What does National Health Insurance Coverage include?

National Health Insurance Coverage generally includes hospitalisation expenses such as room rent, doctor fees, ICU charges, nursing, medicines, and medical procedures. Many plans also cover day-care treatments, ambulance services, and modern treatment procedures.

What are the key National Health Insurance Benefits?

Key National Health Insurance Benefits include cashless treatment, pre- and post-hospitalisation coverage, organ donor expenses, home care treatment, and optional add-ons like sum insured restoration and modern treatment cover.

Does National Health Insurance cover pre-existing diseases?

Yes, pre-existing diseases are covered after completing the applicable waiting period (usually up to 48 months). Once the waiting period ends, claims for declared conditions become eligible.

Are day-care procedures covered under National Health Insurance?

Yes. Treatments that require less than 24 hours of hospitalisation, such as dialysis, chemotherapy, or minor surgeries, are covered under most plans.

Does National Health Insurance provide cashless hospitalisation?

Yes. You can avail cashless treatment at any network hospital approved by National Insurance, subject to policy terms and eligibility.

Does National Health Insurance cover AYUSH treatments?

Most plans offer AYUSH coverage for in-patient treatments under Ayurveda, Yoga, Unani, Siddha, and Homeopathy when taken at recognised centres.

Are modern and advanced treatments covered?

Many National Health Insurance plans cover modern treatments such as robotic surgery, stem cell therapy (as per IRDAI norms), and advanced minimally invasive procedures.

Does the policy cover organ donor expenses?

Yes. Organ donor surgery expenses and medical costs related to harvesting the organ are typically included under National Health Insurance Coverage.

Is home care or domiciliary treatment covered?

Some plans provide domiciliary treatment benefits when a patient cannot be moved to a hospital or when hospitalisation is not feasible.

Does National Health Insurance cover maternity expenses?

Maternity coverage is available only in specific plans or add-ons. Where offered, it includes delivery expenses and may also extend to newborn baby cover, subject to the waiting period.

Are ambulance charges covered?

Yes. Most plans include coverage for emergency road ambulance services, and some higher variants also cover air ambulance services up to specified limits.

What is not covered under National Health Insurance?

Common exclusions include cosmetic surgery (unless accidental), STDs, unproven treatments, non-medical expenses, injuries due to intoxication, and any disease within the waiting period.

Does National Health Insurance offer restoration of the sum insured?

Yes, several plans provide automatic restoration of the base sum insured when it gets exhausted during the policy year, enhancing National Health Insurance Benefits.

Are preventive health check-ups included?

Some National Health Insurance plans offer annual or periodic health check-up benefits based on claim-free years or specific plan features.

Does the policy cover overseas treatment?

Generally, retail National Health Insurance plans do not cover international medical treatment, except in certain travel-related or specialised plans. Always check your policy brochure for clarity.

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National Health Insurance & Coverage Benefits

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National Health Insurance & Coverage Benefits

Customer Testimonials

Real experiences from our valued customers who have chosen our insurance coverage.

Have been associated with Ruchir and his team… They have provided me excellent guidance in choosing the right plans for myself and my family…

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Have been associated with Ruchir and his team… They have provided me excellent guidance in choosing the right plans for myself and my family…

…always been available to assist with any insurance/claim queries.

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verdict

Our Verdict: National Health Insurance Coverage

Pros

Reliable AYUSH and organ donor coverage in key plans.

Strong cashless network, especially in semi-urban and rural areas.

Budget-friendly premiums with good value for families and seniors.

Comprehensive coverage for hospitalisation, day-care, and domiciliary care.

Cons

Fewer high-sum-insured or global coverage options.

Claims process is less digital and can be slower.

Limited wellness, OPD, and preventive care features.

Longer waiting periods for some illnesses.

Pros

Reliable AYUSH and organ donor coverage in key plans.

Strong cashless network, especially in semi-urban and rural areas.

Budget-friendly premiums with good value for families and seniors.

Comprehensive coverage for hospitalisation, day-care, and domiciliary care.

Cons

Fewer high-sum-insured or global coverage options.

Claims process is less digital and can be slower.

Limited wellness, OPD, and preventive care features.

Longer waiting periods for some illnesses.

Final Verdict

National Health Insurance Coverage offers dependable and affordable protection, making it a strong choice for essential health needs. The plans cover major benefits like hospitalisation, day-care procedures, AYUSH treatments, and organ donor expenses, ensuring good value for individuals and families. Its extensive cashless hospital network is especially useful for customers...

National Health Insurance Coverage offers dependable and affordable protection, making it a strong choice for essential health needs. The plans cover major benefits like hospitalisation, day-care procedures, AYUSH treatments, and organ donor expenses, ensuring good...

Key Coverages & Benefits Offered Under National Health Insurance

Get a quick overview of what National Health Insurance covers and excludes, helping you choose the right plan with clarity.

Inclusions

Sum Insured Restoration in eligible plans when the base coverage is fully used.

Home Care / Domiciliary Treatment when hospitalisation is not medically feasible.

Organ Donor Expenses including donor evaluation and surgery costs.

Ambulance Cover for emergency road ambulance; air ambulance available in select plans.

Modern & Advanced Treatments like robotic surgeries, cancer therapies, and other approved technologies.

Day-Care Procedures for treatments not requiring 24-hour hospitalisation.

In-patient Hospitalisation covering room rent, ICU, nursing, medicines, and doctor fees.

Exclusions

Self-inflicted injuries or suicide attempts.

Non-medical expenses such as consumables and administrative charges.

Maternity and fertility treatments unless the plan specifically includes them.

Conditions arising from alcohol, drug misuse, or unlawful acts.

Unproven or experimental treatments not recognised under policy guidelines.

Cosmetic or plastic surgeries unless required due to an accident.

Pre-existing diseases during their waiting period or if not declared at policy purchase.

Inclusions

Sum Insured Restoration in eligible plans when the base coverage is fully used.

Home Care / Domiciliary Treatment when hospitalisation is not medically feasible.

Organ Donor Expenses including donor evaluation and surgery costs.

Ambulance Cover for emergency road ambulance; air ambulance available in select plans.

Modern & Advanced Treatments like robotic surgeries, cancer therapies, and other approved technologies.

Day-Care Procedures for treatments not requiring 24-hour hospitalisation.

In-patient Hospitalisation covering room rent, ICU, nursing, medicines, and doctor fees.

Exclusions

Self-inflicted injuries or suicide attempts.

Non-medical expenses such as consumables and administrative charges.

Maternity and fertility treatments unless the plan specifically includes them.

Conditions arising from alcohol, drug misuse, or unlawful acts.

Unproven or experimental treatments not recognised under policy guidelines.

Cosmetic or plastic surgeries unless required due to an accident.

Pre-existing diseases during their waiting period or if not declared at policy purchase.

Claims Process

How to file National Health Insurance claims?

National Health Insurance & Coverage Benefits

How Coverage and Benefits Vary in National Health Insurance

Plan Type & Sum Insured Options

Coverage depends on the specific plan and the sum insured chosen. Higher sum insured options provide broader protection, better room rent eligibility, and wider support for advanced treatments.

Age, Medical History & Underwriting

Your age, medical history, and health disclosures influence coverage. Some conditions may have longer waiting periods or customised terms based on individual risk assessment.

Add-Ons & Optional Covers

National Health Insurance policies can be enhanced with add-ons. These optional benefits expand coverage to include modern treatments, home care services, and restoration features for added protection.

Plan Type & Sum Insured Options

Coverage depends on the specific plan and the sum insured chosen. Higher sum insured options provide broader protection, better room rent eligibility, and wider support for advanced treatments.

Age, Medical History & Underwriting

Your age, medical history, and health disclosures influence coverage. Some conditions may have longer waiting periods or customised terms based on individual risk assessment.

Add-Ons & Optional Covers

National Health Insurance policies can be enhanced with add-ons. These optional benefits expand coverage to include modern treatments, home care services, and restoration features for added protection.

How to Choose

How to Choose the Right Health Insurance Coverage

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What is the Waiting Period in National Health Insurance?

A waiting period is the mandatory time you must wait after buying your National Health Insurance policy before certain illnesses, treatments, or benefits can be claimed. Any claim filed during this period for the restricted condition will not be approved.

Initial Waiting Period

Most National Health Insurance plans have a 30-day waiting period for all illnesses. Accidental hospitalisation is covered from day one, with no waiting period.

Pre-Existing Disease (PED) Waiting Period

National typically applies a 48-month (4-year) waiting period for pre-existing conditions, depending on the plan. This applies to diseases declared at policy purchase.

Specified Disease / Procedure Waiting Period

Certain listed illnesses and procedures, such as cataract, hernia, joint surgeries, ENT issues, and benign tumors, carry a plan-specific waiting period, usually 1 to 4 years, depending on the policy variant.

Bariatric Surgery Waiting Period

In plans where bariatric surgery is covered (e.g., National Guardian), the waiting period is generally 24 months.

Organ Transplant Waiting Period

For plans offering this benefit, a 3-year waiting period may apply before organ transplant coverage becomes claimable.

Newborn Baby Cover Waiting Period

Where included, newborn baby cover typically becomes available after 1 year of continuous coverage.

Maternity Waiting Period

Plans that include maternity benefits usually have:

2-year waiting period (if both parents are covered), or

. 4-year waiting period (if only the mother is insured).

Initial Waiting Period

Most National Health Insurance plans have a 30-day waiting period for all illnesses. Accidental hospitalisation is covered from day one, with no waiting period.

Pre-Existing Disease (PED) Waiting Period

National typically applies a 48-month (4-year) waiting period for pre-existing conditions, depending on the plan. This applies to diseases declared at policy purchase.

Specified Disease / Procedure Waiting Period

Certain listed illnesses and procedures, such as cataract, hernia, joint surgeries, ENT issues, and benign tumors, carry a plan-specific waiting period, usually 1 to 4 years, depending on the policy variant.

Bariatric Surgery Waiting Period

In plans where bariatric surgery is covered (e.g., National Guardian), the waiting period is generally 24 months.

Organ Transplant Waiting Period

For plans offering this benefit, a 3-year waiting period may apply before organ transplant coverage becomes claimable.

Newborn Baby Cover Waiting Period

Where included, newborn baby cover typically becomes available after 1 year of continuous coverage.

Maternity Waiting Period

Plans that include maternity benefits usually have:

2-year waiting period (if both parents are covered), or

. 4-year waiting period (if only the mother is insured).

Diseases Covered/not Covered

Diseases Covered/Not Covered Under National Health Insurance

Diseases Covered

Daycare Treatment Diseases

Maternity & Newborn Care (Select Plans)

Infectious Diseases

Accidental Injuries

Critical Illnesses (Plan/Add-On Specific)

Lifestyle Diseases

Chronic Conditions (After Waiting Period)

General Illnesses & Medical Conditions

Diseases Not Covered

Unproven or Alternative Therapies

Non-Medically Necessary Treatments

Self-Inflicted Injuries

Substance-Abuse Related Diseases

Infertility and Assisted Reproduction Issues

Cosmetic or Aesthetic Conditions

Sexually Transmitted Diseases (STDs)

Congenital External Diseases

Diseases Covered

Daycare Treatment Diseases

Maternity & Newborn Care (Select Plans)

Infectious Diseases

Accidental Injuries

Critical Illnesses (Plan/Add-On Specific)

Lifestyle Diseases

Chronic Conditions (After Waiting Period)

Diseases Not Covered

Unproven or Alternative Therapies

Non-Medically Necessary Treatments

Self-Inflicted Injuries

Substance-Abuse Related Diseases

Infertility and Assisted Reproduction Issues

Cosmetic or Aesthetic Conditions

Sexually Transmitted Diseases (STDs)

Pre-existing Diseases

Pre-Existing Diseases Covered Under National Health Insurance

Diabetes

Blood sugar-related conditions are covered once the pre-existing disease waiting period is completed. Hospitalisation, medication, and complications are included based on the plan.

Hypertension (High Blood Pressure)

Coverage includes in-patient treatment for complications arising from high blood pressure. Claims are valid after serving the mandatory waiting period.

Thyroid Disorders

Both hypo- and hyperthyroidism are covered after the pre-existing disease waiting period. Treatment costs, hospitalisation, and required tests are included.

Asthma

Chronic or severe asthma is covered post-waiting period. Costs for hospitalisation, emergency care, and long-term monitoring are included under applicable plans.

Hyperlipidemia / Cholesterol Issues

Conditions related to high cholesterol and triglycerides are covered after the waiting period. Claims include hospitalisation, treatment of complications, and related investigations.

Heart Disease (Stable Conditions)

Certain stable heart conditions may be covered post-waiting period. Coverage applies for hospitalisation and medically necessary procedures based on policy terms.

Obesity-Related Illnesses

Complications arising from obesity, such as sleep apnea or joint problems, may be covered after the waiting period. Treatment requires medical justification.

Diabetes

Blood sugar-related conditions are covered once the pre-existing disease waiting period is completed. Hospitalisation, medication, and complications are included based on the plan.

Hypertension (High Blood Pressure)

Coverage includes in-patient treatment for complications arising from high blood pressure. Claims are valid after serving the mandatory waiting period.

Thyroid Disorders

Both hypo- and hyperthyroidism are covered after the pre-existing disease waiting period. Treatment costs, hospitalisation, and required tests are included.

Asthma

Chronic or severe asthma is covered post-waiting period. Costs for hospitalisation, emergency care, and long-term monitoring are included under applicable plans.

Hyperlipidemia / Cholesterol Issues

Conditions related to high cholesterol and triglycerides are covered after the waiting period. Claims include hospitalisation, treatment of complications, and related investigations.

Heart Disease (Stable Conditions)

Certain stable heart conditions may be covered post-waiting period. Coverage applies for hospitalisation and medically necessary procedures based on policy terms.

Obesity-Related Illnesses

Complications arising from obesity, such as sleep apnea or joint problems, may be covered after the waiting period. Treatment requires medical justification.

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