Policy review · National
Mediclaim Plus
National's individual plan, reviewed on the clauses that actually decide your claim — room rent, co-pay, sub-limits, waiting periods and the insurer's claims record.
InsuranceScope score
2.7
★★★☆☆
The verdict
Mediclaim Plus is an individual health insurance plan from National. It stands out for modern-treatment cover. On the downside, a co-payment applies to claims — worth weighing before you buy. On the insurer side, it reports 80.85% of claims settled by count and a 12,000+ cashless hospital network.
Where it wins
Cover grows by 5% for each claim-free year, up to 50% of the base sum insured; the accumulated bonus is reduced if you make a claim.
Modern treatments such as robotic surgery and other advanced procedures are covered, usually up to a specified limit.
Day-care procedures that take under 24 hours — cataract, dialysis, chemotherapy and similar — are covered.
Where it stings
A co-payment applies — you pay a fixed share of every claim out of pocket; check the exact percentage in the policy wording.
Room rent is limited to 1% of the sum insured — choosing a costlier room can trigger proportionate cuts across the whole bill.
Disease-wise sub-limits apply — some treatments are capped below your sum insured, so verify the caps for conditions like cataract or joint replacement.
No restoration in the base plan — once the sum insured is used up within a policy year, there is no automatic refill.
Consumables are not covered — items like gloves, syringes and PPE are deducted from your claim at discharge.
Waiting periods
No cover in this window except for accidental hospitalisation.
Named conditions such as cataract, hernia and joint replacements wait this long.
Conditions you already have are covered only after this period.
Claims snapshot
National, latest IRDAI disclosure year — how the insurer behind the plan actually performs.
Approved by number of claims.
Claims paid vs premium collected.
How quickly claims are paid.
On overall claims — lower is better.
Key features
Limited to 1% of the sum insured; a costlier room can reduce the rest of the claim.
ICU cover: 2% of the sum insured.
Applies — you share part of each claim (true).
Applies — certain treatments are capped below the sum insured.
Not available in the base plan once the cover is used up.
Cover grows by 5% for each claim-free year, up to 50% of the base sum insured; the accumulated bonus is reduced if you make a claim.
Pre-hospitalisation 30 days (up to sum insured) and post-hospitalisation 60 days (up to sum insured) of connected medical costs are covered.
Procedures under 24 hours, such as cataract and dialysis, are covered.
Advanced procedures like robotic and laser surgery are covered, usually up to a limit.
Donor hospitalisation costs are covered (Yes (up to sum insured)).
Additional benefits & add-ons
Maternity benefits on family plan upto 50k after 2 years waiting
Full body checkup every 2 years
Common exclusions
Typical across most Indian health plans — always confirm the exact exclusions in Mediclaim Plus's policy wording.
Cosmetic or aesthetic treatment, unless needed to reconstruct after an accident or burns.
Self-inflicted injuries and conditions arising from alcohol or substance abuse.
Treatment arising from war, nuclear or allied perils.
Admissions purely for investigation, evaluation or bed rest with no active treatment.
Unproven or experimental treatments not backed by established medical practice.
Frequently asked questions
Yes. Mediclaim Plus has a co-payment clause, so you pay a share of every claim. Check the exact percentage in the policy wording.
Room rent under Mediclaim Plus is 1% of the sum insured. Choosing a costlier room can reduce the rest of your claim.
3. Claims for conditions you already had are covered only after this waiting period.
No. Mediclaim Plus does not refill the sum insured once it is used up in the base plan.
Yes. Mediclaim Plus covers day care procedures that take under 24 hours, such as cataract surgery or dialysis.
12,000+ cashless network hospitals are reported for Mediclaim Plus, where the insurer settles bills directly.
Yes. Mediclaim Plus covers modern treatments such as robotic surgery, usually up to a specified limit.