New India Assurance Mediclaim vs National Insurance National Mediclaim policy
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Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Mediclaim is sold by New India Assurance and National Mediclaim policy is sold by National Insurance. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products are quite basic in their structure. They offer modest protection and aren’t comprehensive enough to cover a wide array of use cases. So if you are looking for something more robust, then both these policies may not cut it.
And finally, any comparison is ultimately futile without considering the use case. Who are you buying this policy for? You, your family, your parents?
That’s something you’ll need to answer before using this guide. So with that introduction out of the way, we can get to comparing the actual policies themselves.
Let’s start with Mediclaim. The product comes from New India Assurance’s stable:
New India Assurance, is a government-owned insurance firm that was established in 1919. Their insurance portfolio includes Health, Motor, Travel, and Marine products. But despite being in the business for so long, they’re not the most efficient when it comes to processing your application and dealing with your claims.
And that means, even with a relatively high claim settlement ratio and 3,139 network hospitals, the company isn’t exactly a stellar performer.
National Mediclaim policy meanwhile comes from National Insurance’s stable:
National Insurance is the country's oldest general insurance firm and is wholly owned by the Government of India. That means, despite a claim settlement ratio of 93% and over 3,200 network hospitals it can be a bit difficult to reach the insurer when you need them the most. Perhaps due to the fact that they are still a public sector enterprise.
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Compare Insurances Insurance Parameters Recommended Not Recommended | Mediclaim | National Mediclaim policy |
|---|---|---|
| Network hospitals | 3,139 | 3,200+ |
| Claim settlement ratio (avg. of last 3 years) | 99% | 93% |
| Co-payment | No | No |
| Room rent | Any Room (up to 1% of sum insured) | Any Room (up to 1% of sum insured) |
| Disease sub-limit | Yes | Yes |
| Pre existing diseases waiting | 3 years | 3 years |
| Pre/Post hospitalization | 30/60 days | 45/60 days |
| No claim bonus | 25% per year (up to 50%) | 5% per year (up to 50%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for different illness) | 100% restoration (once for different illness after complete exhaustion of sum insured) |
| Health check-up | Once every 3 years | Once every 4 years |
| Maternity | ||
| Out Patient Department | ||
| Day care |
Feature Comparison
Co payment
With a co-payment clause, the insurer will mandate that you pay a part of the bill. So if the bill adds up to Rs. 2,00,000 and the co-payment is set at 20% then you could be asked to pay Rs. 40,000 from the bill. In this case, however, Mediclaim doesn’t impose a co-payment clause. And neither does National Mediclaim policy.
Room rent
If the policy does impose room rent restrictions then the insurer may only let you stay in a room of a certain specification or impose a cap on the total room rent. If you were to breach either criterion then the insurance company may ask you to pay a portion of all the expenses you incurred while staying in the room. In this case, Mediclaim only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured. And National Mediclaim policy does the same i.e. it only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured.
Sub limits
Some policies will tell you that they will cover all medical expenses up until the sum insured, but then impose caps on the total costs you can incur while dealing with a very specific list of diseases. We call these caps “Disease Wise Sub Limits.” In this case, Mediclaim imposes disease-wise sub-limits on Cataracts, Modern treatments whereas National Mediclaim policy imposes sub-limits on Modern treatments
Waiting periods for pre-existing diseases
If you’re suffering from a lifestyle condition or if you’ve had surgery in the past, or if you’re dealing with an acute or chronic illness at the time of buying the policy, then the insurer may classify this as a pre-existing disease. And they may tell you that they will only cover these illnesses after some time. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, Mediclaim imposes a 3 year waiting period on pre-existing diseases and National Mediclaim policy will similarly tell you to wait 3 years before making a claim related to your pre-existing diseases
Pre and post Hospitalization expenses
Most people aren’t hospitalized right off the bat. Instead, they’ll have to go through a whole series of diagnostic tests before hospitalization and take medication post-discharge. These costs are outlined as pre-hospitalization expenses and post-hospitalization expenses respectively. In this case, Mediclaim covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, National Mediclaim policy covers expenses incurred 45 days before hospitalization and expenses incurred 60 after hospitalization, although there may be different sub-limits
No claim bonus
Some policies will tell you that they will incentivize you for not making a claim in any given year. And they offer such incentives by offering extra cover on top of the existing sum insured. This extra cover is categorized as a no-claim bonus. In this case, however, Mediclaim offers a no-claim bonus of 25% whereas National Mediclaim policy offers a no-claim bonus of 5%. And the no-claim bonus may be capped at different levels too.
Domiciliary
Imagine you are forced to treat yourself at home because you don’t find a hospital bed, or you have a chronic condition that prevents you from visiting one, then, insurers may choose to cover your treatment even if you’re hospitalized at home. And such costs are collectively categorized as domiciliary treatment costs. In this case, however, neither Mediclaim offers domiciliary cover nor does National Mediclaim policy
Ayush treatments
Most policies only cover treatments administered in a registered medical facility. However, on some occasions, you may want to pursue alternative treatments including homoeopathy, Ayurveda, Unani and Siddha. These treatments are collectively categorized as Ayush treatments. And in this case, Mediclaim covers Ayush procedures and National Mediclaim policy also extends coverage for Ayush treatments.
Maternity benefits
If you’re hospitalized during childbirth, then you may have to incur significant costs during delivery of your newborn, child care and other related matters during the course of the hospitalization. These costs are collectively termed maternity costs. And in this case, neither Mediclaim offers maternity cover nor does National Mediclaim policy.
Out Patient Department (OPD)
Doctor visits and regular consultations aren’t usually covered by health insurance policies. They are categorized as Outpatient consultations (or OPD treatments) and patients have to bear the cost on their own. In this case, however, neither Mediclaim extends coverage for outpatient consultations, nor does National Mediclaim policy.
Final Conclusion
After considering all the features on hand and the claim settlement ratio of New India Assurance, we believe that Mediclaim is a better alternative to National Mediclaim policy for most use cases that we’ve evaluated so far.
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Other National Insurance National Mediclaim policy Comparisons
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