Insurance Mediclaim policy premium chart.

Loadings and Discounts: Third-Party Administrator (TPA) servicing (needed for cashless) adds 5.4%.
A 20% co-pay earns a 25% discount. A 10% co-pay earns a 12.5% discount.
Direct online purchase adds another flat 10% off.
Paying annually is cheaper than half-yearly (102% of the annual rate) or quarterly (103% of the annual rate).

Important

These sublimits do not apply when a listed procedure is taken at a Preferred Provider Network (PPN) hospital under the applicable package rate. So, before hospitalization, check whether the hospital and planned procedure qualify under National Insurance's PPN.

National Insurance: Performance Metrics

Metric (Average FY 2024-26)	National Insurance	Industry Average	Key Insight
Claim Settlement Ratio (CSR)	93.76%	92.02%	Above average, a reasonably dependable claims record.
Incurred Claims Ratio (ICR) (Average FY 2023-25)	96.41%	81.88%	Well above the healthy 55%-85% range, leaving thin operating margins and a risk of increased premiums to sustain.
Complaints Volume (Per 10,000 Claims)	39.13	29.35	Higher than average, pointing to room for service improvement and customer grievances.
Network Hospitals	5,300+	10,000+ (Recommended)	Below the recommended number, increasing the risk of cashless claim rejections and limiting access to quality healthcare.
Gross Written Premium (GWP) / Annual Business - Total Health (In Crore)	₹8,282.91	₹4,504.48	Well above average, reflecting a large, established customer base.

Note: This information is sourced from the IRDAI annual reports and National Insurance public disclosures. To explore more such data, look at Ditto Data Lab. For a complete picture of the insurer, check our National Health Insurance review.

Important

National Insurance continues to face solvency pressure. Its solvency ratio was about -1.1 as of March 31, 2026, well below the regulatory requirement of 1.5. This is an insurer-level financial-strength concern and should be considered alongside its claims and service metrics.

Pros & Cons of the National Mediclaim Policy

What Works Well

Separate SI per family member, tracked individually
140+ day care procedures and full AYUSH cover
No mandatory co-payment and a 10% direct-purchase discount available

What Falls Short

Maximum basic SI is only ₹10 lakh
Heavy room-rent, doctor-fee, and treatment sub-limits
No domiciliary or OPD cover
Cashless needs the TPA option, adding 5.4% to premium
Insurer's solvency ratio has stayed negative for years

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How to Renew the National Mediclaim Policy Online?

National Insurance mediclaim renewal online payment is available through National Insurance's Quick Renewal facility and the NIMA app. Follow these steps.

Visit National Insurance's official website or the NIMA app (Google Play Store and App Store), and go to Quick Renewal.
Enter your policy number and captcha to pull up existing details.
Review your SI, TPA option, and co-payment, since insurers can't re-underwrite you at renewal unless you're increasing the SI.
Complete the online payment via net banking, card, or UPI.
For a National Insurance Mediclaim policy download, retrieve the renewed policy PDF from your registered email or customer portal after payment.

A 30-day grace period applies, meaning renewing within it preserves your cumulative bonus and waiting-period continuity, though cover isn't active during the unpaid gap.

How to Claim Under the National Mediclaim Policy?

Cashless Claim Process

This benefit is available only with TPA servicing. Intimate at least 72 hours before planned admission, or within 24 hours for emergencies. The hospital sends a pre-authorization request. You can expect a response within 1 hour and final discharge authorization within 3 hours. A declined pre-authorization doesn't mean the claim itself is inadmissible. You can still pay and file for reimbursement.

Reimbursement Claim Process

Notify the insurer within 72 hours (planned) or per emergency timelines. Submit hospitalization and ambulance bills within 30 days of discharge, and post-hospitalization bills within 30 days of completing that treatment. Non-cashless claims must be settled within 15 days under IRDAI norms.

Documents Required for a Claim

Duly filled claim form
Original hospital bills, receipts, and discharge summary
Doctor's prescriptions and diagnostic reports
Surgeon's certificate (for surgical claims)
KYC documents and policy copy

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Conclusion

National Mediclaim delivers a dependable claim settlement ratio and the flexibility of per-member sum insured tracking, which matters. But a ₹10 lakh sum insured doesn't stretch as far as it looks, given the room-rent caps, per-illness sub-limits, and fixed rupee ceilings on several treatments. Add in the insurer's persistently negative solvency ratio and below-average hospital network, and the fine print matters more than usual. The company also uses Third-Party Administrators (TPAs), which can delay claims and add an extra layer between the insurer and the customer.

If those trade-offs feel like too much of a compromise, it's worth comparing National Mediclaim against options like HDFC ERGO Optima Secure Plus or Care Supreme.

Whatever you decide, go through the full National Mediclaim prospectus first, especially the sub-limit and waiting-period clauses, so nothing catches you off guard at claim time. Still exploring your options? Take a look at our guide to the best health insurance plans in India.

Frequently Asked Questions

How many daycare procedures does the National Mediclaim Policy cover?

The policy covers over 140 listed daycare procedures, including dialysis, chemotherapy, and cataract surgery, even when hospitalization runs under 24 hours. This makes it useful for modern treatments that no longer require extended in-patient stays, though each procedure may still carry its own sub-limit under the policy.

Can I renew my National Mediclaim Policy online, and what happens if I miss the renewal date?

Yes, you can renew via National Insurance's website or the NIMA app under Quick Renewal. A 30-day grace period applies after expiry, preserving your accumulated bonus and waiting-period continuity, but you won't have active cover during this unpaid gap, so any hospitalization in that window won't be claimable.

Does National Mediclaim Policy cover organ donor medical expenses?

Yes, it covers the organ donor's in-patient hospitalization expenses for harvesting the donated organ if the insured is medically advised to undergo the transplant. However, it excludes the donor's pre- and post-hospitalization costs, organ acquisition charges, experimental transplants, donor complications, and organ transportation expenses.

What is the Sum Insured reinstatement benefit under National Mediclaim Policy?

This restoration benefit reinstates 100% of your Basic Sum Insured once per policy year, but only if your Basic SI is ₹6 lakh or above. It applies solely to a subsequent hospitalization for a different illness, not the same one, so it won't help if the original SI is exhausted mid-treatment.

Is morbid obesity treatment covered under the National Mediclaim Policy?

Yes, surgical treatment for morbid obesity is covered following failure of less-invasive methods of weight loss, subject to a 3-year waiting period, if the insured is 18 or older, the surgery follows clinical protocols on medical advice, and BMI is 40 or above, or 35+ with severe co-morbidities like coronary heart disease, sleep apnea, or uncontrolled Type 2 diabetes.

How is the National Mediclaim Policy different from National Insurance's senior citizen or young India variants?

National Mediclaim is a standard adult hospitalization plan (entry age 18-65) with sum insured up to ₹10 lakh. National Insurance's senior-citizen or young-age variants typically target different age brackets with adjusted premiums, waiting periods, or entry criteria. Check National Insurance's product list to compare eligibility and benefits precisely.

Last updated on: 6 Sep, 2026

National Mediclaim Policy: Coverage & Premium