Policy explained · National Insurance
National Insurance Mediclaim Plus: what your policy covers
National Insurance Mediclaim Plus caps room rent at 1% of the sum insured a day, up to ₹15,000 a day (Plan A), on a ₹5 lakh cover. It has a 36-month wait for knee & hip replacement (the CIS says 48). For our example person, a typical ₹4,50,000 bill (estimate) is not covered yet: 36-month waiting period.
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At a glance
- 🛏️1% of SI a dayRoom rent1% of the sum insured a day, up to ₹15,000 a day (Plan A, sum insured 2 to 10 lakh)Policy wordings, page 18, read 27 Sep 2026
- 🧾10% to 20%Co-payIf you chose an optional co-pay or add-onNot in the worked examplePolicy wordings, page 12, read 27 Sep 2026
- ⏳36 monthsKnee & hip replacement waitNot over at month 30The wordings say 36 months, the CIS says 48Policy wordings, page 8, read 27 Sep 2026
- ⏳36 monthsPre-existing conditions waitNot over at month 30Policy wordings, page 8, read 27 Sep 2026
- 🩹Not coveredConsumablesThese are yours to pay; conditions apply, see the termsPolicy wordings, page 7, read 27 Sep 2026
The documents disagree. The wordings and the customer information sheet (CIS) of this policy differ on waiting period for knee & hip replacement (36 months in the wordings, 48 in the CIS); waiting period for bariatric surgery (36 months in the wordings, 48 in the CIS). This page follows the wordings, as our estimate does. Check the terms on your own policy schedule.
Waiting periods, month by month
- Pre-existing conditions36 monthsNot over at month 30
- Knee & hip replacement36 monthsNot over at month 30Conditions apply, see the terms36 months in the wordings; the CIS says 48
- Elective cardiac surgery3 monthsOver by month 30Conditions apply, see the terms
- Spine surgery24 monthsOver by month 30
- Prostate surgery24 monthsOver by month 30
- Hysterectomy24 monthsOver by month 30
- Bariatric surgery36 monthsNot over at month 3036 months in the wordings; the CIS says 48
Worked example: a knee & hip replacement bill
The example person joined the policy before age 61, is treated at a network hospital in the zone their policy covers, has no add-ons, and has a ₹5,00,000 sum insured on a policy running 30 months.
Room rent ₹9,000 a day for 4 days (example), a semi-private room, on a typical NCR knee & hip replacement bill of ₹4,50,000 (estimate).
Not in these numbers: a 10% to 20% co-pay applies if you chose an optional co-pay or add-on. A limit of ₹1,25,000 applies if you have robotic surgery (policy wordings).
Not covered yet: 36-month waiting period. The insurer pays ₹0 and you pay ₹4,50,000 (estimate).
The terms, with the policy text
14 terms read from the National Insurance Mediclaim Plus documents (UIN NICHLIP25038V032425). Open a source to read the policy text, its conditions and the page.
| Term | What it means | Policy text and source |
|---|---|---|
| Room rent limit | 1% of the sum insured a day, up to ₹15,000 a day (Plan A, sum insured 2 to 10 lakh)Limit applies | Policy wordings, page 18Room/ ICU charges Room - Up to 1% of SI per day ICU - Up to 2% of SI per day subject to max. of INR 15,000 per day |
| ICU limit | 2% of the sum insured a day, up to ₹15,000 a day (Plan A, sum insured 2 to 10 lakh)Limit applies | Policy wordings, page 18Room/ ICU charges Room - Up to 1% of SI per day ICU - Up to 2% of SI per day subject to max. of INR 15,000 per day |
| Co-pay | No general co-pay in the wording. With an add-on: 10% to 20% if you chose an optional co-pay or add-onOnly in some cases | Policy wordings, page 1220% Co-payment on each admissible claim under the Policy, with a 25% discount in total premium. |
| Consumables (gloves, masks and other non-medical items) | Not covered: these are yours to payNot covered | Policy wordings, page 7Condition: An optional paid add-on, Non Medical Expenses, pays them up to 10% of the basic sum insured. Note: The expenses that are not covered in this policy are placed under List-l of Annexure-II of the Policy. |
| Costs before and after the hospital stay | 30 days before admission, 60 days after dischargeCovered | Policy wordings, page 18Hospitalisation, Pre (30 days) and Post (60 days) |
| Waiting period for pre-existing conditions | 36 months of continuous coverNot over at month 30 | Policy wordings, page 8a) Expenses related to the treatment of a Pre-Existing Disease (PED) and its direct complications shall be excluded until the expiry of thirty six (36) months of continuous coverage after the date of inception of the first policy with us. |
| Waiting period for knee & hip replacement | 36 months of continuous coverNot over at month 30 | Policy wordings, page 8Condition: Not applicable if the replacement follows an accident. The CIS says: 48 months of continuous cover. The CIS heading says three years, but its text says four years. iv. Three years waiting period Following diseases even if pre-existing shall be covered after four years of continuous cover from the inception of the policy. a. Treatment for joint replacement unless arising from accident Following diseases shall be covered after three years of continuous cover from the inception of the Policy. a. Treatment for joint replacement unless arising from accident |
| Waiting period for elective cardiac surgery | 90 days of continuous coverOver by month 30 | Policy wordings, page 8Condition: A lifestyle-conditions wait for hypertension, diabetes and cardiac conditions. Not applicable to accidents. A pre-existing condition has the 36-month wait instead. i. 90 Days Waiting Period (Life style conditions) a. Hypertension and related complications b. Diabetes and related complications c. Cardiac conditions |
| Waiting period for spine surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 8p. Surgery for prolapsed intervertebral disc unless arising from accident |
| Waiting period for prostate surgery | 24 months of continuous coverOver by month 30 | Policy wordings, page 8iii. Two years waiting period a. Cataract b. Benign prostatic hypertrophy |
| Waiting period for hysterectomy | 24 months of continuous coverOver by month 30 | Policy wordings, page 8r. Hysterectomy |
| Waiting period for bariatric surgery | 36 months of continuous coverNot over at month 30 | Policy wordings, page 7The CIS says: 48 months of continuous cover. The CIS heading says three years, but its text says four years. c. Morbid Obesity and its complications incurred for surgical treatment of obesity that fulfils all the following conditions and subject to Waiting Period of three (03) years as per Section 4.2.f.iv |
| Exclusion rule for bariatric surgery | Covered when the policy's conditions are metConditions apply | Policy wordings, page 94.6. Obesity/ Weight Control (Excl 06) Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions: |
| Robotic surgery sub-limit | 25% of the sum insured, for the robotic component onlyLimit applies | Policy wordings, page 18Condition: The limit covers the robotic component only, on every plan. Up to 25% of SI for the related modern procedure/ component/ medicine |
Questions
Does National Insurance Mediclaim Plus have a room rent limit?
At a ₹5 lakh sum insured: 1% of the sum insured a day, up to ₹15,000 a day (Plan A). Plan A (sum insured ₹2 lakh to ₹10 lakh): up to 1% of the sum insured a day, at most ₹15,000 a day. Source: Policy wordings, page 18, read 27 Sep 2026.
Check your own policy
Send your policy on WhatsApp. A person reads it and works out what your stay would cost you before you are admitted.
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Sources
- National Insurance Mediclaim Plus: policy wordings (accessed 27 Sep 2026)
- National Insurance Mediclaim Plus: customer information sheet (cis) (accessed 27 Sep 2026)