Mediclaim Policy – Individual Plan· the insurer· ₹1L–₹10L· Reinstatement· 11 Modern Treatments| takemyinsurance.com

Q: What discounts are available on NMP — and can I combine the online discount with co-payment discount?

Two confirmed discounts from NMP Prospectus Section 2.5: 1. Online / Direct Sale Discount (10%): "If the Policy is bought online or by walk-in/direct customer (where no intermediary is involved), a discount of 10% shall be allowed on the total premium for both new policy and subsequent renewals." — Prospectus 2.5.2. How to get it: Buy via the insurer online portal directly or walk in to the insurer's office without a broker/agent. Applies on every renewal if no intermediary is involved. 2. Optional Co-Payment Discount: "25% discount in total premium, for 20% Co-payment on each admissible claim. 12.5% discount in total premium, for 10% Co-payment on each admissible claim." — Prospectus 2.5.1. Can both discounts combine? In principle: purchasing directly online (10% off) AND opting for co-payment (12.5% or 25% off) would apply to the same total premium — potentially up to 35% total reduction. Confirm exact stacking mechanics and current the insurer pricing at 022 4302 0000. NMP vs ASP co-pay comparison: ASP: 5% co-pay mandatory — no discount option. You pay co-pay regardless and there's no premium benefit. NMP: No co-pay mandatory. If you CHOOSE co-pay (optional), you get a real discount of 12.5% or 25% off premium. Much better for risk-tolerant policyholders who want to save premium.

the insurer Health· August 2024 Version

What is the Mediclaim Policy (Individual Plan)?

"Mediclaim Policy is an indemnity health insurance policy. The Policy covers expenses incurred due to Hospitalisation for In-Patient Care (allopathy, AYUSH) or Day Care Treatment Reasonably and Customarily incurred for treatment of an Illness contracted/Injury sustained during the Policy Period. The Policy provides for Pre Hospitalisation (45 days) and Post Hospitalisation (60 days) expenses, Day Care Procedures, organ donor's medical expenses, ambulance charges, Morbid Obesity Treatment, Correction of Refractive Error and provides for Reinstatement of Basic Sum Insured (above SI of 6L), if applicable as per terms." — NMP Prospectus.

Source Confirmation: NMP Prospectus (Full, August 2024)· the insurer/the insurer Distribution Partner PDF

"This policy indemnifies for In-patient treatment expenses (minimum 24 hour hospitalization) and 140+ Day Care Procedures on Cashless/Reimbursement basis during the policy period."
"Annual Increase in SI by 5% for each claim free year up to maximum 50% of SI opted. Health Check Up Facility: Expenses of health check-up once at the end of a block of four claim free policy periods @ maximum of 1% of the average sum insured. Instalment facility is available under the policy. Online Discounts: 10%, where no intermediary is involved. Tax Rebate under Section 80D of Income Tax Act 1961 for premium paid."
"For Whom – Proposers aged 50 years and above (including dependents) and availing the policy for the first time. 50% of the expenses incurred for pre policy check-up shall be reimbursed, if the proposal is accepted." (NMP starts at 50; ASP starts at 55.)
Room Rent: 1% of SI/day, max ₹10,000/day· ICU: 2% of SI/day, max ₹20,000/day. Both within 25% of SI overall cap per illness. NMP's limits are double ASP's (₹5,000 and ₹10,000 respectively).
"Basic SI of ₹1/2/3/4/5/6/7/8/9/10 L." — Prospectus Section 2.4. Ten options in ₹1L increments — more granular than ASP's ₹50K multiples.

Key Features — Why NMP Is the insurer's Flagship Individual Health Policy

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Reinstatement of SI (₹6L+)

"For Insured Persons with Basic Sum Insured of ₹6 lacs and above, in the event of available Sum Insured being exhausted anytime during the Policy Period, the Company shall reinstate the Basic Sum Insured." — Prospectus 1.4.1. Effectively doubles annual cover for ₹6L+ policyholders. Not available in ASP.

₹6L+ Only· Once per Year

🤖

12 Modern Treatments

Robotic Surgery, HIFU, Stem Cell Therapy, Oral Chemotherapy, Intravitreal Injections, Balloon Sinuplasty, Deep Brain Stimulation, Immunotherapy, Bronchial Thermoplasty, Stereotactic Radio Surgery, Prostate Laser, IONM — from Prospectus 1.2.e.

25% of SI Each

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No Mandatory Co-Pay

Unlike ASP's non-negotiable 5% co-pay on every claim, NMP has NO mandatory co-pay. Optional co-pay discounts available: 20% co-pay → 25% premium discount; 10% co-pay → 12.5% discount. You decide whether to share risk for lower premium.

Optional Co-Pay Only

📅

45-Day Pre-Hospitalisation

"Up to forty five (45) days immediately before the Insured Person is Hospitalised." NMP's pre-hospitalisation window is 50% longer than ASP's 30 days — covering more investigation and consultation costs before admission.

45 Days· ASP: 30 Days

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Room Rent: ₹10,000/day

Room Rent: 1% of SI/day, max ₹10,000/day. ICU: 2% of SI/day, max ₹20,000/day. Confirmed from Prospectus 1.2.a. Double the ASP limits (₹5,000 and ₹10,000 respectively). Plus sub-limits waived entirely at PPN hospitals for listed procedures.

₹10K/day· PPN: No Limit

👨‍👩‍👧

Siblings + Both Parent Sets

"Brother, till marriage. Sister, till marriage. Parent-in-laws." — Prospectus 2.2.iv. NMP can cover unmarried siblings AND both proposer's parents AND in-laws under one policy — individual SI for each. ASP floater restricts to one set of parents and excludes siblings.

Most Inclusive Family Cover

NMP Prospectus vs IRDAI ASP Standard· Head-to-Head· Which the insurer Health Policy Is Right for You

NMP vs Arogya Sanjeevani (ASP) — The Critical Differences

Both are the insurer health policies — but NMP is the insurer's flagship comprehensive product while ASP is the IRDAI-mandated standard product. Understanding the key differences helps you choose the right policy for your family's specific needs and risk profile.

🌿 Arogya Sanjeevani (ASP)

✅ SI: ₹1L–₹10L (the insurer enhanced, IRDAI std = ₹5L)
❌ 5% mandatory co-pay — non-negotiable on all claims
❌ Pre-hospitalisation: 30 days
❌ Room rent: ₹5,000/day cap (2% of SI)
❌ ICU: ₹10,000/day cap (5% of SI)
❌ No reinstatement of SI
✅ Modern treatments: 50% of SI (different structure)
❌ No sibling coverage in floater
❌ Pre-medical from age 55
✅ IRDAI standardised — easy to compare across insurers
✅ Lower premium — standard product

💙 Mediclaim Policy (NMP) —

✅ SI: ₹1L–₹10L in ₹1L increments (10 options)
✅ NO mandatory co-pay — optional co-pay for premium discount
✅ Pre-hospitalisation: 45 days (50% longer than ASP)
✅ Room rent: ₹10,000/day at ₹10L SI (1% of SI)
✅ ICU: ₹20,000/day at ₹10L SI (2% of SI)
✅ Reinstatement of Basic SI for ₹6L+ policyholders
✅ 12 modern treatments (25% of SI each)
✅ Siblings coverable till marriage
⚠️ Pre-medical from age 50 (stricter than ASP's 55)
✅ More comprehensive underwriting = richer claims
⚠️ Slightly higher premium for richer features

💡 When to Choose NMP Over ASP

Choose NMP if:You want ₹6L+ cover with reinstatement safety net· You want no mandatory co-pay· You have siblings to cover· You need longer pre-hospitalisation window· You want robotic surgery / modern treatment coverage with higher sub-limit· You're covering both sets of parents· You want optional co-pay to reduce premium without mandatory exposure.
Consider ASP if:Budget is the primary driver· You want the simplest standardised product· You're comfortable with 5% co-pay· You're a first-time buyer wanting the most transparent product· You plan to port later and want IRDAI-standard continuity across insurers.
The reinstatement breakeven:NMP's premium is typically ₹3,000–₹8,000/year higher than ASP for the same SI at the same age. For ₹6L+ policyholders, the reinstatement provides up to ₹6L additional cover annually. If you have even one moderate claim year that exhausts your SI, the reinstatement pays back multiple years of premium difference in a single event.

NMP Prospectus Section 2.2· Entry Age· Family Members· Pre-Medical from 50

Eligibility — Who Can Be Covered Under NMP

"Entry age of Proposer should be between eighteen (18) years and sixty five (65) years. Maximum entry age of any family member is sixty five (65) years." — Prospectus Section 2.2.i-ii. NMP is an individual policy — each family member covered separately with their own dedicated SI and cumulative bonus.

👤

Proposer

Primary insured. Age 18–65 at entry.

Lifelong Renewal

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Spouse

Mid-term addition within 60 days of marriage. Own individual SI.

60 Days of Marriage

👶

Children

Natural/adopted. From 3 months. Mid-term: 3–6 months. Till marriage.

3 Months Onwards

👨‍👩

Parents

Proposer's biological parents. Max age 65 at entry. Own SI.

Both Permitted

👨‍👩

Parents-in-Law

Spouse's parents eligible. BOTH sets of parents allowed — unique to NMP.

Both Sets OK

👫

Siblings

"Brother, till marriage. Sister, till marriage." — Prospectus 2.2. Unmarried siblings coverable. Removed at next renewal after marriage.

Till Marriage

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Pre-Medical Check-Up — Confirmed from Prospectus Section 2.8

Required from age 50 (first-time buyers):"Pre policy checkup is required for persons aged fifty (50) years and above, and availing the Policy for the first time with the Company." — Prospectus 2.8.i. Note: NMP's threshold is 50 years vs ASP's 55 years.
Physical examination (MD Medicine doctor)· Blood sugar fasting/post prandial (SI up to ₹5L) or HBA1C (SI ₹6L+)· Lipid profile· Serum creatinine· Urine routine and microscopic· ECG· Eye check-up including retinoscopy· Any other investigation required by the insurer.
the insurer reimburses 50%:"The Company shall reimburse 50% of the expenses incurred for pre policy checkup, if the proposal is accepted." Report validity: 30 days prior to proposal date.
Mid-term inclusions:"Midterm inclusion of family members at pro-rata premium is allowed only in case of: a. newborn between the age of three (03) months and six (06) months; b. spouse within sixty (60) days of marriage." — Prospectus 2.2.vi. All other members: renewal only.

NMP Prospectus Sections 1.1–1.3

What NMP Covers — Complete Coverage Scope

All coverage confirmed directly from the NMP Prospectus (August 2024 version). NMP's scope goes beyond standard indemnity — incorporating HIV, mental illness, organ donation, morbid obesity, refractive error correction, and 12 modern treatments within the same policy.

🏥 Inpatient — Min 24 Hours

Room/ICU charges, nursing, RMO, surgeon/anaesthetist/consultant fees, anaesthesia, blood, oxygen, OT charges, surgical appliances, medicines, diagnostics, prosthetics implanted during surgery. Subject to sub-limits (Sec 1.2a–1.2c). Waived at PPN for listed procedures.

Core Coverage· PPN Waiver Available

⚡ Day Care Procedures — All 140+

"The Company shall indemnify Medical Expenses for Day Care Treatments requiring Hospitalisation as an In-Patient for less than 24 hours." — Prospectus 1.3.1. Includes dialysis, chemotherapy, cataract surgery, and all 140+ listed day care procedures.

All Day Care Included

📅 Pre-Hospitalisation — 45 Days

"Up to forty five (45) days immediately before the Insured Person is Hospitalised." Doctor consultations, diagnostics, and medicines related to the admitted condition: covered for 45 days before admission. 50% longer than ASP.

45 Days· NMP Advantage

📅 Post-Hospitalisation — 60 Days

"Up to sixty (60) days immediately after the Insured Person is discharged." Follow-up consultations, prescribed medicines, and related diagnostics: covered 60 days after discharge.

60 Days After Discharge

🌿 AYUSH — Up to Full SI

"The Company shall indemnify Medical Expenses incurred for Inpatient Care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines.up to the limit of Sum Insured.in any AYUSH Hospital."

Full SI· AYUSH Hospital

❤️ HIV/AIDS — All 3 Stages

"Acute HIV infection – acute flu-like symptoms; Clinical latency – usually asymptomatic or mild symptoms; AIDS – full-blown disease; CD4 < 200." All three stages of HIV progression explicitly covered.

3 Stages

🧠 Mental Illness

"The Company shall indemnify Medical Expenses related to Mental Illnesses, provided the treatment shall be undertaken at a Hospital with a specific department for Mental Illness, under a Medical Practitioner qualified as Psychiatrist." — Prospectus 1.3.4. Inpatient only. Counselling/therapy without hospitalisation: excluded.

Inpatient· Psychiatrist Required

🫀 Organ Donor's Hospitalisation

"Medical Expenses incurred in respect of an organ donor's Hospitalisation during the Policy Period for harvesting of the organ donated to an Insured Person." — Prospectus 1.3.5. Donation must conform to Transplantation of Human Organs Act 1994. Donor's pre/post-hospitalisation: not covered.

Harvesting Hospitalisation Only

🚑 Ambulance — ₹2,000

"Up to 1% of Sum Insured subject to maximum ₹2,000/- in a Policy Period for each Insured Person, for transportation to the Hospital or from the Hospital to another Hospital or to diagnostic centre." — Prospectus 1.3.6. Admissible only when hospitalisation claim admitted.

₹2,000 / Policy Period

⚖️ Morbid Obesity — 3-Year Wait

Surgical treatment for BMI ≥40, or BMI ≥35 with severe co-morbidities (cardiac, sleep apnea, uncontrolled Type 2 diabetes). Patient ≥18 years, medically advised, clinically supported. 3-year waiting period (Prospectus 1.3.7 + 4.2.f.iv).

BMI ≥40· 3-Year Wait

NMP Prospectus Sections 1.2a–1.2h· PPN Waiver· At-a-Glance Numbers

Sub-Limits — Every Key Number from the NMP Prospectus

"Sub limits as mentioned in Section 1.2.a, 1.2.b and 1.2.c above, will not apply in case of treatment undergone in a Preferred Provider Network (PPN) for a listed procedure as per eligible package." NMP's room rent and ICU caps are double those of ASP.

Coverage Category (Prospectus Section)	Sub-Limit Rule	At ₹5L SI	At ₹10L SI
Room Rent/Day (1.2a) Includes diet, nursing, RMO, IV admin	1% of SI/day· Max ₹10,000/day· 25% of SI cap (per illness)	₹5,000/day· ₹1.25L cap	₹10,000/day· ₹2.5L cap
ICU Charges/Day (1.2a)	2% of SI/day· Max ₹20,000/day· Within 25% cap	₹10,000/day	₹20,000/day
Medical Practitioner Fees (1.2b) Surgeon, anaesthetist, consultant, specialist	25% of SI (Basic + CB) per illness	₹1.25L	₹2.5L
Other Expenses (1.2c) Anaesthesia, blood, OT, medicines, diagnostics, prosthetics, ambulance	50% of SI (Basic + CB) per illness	₹2.5L	₹5L
Dialysis/Chemo/Radiotherapy (1.2d) Inclusive of 1.2a, 1.2b, 1.2c	Lower of 50% of SI or PPN Package Rate per illness	₹2.5L or PPN	₹5L or PPN
Modern Treatments (1.2e) 12 procedures — each treated separately	25% of SI (Basic + CB) per treatment per policy period	₹1.25L each	₹2.5L each
Hazardous Sports (1.2f) Non-professional participation only	Lower of 25% of SI per illness	₹1.25L	₹2.5L
Refractive Error (1.3.8) ≥7.5 dioptres· 2-year wait	Within main sub-limits· 2-year waiting period applies	No separate sub-limit beyond main structure
Health Check-Up (1.5.2) Every 4 claim-free years	1% of average Basic SI of block· Max ₹5,000 per insured	₹5,000 max· Not counted as claim
Ambulance (1.3.6)	1% of SI· Max ₹2,000 per policy period per insured	₹2,000	₹2,000

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The PPN Sub-Limit Waiver — NMP's Hidden Advantage

"Sub limits as mentioned in Section 1.2.a, 1.2.b and 1.2.c above, will not apply in case of treatment undergone in a Preferred Provider Network (PPN) for a listed procedure as per eligible package." At a PPN hospital for a listed procedure: no room rent, no doctor fee, no "other expenses" sub-limits. Only the PPN package rate applies.
Why this matters in practice:Major surgery at a premium hospital (e.g., Sir HN Reliance, Kokilaben, Manipal) — if that hospital is in the insurer's PPN network, your room at ₹8,000/day doesn't trigger the 1% sub-limit penalty. The full PPN package rate is covered. Non-PPN network: sub-limits apply and proportionate deductions may occur if you exceed the room cap.
Always verify PPN status:Before planned admissions, call 022 4302 0000 or contact Probitas (022 4302 0000) to confirm whether your hospital is the insurer's PPN. The difference in out-of-pocket cost between PPN and non-PPN can be substantial for multi-day admissions.

NMP Prospectus Section 1.2e· 12 Procedures· 25% of SI per Treatment

12 Modern Treatments Covered — Confirmed from NMP Prospectus

"Following Modern Treatments will be covered (wherever medically indicated) either as In patient or as part of Day Care Treatment in a Hospital, inclusive of above sub limits (i.e., Section 1.2.a, 1.2.b, 1.2.c). Maximum amount admissible for the related modern procedure/component/medicine of each modern treatment shall be 25% of Sum Insured (i.e., Basic Sum Insured and Cumulative Bonus) during the policy period."

🔊 Uterine Artery Embolization & HIFU

High-Intensity Focused Ultrasound. Limit applies to procedure cost only.

🦷 Balloon Sinuplasty

Minimally invasive sinus surgery. Limit applies to balloon cost only.

🧠 Deep Brain Stimulation

Parkinson's, essential tremor. Limit: implants including batteries only.

💊 Oral Chemotherapy

Cancer treatment in pill form. Only medicine cost counts toward 25% limit. Other incidental charges (investigations, consultation) not under this limit.

💉 Immunotherapy (Monoclonal Antibody)

Given as injection. Limit: cost of injections only. Administered at hospital.

👁️ Intravitreal Injections

AMD, diabetic macular oedema, retinal diseases. Limit: complete treatment including pre & post hospitalisation.

🤖 Robotic Surgery

Robot-assisted surgical procedures. Limit: robotic component cost only. Standard surgical charges under main sub-limits.

☢️ Stereotactic Radio Surgeries

Gamma knife, CyberKnife. Limit: radiation procedure cost only. Brain tumours, AVMs.

🫁 Bronchial Thermoplasty

Severe asthma treatment. Limit: complete treatment including pre & post hospitalisation.

🟢 Prostate Laser Vaporisation

Green laser or Holmium laser (HoLEP) for BPH. Limit: laser component cost only.

🧬 Stem Cell Therapy

Hematopoietic stem cells for bone marrow transplant — haematological conditions only. Limit: complete treatment including pre & post hospitalisation.

🧪 IONM (Intra Operative Neuro Monitoring)

Neuro monitoring during complex spinal/brain surgery. Limit: IONM procedure cost only.

⚠️ How the 25% Modern Treatment Sub-Limit Works — Key Rules

Per treatment, per policy period:The 25% cap applies individually to each modern treatment. If you need robotic surgery AND intravitreal injections in the same year, each gets its own 25% cap — they don't share a single 25% pool.
Inclusive of main sub-limits:"Inclusive of above sub limits (i.e., Section 1.2.a, 1.2.b, 1.2.c)." The 25% cap includes room rent, doctor fees, and other hospitalisation expenses within it. The total claim for the modern treatment procedure cannot exceed 25% of SI.
Only the specific component counts toward the limit:Robotic surgery: only the robotic component is within the 25% modern treatment limit — other standard surgical costs fall under the main sub-limits (1.2a/b/c). Understanding which cost component applies to which limit is essential for planning high-cost procedures.
₹10L SI advantage:At ₹10L Basic SI + ₹1L CB: each modern treatment is capped at ₹2.75L (25% of ₹11L). At ₹5L SI + ₹1.5L CB: cap is ₹1.625L per treatment. The higher SI significantly increases the practical modern treatment sub-limit.

NMP Prospectus Section 1.4.1· Available Only for Basic SI ₹6L+· Once per Policy Year· Official Illustrations

Reinstatement of Sum Insured — NMP's Most Powerful Differentiator

📊 Case I — Official Illustration: Basic SI ₹6L + CB ₹1L = Total ₹7L

Claim 1 — Disease Hospitalisation — ₹3L Bill

SI remaining: ₹7L. Admissible: ₹3L. Payable: ₹3L. Balance: ₹4L. SI NOT yet exhausted → No reinstatement.

Claim 2 — Road Accident — ₹5L Bill

SI remaining: ₹4L. Admissible: ₹5L. Payable: ₹4L. SI exhausted → YES. Basic SI REINSTATED: ₹6L (Basic only, CB excluded)

Claim 3 — New Disease — ₹2L Bill

Reinstated SI: ₹6L. Admissible: ₹2L. Payable: ₹2L. Note: Claim 3 CANNOT be same disease as any prior claim under this policy year.

Total Paid This Year: ₹3L + ₹4L + ₹2L = ₹9L

On a ₹6L Basic SI policy. ₹7L base cover + ₹2L from reinstated SI.

📊 Case II — Official Illustration: Basic SI ₹6L + CB ₹1L = Total ₹7L

Claim 1 — Major RTA — ₹10L Bill

SI: ₹7L. Admissible: ₹10L. Payable: ₹7L (full SI). SI exhausted → YES. Basic SI REINSTATED: ₹6L immediately (available from next claim)

Claim 2 — New Disease — ₹8L Bill

Reinstated SI: ₹6L. Admissible: ₹8L. Payable: ₹6L. Reinstated SI exhausted → YES. No further reinstatement — allowed only once per policy year.

Total Paid This Year: ₹7L + ₹6L = ₹13L

On a ₹6L Basic SI policy. Effective annual protection = ₹13L. Without reinstatement: only ₹7L maximum.

⚠️

Five Reinstatement Rules — Every Policyholder Must Know

Rule 1 — Only Basic SI ₹6L+:Policies with Basic SI below ₹6L (i.e., ₹1L to ₹5L) do not get reinstatement. This is the single most important reason to choose ₹6L over ₹5L.
Rule 2 — Basic SI only (not CB):"The Company shall reinstate the Basic Sum Insured (i.e., excluding any CB)." If Basic SI = ₹6L and CB = ₹1.5L (total ₹7.5L), only ₹6L is reinstated — not ₹7.5L.
Rule 3 — Only after full SI exhaustion:Reinstatement kicks in only after the total available SI (Basic + CB) is completely used up. A partially-used SI does not trigger reinstatement.
Rule 4 — Not for same illness:"Any Illness/Injury for which a claim has been admitted or paid under the Policy prior to such reinstatement, shall not be considered under the Reinstated Basic Sum Insured." The reinstated SI is for NEW illnesses or injuries only.
Rule 5 — Once per policy year, no carry-forward:"Reinstatement shall be allowed only once during the Policy Period." And "Reinstated Basic Sum Insured, if not exhausted, will not be carried forward to next Policy Period on Renewal."

NMP Prospectus Section 1.5· Good Health Incentive· Two Components

Good Health Incentive — Cumulative Bonus & Free Health Check-Up

"For each claim free Policy Period provided the policy is continuously renewed with the Company without a Break in Policy, each Insured Person will be eligible to get a Cumulative Bonus (CB) at the rate of 5% of the Basic Sum Insured of the expiring Policy.the maximum CB shall not exceed 50% of the Basic Sum Insured."

Cumulative Bonus at ₹6L Basic SI

Claim-Free Years	CB	Effective Total SI	Reinstatement Pool
Year 0	0%	₹6,00,000	₹6,00,000
Year 1	5%	₹6,30,000	₹6,00,000
Year 5	25%	₹7,50,000	₹6,00,000
Year 10	50%	₹9,00,000	₹6,00,000

After 10 claim-free years: ₹9L effective SI + ₹6L reinstatement pool = up to ₹15L protection in a catastrophic claim year.

🏥 Preventive Health Check-Up — Prospectus 1.5.2

Trigger:"Once at the end of a block of four (04) continuous Policy Periods provided no claims are reported and admitted during the block and the policy has been continuously renewed without a Break."
Amount:"Up to 1% of the average Basic Sum Insured of the block, subject to a maximum of ₹5,000 per Insured Person." At ₹6L SI: 1% = ₹6,000 → capped at ₹5,000. Must be lodged 45 days before the fifth policy period expiry.
Not a claim:"Availing benefit under Section 1.5.2 shall not be counted as a claim under the Policy." — Confirmed. Using this benefit does NOT affect your cumulative bonus accumulation or reset your claim-free years.
NMP vs Mediclaim Plus:NMP: check-up after 4 CLAIM-FREE years. NMP Plus: check-up after every 2 years irrespective of claims. For low-claim families, NMP's check-up is effectively free every 4 years.

NMP Prospectus Sections 4.1–4.3· the insurer/the insurer· 30-Day + Specific + 48-Month PED

Waiting Periods — Four Tiers for NMP

the insurer/the insurer distribution partner confirmed for NMP: "90 days, 1, 2 and 3 years waiting period for specific diseases· All pre-existing diseases included after first forty eight months (48) of Policy." NMP has a more granular waiting period structure than ASP — with four disease-specific tiers.

⏱️ Initial Waiting

30 Days

Only accident claims payable in first 30 days
All illness claims: excluded initially
Fresh/new policies only
Not applicable on continuous renewals

🦴 Specific Diseases

90D/1Y/2Y/3Y

90 days: Benign ENT disorders
1 year: Hernia, piles, fissure, fistula
2 years: Cataract, sinusitis, varicose veins
2 years: Gall bladder, kidney stones
2 years: Refractive error ≥7.5D
3 years: Joint replacement
3 years: Morbid obesity (Sec 1.3.7)

🩺 Pre-Existing Diseases

48 Months

All PEDs covered after 48 months continuous
Must disclose ALL PEDs at proposal
Non-disclosure = claim rejection risk
5-year moratorium: no rejection after 5 years (except fraud)
Portability: time served credited by IRDAI rules

⚕️ Special Conditions

Varies

Mental illness: 12-month wait
HIV/AIDS: 48 months (PED category)
Morbid obesity: 3 years (1.3.7)
Refractive error ≥7.5D: 2 years (1.3.8)
Genetic disorders: 48 months
Congenital conditions: 48 months

💡

Portability and Waiting Period Credit

IRDAI portability mandate:"Portability (migration) allowed from/to similar products as per IRDAI guidelines." If you're porting from another insurer to the insurer NMP, the waiting periods already served at the prior insurer must be credited. You don't restart from zero.
Incremental SI increases:"For the incremental portion of the Basic SI, the Waiting Periods as mentioned in Exclusion 4.1, 4.2, 4.3 shall apply." — Prospectus 2.4.1.ii. If you increase your SI from ₹5L to ₹6L at renewal, the additional ₹1L has fresh waiting periods applied to it. Pre-existing conditions covered under the original ₹5L are NOT automatically covered under the enhanced ₹1L until the new waiting period completes.

NMP Prospectus Section 2.5· Online Discount + Optional Co-Pay Discount

Discounts — Two Ways to Reduce NMP Premium

Two confirmed discount mechanisms from Prospectus 2.5. NMP's optional co-pay discount structure is unique — unlike ASP where co-pay is mandatory with no premium benefit, NMP gives you the choice: pay full premium with no co-pay, OR accept co-pay and get a meaningful premium reduction.

💻

Online / Direct Sale Discount

10% off

"If the Policy is bought online or by walk-in/direct customer (where no intermediary is involved), a discount of 10% shall be allowed on the total premium for both new policy and subsequent renewals (provided no intermediary is involved in Renewals)."

Applies to new purchase AND all subsequent renewals — as long as no intermediary is involved at each renewal. Buy via the insurer online portal online for full 10% discount.

💰

Optional Co-Payment Discount

12.5–25% off

"25% discount in total premium, for 20% Co-payment on each admissible claim. 12.5% discount in total premium, for 10% Co-payment on each admissible claim."

You choose your risk-sharing level: 20% co-pay on every claim saves 25% premium annually. Best value for ₹6L+ policyholders where reinstatement provides a safety net even if one claim's co-pay is significant.

💡 Co-Payment Strategy for ₹6L+ Policyholders — Reinstatement as Safety Net

The strategic advantage of optional co-pay for ₹6L+ NMP holders:With reinstatement available, a ₹6L+ policyholder has up to ₹12L+ of effective annual cover. Even with 20% co-pay, if a ₹5L claim arises, you pay ₹1L co-pay but save 25% premium annually. If annual premium is ₹30,000: saving = ₹7,500/year. After 4 claim-free years: savings = ₹30,000 — equivalent to one full year of premium.
Not recommended for:Families with elderly members (>60) at high hospitalisation frequency. If claims are frequent, the 20% co-pay on each claim quickly exceeds annual premium savings. For elderly-heavy families: full premium, no co-pay is the better value.
Can both discounts stack?If you purchase via the insurer's direct online portal (10% discount) AND opt for 20% co-pay (25% premium discount): in principle both discounts apply on total premium. Net result: up to 35% off total premium vs full-premium broker purchase. Confirm exact stacking with the insurer/Probitas at 022 4302 0000.

the insurer/the insurer· NMP Standard Exclusions

What NMP Does NOT Cover

Exclusions confirmed from the insurer's product page, the insurer/the insurer, and the NMP Prospectus standard exclusions section.

🦷 Dental & OPD

"Dental treatment (unless arising out of accident and requiring hospitalization) and Out Patient Department treatment (OPD treatment)." Routine dental, outpatient consultations, OPD medicines without hospitalisation: excluded.

💊 Vitamins, Tonics & Drug Abuse

"Vitamins, tonics drug/alcohol abuse, self-inflicted Injury." Health supplements, vitamins, tonics not prescribed for active disease treatment, and substance abuse-related conditions: excluded.

💄 Cosmetic & Gender Change

"Change-of-gender treatments, cosmetic or plastic surgery." Gender reassignment surgery, cosmetic procedures, elective aesthetic plastic surgery. Only reconstructive surgery necessitated by accident or disease is covered.

🚫 Excluded Providers

Treatment at hospitals not meeting minimum criteria (10 beds <10L population cities, 15 beds elsewhere) or specifically blacklisted providers: excluded. Always verify the hospital meets the insurer's network criteria before admission.

🧘 Non-Medical Personal Items

"Items of personal comfort and convenience including telephone, television, aya, barber, beauty services, diet charges, baby food, cosmetics, napkins, toiletries, guest services." Standard IRDAI non-payable list applies. Non-Medical Expenses Add-On can cover many of these.

🏋️ Adventure Sports

Professional participation in adventure or hazardous sports: excluded. Non-professional participation has a sub-limit (25% of SI — Section 1.2.f) rather than full exclusion. Professional athletes/sportspersons: excluded entirely.

⏳ Waiting Period Conditions

PEDs during 48-month wait. Specific diseases during 90-day/1-year/2-year/3-year waiting periods. Illness in first 30 days (non-accident). Incremental SI enhancements — fresh wait applies to the enhanced portion.

☢️ War & Nuclear

War, invasion, nuclear events, radioactive contamination: standard universal insurance exclusion. No coverage for illness or injury arising from war, civil war, or nuclear/radiological incidents.

72-Hour/24-Hour Intimation· Cashless + Reimbursement· 15-Day Submission

How to File an NMP Claim

"For Cashless Facility – available only for policies serviced by a Third Party Administrator (TPA). Check if the hospital falls under the networked hospitals, as cashless is available only for empanelled network hospitals of the Company/TPA." the insurer Toll-Free: 022 4302 0000.

Verify TPA Assignment and Network Status
Check your NMP policy schedule for the assigned TPA name and helpline. Confirm the hospital is in the insurer's network. If planning surgery: check whether the hospital is the insurer's PPN (Preferred Provider Network) — PPN status waives room rent, doctor fee, and "other expenses" sub-limits entirely. The difference is material for multi-day admissions.
Intimate TPA/the insurer Within Required Timeframes
"For planned hospitalisation, intimation is to be sent to the TPA/Company in advance (72 hours prior) with details of Name and address of the hospital and condition requiring hospitalisation.In case of an emergency hospitalisation, intimation is to be sent to the TPA/Company within 24 hours of admission."
Cashless Pre-Authorisation at Network Hospital
Hospital's insurance desk submits a Pre-Authorisation Request to the TPA with your NMP policy details, diagnosis, and estimated treatment cost. TPA approves (typically within 2–4 hours for planned, immediately for emergency). You pay only your optional co-pay (if applicable) at discharge. PPN hospitals: no sub-limit deductions on approved procedures.
Collect All Documents at Discharge
Before leaving: collect the complete Discharge Summary (signed by treating doctor), all original investigation reports, itemised hospital bill, Claim Form Part A (hospital) and Part B (if needed). If you're at a non-network hospital and paying out-of-pocket: collect all original bills and payment receipts without exception.
Submit Within 15 Days of Discharge
"All the documents in original are to be submitted to TPA/Office within 15 days from date of discharge." Pre-hospitalisation and post-hospitalisation claims: submit separately after treatment completion, within 15 days of end of post-hospitalisation period. KYC documents (identity + address proof) if claim >₹1 lakh (AML guidelines).
Track Reinstatement (₹6L+ Only — Automatic)
If your total SI (Basic + CB) is exhausted by a claim, reinstatement of your Basic SI activates automatically after discharge from the exhausting hospitalisation. No separate application needed. Your reinstated Basic SI is available for any NEW illness or injury in the same policy year. the insurer/TPA will inform you of the reinstated balance.

Key Documents for NMP Claims

Standard documents:Completed NMP Claim Form· NMP policy schedule (with )· Original hospital bills, receipts, and itemised cost breakdown· Discharge summary from treating doctor· All investigation reports (blood tests, imaging, biopsies)· Doctor's prescription and referral letters.
AML documents (claims >₹1L):"KYC (Identity proof with Address) of the proposer, where claim liability is above Rs 1 Lakh as per AML Guidelines." Aadhaar, PAN, or passport with current address proof required for all claims exceeding ₹1 lakh.
Legal heir certificate:"Legal heir/succession certificate, wherever applicable." Required when the insured is deceased and a family member or legal heir is filing the claim. Also needed for deceased organ donors' hospitalisation claims.

Mediclaim Policy (Individual Plan) — Frequently Asked Questions

Frequently Asked Questions

NMP (Mediclaim Policy, ) is the insurer's flagship comprehensive individual health policy. ASP is the IRDAI-mandated standard product.

Critical NMP advantages over ASP:
✅ No mandatory co-pay (ASP: 5% non-negotiable on all claims)
✅ Pre-hospitalisation: 45 days (ASP: 30 days)
✅ Room rent: up to ₹10,000/day at ₹10L SI (ASP: ₹5,000/day cap)
✅ ICU: up to ₹20,000/day at ₹10L SI (ASP: ₹10,000/day cap)
✅ Reinstatement of SI for ₹6L+ — not available in ASP at all
✅ 12 named modern treatments including robotic surgery and stem cell therapy
✅ Siblings coverable till marriage (ASP floater: No)
✅ Both proposer's parents AND in-laws coverable (ASP floater: One set only)
✅ Optional co-pay discount (ASP: co-pay is mandatory, no discount for it)

When to choose NMP:
→ You want ₹6L+ cover with reinstatement doubling your annual protection
→ You have siblings to cover
→ You need 45-day pre-hospitalisation window for chronic condition monitoring
→ You want no mandatory co-pay exposure
→ You're planning modern treatments (robotic surgery, etc.)

Call 022 4302 0000 for a direct premium comparison at your age and SI.

"For Insured Persons with Basic Sum Insured of ₹6 lacs and above, in the event of available Sum Insured being exhausted anytime during the Policy Period on account of Hospitalisation claim(s), the Company shall reinstate the Basic Sum Insured (i.e., excluding any CB)."

Why ₹6L is the reinstatement threshold:
Below ₹6L Basic SI (i.e., ₹1L to ₹5L): NO reinstatement — ever. The maximum annual protection is your Basic SI + CB, regardless of claims.
At ₹6L+ Basic SI: If your total SI (Basic + CB) is exhausted, the insurer reinstates your Basic SI once in the same policy year for NEW illnesses/injuries.

The financial case for ₹6L over ₹5L:
₹5L policy: Max annual payout = ₹5L + CB (say ₹7.5L at 50% CB)
₹6L policy: Max annual payout = ₹6L + CB (say ₹9L at 50% CB) + ₹6L reinstated = ₹15L in a catastrophic year
Premium difference (₹5L to ₹6L): typically ₹2,000–₹6,000/year depending on age. The reinstatement value (additional ₹6L cover) for a few thousand rupees annual premium is outstanding value for any family with meaningful health risk.

Five reinstatement rules to remember:
1. Only ₹6L+ Basic SI | 2. Basic SI reinstated (not CB) | 3. After full exhaustion only | 4. Not for same illness/injury | 5. Once per policy year, no carry-forward

Call 022 4302 0000 for premium comparison at ₹5L vs ₹6L.

"Maximum amount admissible for the related modern procedure/component/medicine of each modern treatment shall be 25% of Sum Insured (i.e., Basic Sum Insured and Cumulative Bonus) during the policy period."

The 12 covered modern treatments:
1. Uterine Artery Embolization & HIFU (procedure cost)
2. Balloon Sinuplasty (balloon cost)
3. Deep Brain Stimulation (implants + batteries)
4. Oral Chemotherapy (medicine cost only)
5. Immunotherapy — Monoclonal Antibody injection (injection cost)
6. Intravitreal Injections (complete treatment incl. pre/post)
7. Robotic Surgery (robotic component only)
8. Stereotactic Radio Surgeries (radiation procedure cost)
9. Bronchial Thermoplasty (complete treatment incl. pre/post)
10. Prostate Laser Vaporisation — Green/Holmium (laser component)
11. IONM — Intra Operative Neuro Monitoring (IONM procedure)
12. Stem Cell Therapy — Hematopoietic, bone marrow only (complete treatment incl. pre/post)

How the 25% limit works:
At ₹10L Basic SI + ₹1L CB: 25% = ₹2.75L per modern treatment
At ₹6L Basic SI + ₹1.5L CB: 25% = ₹1.875L per treatment
Each treatment has its own 25% cap — they don't share a pool
The 25% is inclusive of room, doctor fees, and other hospitalisation costs during the modern treatment

Call 022 4302 0000 for hospital recommendations for specific modern treatments under the insurer network.

"Family members allowed under same policy: a. Proposer; b. Spouse; c. Dependent natural or legally adopted children; d. Parents; e. Brother, till marriage; f. Sister, till marriage; g. Parent-in-laws."

NMP's family coverage is broader than ASP in two critical ways:

1. Siblings: Unmarried brothers and sisters of the proposer can be covered under NMP. Coverage ends at their marriage (removed at next renewal). This feature is unique to NMP — ASP's floater format does not allow siblings.

2. Both parent sets: Under NMP's individual basis, you can add your biological parents AND your spouse's parents (parents-in-law) to the same policy, each with their own individual SI. ASP's family floater restricts to either parents OR parents-in-law — not both.

Mid-term additions allowed for:
Newborns: Between 3–6 months (pro-rata premium)
Spouse: Within 60 days of marriage
All others: Addition only at policy renewal

Important: NMP is individual basis. Each family member has their own dedicated SI and cumulative bonus — not a shared floater pool. This means premiums are calculated per person. For large families: the total premium can be higher than a floater, but each member's SI is fully protected.

Call 022 4302 0000 for a multi-member NMP quote vs Parivar Mediclaim floater comparison.

Two confirmed discounts from NMP Prospectus Section 2.5:

1. Online / Direct Sale Discount (10%):
"If the Policy is bought online or by walk-in/direct customer (where no intermediary is involved), a discount of 10% shall be allowed on the total premium for both new policy and subsequent renewals." — Prospectus 2.5.2.
How to get it: Buy via the insurer online portal directly or walk in to the insurer's office without a broker/agent. Applies on every renewal if no intermediary is involved.

2. Optional Co-Payment Discount:
"25% discount in total premium, for 20% Co-payment on each admissible claim. 12.5% discount in total premium, for 10% Co-payment on each admissible claim." — Prospectus 2.5.1.

Can both discounts combine?
In principle: purchasing directly online (10% off) AND opting for co-payment (12.5% or 25% off) would apply to the same total premium — potentially up to 35% total reduction. Confirm exact stacking mechanics and current the insurer pricing at 022 4302 0000.

NMP vs ASP co-pay comparison:
ASP: 5% co-pay mandatory — no discount option. You pay co-pay regardless and there's no premium benefit.
NMP: No co-pay mandatory. If you CHOOSE co-pay (optional), you get a real discount of 12.5% or 25% off premium. Much better for risk-tolerant policyholders who want to save premium.

"Expenses of preventive health check-up/prescribed diagnostic tests will be reimbursed once at the end of a block of four (04) continuous Policy Periods provided no claims are reported and admitted during the block and the policy has been continuously renewed with the Company without a Break in Policy."

Amount: "Up to 1% of the average Basic Sum Insured of the block, subject to a maximum of ₹5,000 per Insured Person."

At different SI levels:
₹5L SI: 1% = ₹5,000 (at cap)
₹6L SI: 1% = ₹6,000 → capped at ₹5,000
₹10L SI: 1% = ₹10,000 → capped at ₹5,000

Does it affect cumulative bonus? No.
"Availing benefit under Section 1.5.2 shall not be counted as a claim under the Policy." Using the health check-up benefit does NOT count as a claim, does NOT reset your claim-free years, and does NOT reduce your cumulative bonus. It's a free benefit for maintaining 4 consecutive claim-free years.

When to lodge the claim:
"Claim for health check-up benefits may be lodged at least forty five (45) days before the expiry of the fifth Policy Period." — Confirmed. Lodge at least 45 days before the 4-year block ends to receive reimbursement before the next policy year begins.

Difference vs Mediclaim Plus:
NMP: health check-up after 4 CLAIM-FREE years only (the insurer incentivises healthy behaviour).
NMP Plus: health check-up every 2 years irrespective of claims. For high-risk families, NMP Plus's unconditional check-up may be preferable. Call 022 4302 0000 for comparison.

NMP has four waiting period tiers — more granular than ASP:

1. Initial 30-day wait: Only accident claims in first 30 days. All illness claims excluded. Fresh policies only.

2. Specific disease waiting periods:
90 days: Benign ENT disorders
1 year: Hernia of all types, piles, fissure, fistula
2 years: Cataract and age-related eye ailments, sinusitis, varicose veins, gall bladder/kidney stones, refractive error ≥7.5D
3 years: Joint replacement, age-related osteoarthritis and osteoporosis, morbid obesity

3. Pre-Existing Diseases: "All pre-existing diseases included after first forty eight months (48) of Policy." 48-month wait from policy inception.

4. Special conditions: Mental illness (12 months), HIV/AIDS (48 months as PED), genetic/congenital disorders (48 months).

Portability and waiting period credit:
"Portability (migration) allowed from/to similar products as per IRDAI guidelines." If you're porting from another insurer to the insurer NMP at renewal, IRDAI mandates that waiting periods already served must be credited. Example: 24 months of PED wait served at previous insurer → only 24 months remaining at the insurer. This makes NMP accessible even for buyers who've been with other insurers for 2+ years.

Incremental SI enhancement: If you increase SI at renewal (₹5L → ₹6L), the additional ₹1L has fresh waiting periods. Covered at ₹5L does not carry over to the new ₹1L portion. Call 022 4302 0000 for guidance on optimal SI selection and portability.

NMP (Mediclaim Policy) and Mediclaim Plus are different the insurer products. Here's when NMP is the better choice:

Choose NMP when:
✅ SI requirement: ₹1L–₹10L — NMP covers this fully
✅ You want reinstatement safety net for ₹6L+ SI (NMP Plus also has this)
✅ You want the standard, well-established the insurer product (NMP has been the insurer's core product for decades)
✅ Budget is somewhat constrained — NMP premiums are lower than NMP Plus for same SI
✅ You want health check-up tied to claim-free years (rewards healthy behaviour)
✅ Your family is moderate-sized (6 members or fewer)

Choose Mediclaim Plus when:
→ You need SI above ₹10L (NMP Plus goes up to ₹50L)
→ You want health check-up every 2 years irrespective of claims (not claim-dependent)
→ You need optional maternity cover, hospital cash, air ambulance, or OPD cover
→ You want critical illness benefit available as optional add-on (up to ₹25L CI benefit)
→ You have a large family requiring very high total SI exposure

For most Indian families needing ₹3L–₹10L per person with reinstatement protection, NMP (not NMP Plus) is the right product — more cost-effective, proven product, excellent coverage scope.

Call 022 4302 0000 for a direct NMP vs NMP Plus premium and feature comparison for your family's specific profile.

the insurer's Flagship Individual Health Policy — ₹1L to ₹10L — 140+ Day Care Procedures — 12 Modern Treatments Including Robotic Surgery & Stem Cell — Reinstatement for ₹6L+ Plans — 45-Day Pre-Hospitalisation — No Mandatory Co-Pay —Mediclaim Policy, Individual Plan —