Mera Mediclaim Plan

Key Benefits of Mera Mediclaim Plan

  • 1

    7.5% discount on Combined premiums

  • 2

    Life cover with Inbuilt Terminal Illness Rider

  • 3

    Up to 150% increase in Sum Insured with NCB & NCB – Super (Optional Cover)

  • 4

    Automatic recharge of Sum Insured

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Mera Mediclaim Plan - Video

Overview

PNB MetLife Insurance (PMLI) and Care Health Insurance Limited”(Formerly Religare Health Insurance Company Limited) have joined hands to help you in protecting your and your family's health and ensuring a secure financial future for your loved ones, even when you are not around. Mera Mediclaim Plan is a solution that offers you the benefits of both health and life insurance in a single plan. It simple, comprehensive and flexible. The health insurance benefit under the plan is offered by RHI and the life cover is offered by PMLI.

Health Plus Life Combined Benefits:

  1. Health and Life cover under a single plan
  2. 7.5% discount on Combined premiums
  3. Tax benefit under section 80(C), 80(D) and 10(10D); as per prevailing tax laws

Health Benefits

  • Comprehensive in-patient hospitalization and cover for more than 540 day-care treatments
  • Up to 150% increase in Sum Insured in 5 claim-free years with No Claim Bonus & No Claim Bonus – Super (Optional Cover)
  • Automatic recharge of Sum Insured – reinstate your entire Sum Insured amount when it gets exhausted due to a claim (With Optional Cover ‘Unlimited Automatic Recharge’ you can avail this unlimited times)
  • Annual Health Check-up for all insured members including children
  • Cashless hospitalization at more than 7500 network hospitals

Life Benefits

  • Protection against Death and Terminal Illness
  • Special rates for women

Health benefits

FeaturesSum Insured
5, 10 Lacs15, 25 Lacs
In-Patient Hospitalization

Upto Sum Insured

Upto Sum Insured

Pre-hospitalization

30 Days

30 Days

Post-hospitalization

60 Days

60 Days

Day Care

Yes

Yes

Room Rent

Single Private Room

Single Private Room

(upgradable to next level)
ICU Charges

No Limit

No Limit

Ambulance Cover

Upto Rs.2,000/Hospitalization

Upto Rs.2,500/Hospitalization

Domiciliary Hospitalization

Upto 10% of SI

Upto 10% of SI

Health Check-up

yes

yes

Automatic Recharge of Sum Insured

yes

yes

No Claim Bonus

yes

yes

Organ Donor Cover

Upto Rs.100,000

Upto Rs.200,000

Alternative treatments (AYUSH)

Upto Rs. 20,000

Upto Rs. 30,000

*Co-payment during purchase of the first policy, if eldest member insured is

  • Below 61 years, no co-payment is applicable.
  • 61 years or above, 20% of the claim amount under the policy has to be borne by you.

Life benefits

Death Benefit

Death or Terminal Illness Benefit shall be payable in the event of Death or Diagnosis of Terminal Illness during the policy term. The policy shall cease upon payment of this benefit.

Who can be covered under Family Covers under Health Benefit

How can you cover yourself

Individual basis (maximum up to 6 Persons having equal Sum Insured) or Floater basis

Floater combinations

1 Adult + 1 Child OR 1 Adult + 2 Children OR 1 Adult + 3 Children OR 1 Adult + 4 Children OR 2 Adults
+ 1 Child OR 2 Adults + 2 Children OR 2 Adults + 3 Children OR 2 Adults + 4 Children

Who are covered (Relationship with respect to the Proposer)
  1. 1. Individual: Self, legally married spouse, son, daughter, father, mother, brother, sister, mother-in-law, father-in law, grandmother, grandfather, grandson, granddaughter, uncle, aunt, nephew, niece, employee or any other relationship having an insurable interest.
  2. 2. Family Floater: Self, Legally married spouse, son, daughter, father, mother, employee and his/her dependents (Legally married Spouse, Children & Parents) or any other relationship having an insurable interest.

Notes:

  • Child would be ported to an individual policy (having a separate Sum Insured) and treated as an adult Insured Person, upon attaining 25 years of age, at the time of renewal.
  • All the Age calculations are as per “Age Last Birthday” as on the date of first issue of Policy and / or at the time of Renewal.
  • Option of Mid-term inclusion of a Person in the Policy will be only upon marriage or childbirth; Additional differential premium will be calculated on a pro rata basis.
  • If Insured persons belonging to the same family are covered on an Individual basis, then every Insured person can opt for different Sum Insured and different Optional Covers.

Exclusions:

  • Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide).
  • Expenses arising out of or attributable to alcohol or drug use/misuse/abuse
  • Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion and its consequences
  • External Congenital disease
  • Tests and treatment relating to infertility and in vitro fertilization
  • War, riot, strike, nuclear weapons induced hospitalization

Waiting Periods:

  • Initial Waiting period of 30 days for any illness except injury
  • For Pre-existing diseases, waiting period of four years of continuous coverage is applicable

Key Benefits of Mera Mediclaim Plan

  • A cost-effective combination plan with comprehensive health and life insurance cover
  • Stable security for uncertain and vulnerable times
  • A reliable medium to safeguard the family’s financial future in your absence
  • Tax advantageous
  • Better return on investment

Overview of Mera Mediclaim Plan
Insurance – health and life are two of the most significant protection you can guarantee for yourself and your family. You like to ensure that your loved ones are comfortable protected and financially secured against all eventualities. A comprehensive health insurance policy, which bundles up a life cover, can be a perfect policy for you. The combi plan from PNB MetLife – Mera Mediclaim Plan, aims to provide an all-round health indemnity, wrapped up with a death benefit, thus offering dual blanket cover for you and your family.

It is important to remember ‘Health is wealth’ and good health is the basic foundation of a good life. With Mera Mediclaim Plan, we insure both!

Product Benefits of Mera Mediclaim Plan
Mera Mediclaim Plan is an extremely thoughtful policy designed by PNB MetLife for all those looking to ensure all-round health coverage for themselves and their families, along with enjoying comprehensive life cover. The Mera Mediclaim Plan combines the best of health insurance and life plan to provide you with an all-inclusive policy that caters to dual insurance needs.


Some benefits of the Mera Mediclaim Plan include:

  1. Comprehensive: The Mera Mediclaim Plan by PNB MetLife is a very exhaustive policy that provides for extensive health and life insurance cover. For the health insurance, the plan is not limited to only medical expenses but includes all IPD and daycare expenses (for more than 540 procedures), pre and post-hospitalization costs, floater charger, donor, ambulance costs, medical checkups, etc. Also, there is no sub-limit for ICU. Moreover, in terms of life insurance, the cover includes a death benefit, as well as has an inbuilt terminal illness reimbursement.
  2. Cost-effective: The PNB MetLife Mera Mediclaim Plan is a combination plan and hence, is more cost-effective when compared to health and life insurance brought individually. This plan offers a 7.5 per cent discount on both the health and life components.
  3. Affordable: The plan is more affordable since it offers cheaper rates and also annualized combined premiums, which are significantly lower than individual premiums for each of these plans.
  4. Lifelong: This combination plan by PNB MetLife offers a lifelong continuous renewal for the health component.
  5. Terminal Illness Cover: The plan offers an integrated Terminal Illness Cover, along with life cover of up to Rs 25 lakhs.
  6. Tax-benefits: The Mera Mediclaim Plan offers tax benefits for the premiums paid under Section 80C and 80D of The Income Tax Act, 1961. Further, the payout of the sum assured is also exempt from taxes under Section 10(10d).
  7. Family coverage: The health insurance part of the plan provides free annual medical checkups for the entire family of the insurer. The family includes spouse, children, and parents. Also, the death benefit is received by the family, as directed by the insurer.

Additional Benefits Offered by Mera Mediclaim Plan Apart from these benefits, there are a host of advantages offered by the Mera Mediclaim Plan.

These include:

  1. Cashless treatment: The policy secures the insurer by allowing cashless treatment facilities across India in over 7500 network hospitals. This allows for quick and hassle-free treatment
  2. NCB and Super NCB: Up to 150% increase in Sum Insured with NCB & NCB – Super (Optional Cover
  3. Automatic recharge cover: In such critical times, insurance is more a necessity than a luxury. Hence, the Mera Mediclaim Plan ensures you never run out of insurance and thus, provides an automatic recharge cover facility. In this feature, the insurer can avail the recharge benefit for unlimited times in a year
  4. Alternative treatment: This combination plan also covers alternative medical treatment costs up to ₹30,000 such as Ayurveda, Unani, Siddha and Homeopathy.
How does the Mera Mediclaim Plan Work?

The procedure of a Mera Mediclaim Plan is remarkably simple and hassle-free to understand. The two-in-one plan that offers health cover and death benefits has been widely popular among people aspiring for a flexible, cost-effective, and affordable cover with extensive dual benefits.

To demonstrate how the Mera Mediclaim Plan works, here are some illustrations of the plan:

Case 1: Mr Pandit is a 35-year old man who is looking for illness and a death cover. Hence, he buys the PNB MetLife Mera Mediclaim Plan to get health insurance and life cover for a term of 30 years. Under the policy, the basic sum assured as a life insurance component by Mr Pandit is ₹25 lakhs, while the health component is ₹10 lakhs.

He opts for a regular premium paying term, and the annualized combined premium of the plan is calculated at ₹14,157. The Mera Mediclaim Plan offers a 7.5% discount on both the life and health plan. In this case, the discount calculates to be ₹1,148.

Annualized Premium: ₹14,157 including:

  • Life Component:
  • Health Component: ₹7,705
  • Discount: ₹1,148

However, at the age of 40, Mr Pandit is admitted in the hospital and thus, makes a health insurance claim. He is eligible to get benefits up to ₹25 lakhs (owing to ₹10 lakh of sum assured + 10% sum assured as No claim bonus + 50% sum assured as No claim bonus Super). This amount is reimbursed to Mr Pandit, and the policy continues with the medical policy available for all insured. At the age of 50 years, Mr Pandit dies, and the family gets the death benefit of ₹25 lakhs and the policy terminates.

Case 2: In another example, Mrs Sridevi, 40 years, buys the Mera Mediclaim Plan to get a health policy along with a life cover. In the regular pay programme, she opts for a 25-year long policy term with ₹25 lakhs as life insurance and another ₹5 lakhs as a health plan.
Her annualized combined premium for the policy is ₹13,262. The Mera Mediclaim Plan offers a 7.5% discount on both the life and health plan. In this case, the discount calculates to be ₹1,075.

Annualized Premium: ₹13,262 including:

  • Life Component: ₹7,625
  • Health Component: ₹6,712
  • Discount: ₹1,075

At the age of 45 years, Mrs Sridevi made a medical insurance policy claim and was reimbursed ₹12.5 lakhs (owing to ₹5 lakh of sum assured + 10% sum assured as No claim bonus + 50% sum assured as No claim bonus Super). Post this, the policy continues to provide a health insurance plan for all those insured. At the age of 55 years, Mrs Sridevi dies, and the family gets the death benefit of ₹25 lakhs and the policy terminates.

Case 3: Mr Ayush, who is a healthy 55-year-old man, aims to get a health insurance plan combined with life insurance policy. He secures a sum of ₹25 lakhs in life insurance and ₹15 lakhs in health policy under the Mera Mediclaim Plan. The policy term is 20 years.

His annualized combined premium for the policy is ₹47,088. The Mera Mediclaim Plan offers a 7.5% discount on both the life and health plan. In this case, the discount calculates to be ₹3,818.

Annualized Premium: ₹47,088 including:

  • Life Component: ₹26,850
  • Health Component: ₹24,056
  • Discount: ₹3,818

At the age of 60 years, Mr Ayush is admitted to the hospital and thus, files for reimbursement. He is granted ₹37.5 lakh (owing to ₹15 lakh of sum assured + 10% sum assured as No claim bonus + 50% sum assured as No claim bonus Super). Post this, the policy continues to provide health coverage for all those insured. At the age of 75 years, Mr Ayush dies, and the policy terminates.

Eligibility of Mera Mediclaim Plan
To be eligible for this plan, a person must conform to the following conditions and criteria:

Life Insurance Component

  • The minimum age of enrollment for the life insurance component is 18 years while the maximum age is 65 years.
  • The maximum age at the time of maturity is 28 years and the maximum age for the same is 80 years.
  • The minimum term of the plan is 10 years, while the maximum term is 40 years.
  • The policy only offers regular premium paying term on an annual basis.
  • The maximum sum assured is ₹25 lakhs.

Health Insurance Component

  • The minimum age of enrollment for health insurance component for an individual is 5 years, while for the floater it is 91 days
  • The health insurance component of the policy is on a continuous renewal basis for the entire life. Making sure the individual is always secured.
  • The plan offers lifelong renewability for the entire life of the insurer.
  • The policy only offers regular premium paying term on an annual basis.
  • The minimum and maximum sum assured depends on the individual and can vary between 5 to 10 Lacs and 15 to 25 lacs

Automatic Recharge Facility
The Mera Mediclaim Plan is not an ordinary plan which expires once a claim is made. PNB MetLife understands the critical need for a person to be insured and backed financially for all times.

In this option, if an insurer runs out of or completely exhausts his health insurance policy component due to claims made, then PNB MetLife reinstates the entire sum insured in the policy for the leftover period of the cover. The reinstated amount can be used by the insurer for a different claim or by any other individual (in case of a floater policy) for any claim. The automatic recharge feature allows the insurer to avail the recharge benefit for as many times as needed in a year.

How to Buy Mera Mediclaim Plan?

The plan can be bought via the below steps:

  1. Visit the official PNB MetLife website
  2. Choose the Mera Mediclaim Plan and fill in the required details on Speak to an Advisor form
  3. A representative/agent from the company will help you buy the perfect policy for your requirements

About PNB MetLife
PNB MetLife is a joint venture between MetLife International Holdings LLC, Punjab National Bank Limited, Jammu & Kashmir Bank Limited, M. Pallonji and Company Private Limited, and other private investors. MetLife International Holdings LLC and Punjab National Bank Limited are the major shareholders in the company, which started operation in 2001 in India. PNB MetLife is an amalgamation of MetLife Inc’s financial know-how and Punjab National Bank’s distribution strength. MetLife Inc has served over 90 million customers in the last 140+ years, while Punjab National Bank has catered to over 80 million customers in the last 120 years.


Disclaimers:

Mera Mediclaim Plan is an Individual, Non-Linked, Non-Participating, Pure Risk Premium, Combi Insurance Plan (UIN: 117Y102V01). Policyholders are advised to familiarize themselves with the policy benefits and policy service structure of the ‘Combi Product’ before deciding to purchase the policy. Please read the Sales brochure carefully before concluding any sale. This product is jointly offered by PNB Met Life India Insurance Company” and “Care Health Insurance Limited”(Formerly Religare Health Insurance Company Limited).The risks of this ‘Combi Product’ are distinct and are assumed / accepted by respective insurance companies. The liability to settle the claim vests with respective insurers, i.e., for health insurance benefits “Care Health Insurance Limited”(Formerly Religare Health Insurance Company Limited) and for life insurance benefits “PNB MetLife India Insurance Company”. The policyholders of the ‘Combi Product’ are eligible to continue with either part of the policy, discontinuing the other during the policy term. Goods and service Tax (GST) shall be levied as per the prevailing tax laws which are subject to change from time.  "Tax benefits are as per the Income Tax Act, 1961, & are subject to amendments made thereto from time to time. Please consult your tax consultant for more details". Reg Office - Care Health Insurance Limited (Formerly known as Religare Health Insurance Company Limited), 5th Floor, 19, Chawla House, Nehru Place, New Delhi-110019 | CIN - U66000DL2007PLC161503.

*For 24 years old healthy non-smoker male at 31 year policy term and premium payment term. Above premium is applicable for various other nodal points as well and final premium shall be based on Business Illustration generated within application login. AD-F/2020-21/00344

 

Product SpecificationsLife Health 
MinimumMaximumMinimumMaximum
Age at Entry

18 years

65 years

Individual: 5 years
Floater: 91 days

No limit on Entry Age

Max. Age at Maturity (Years)

28 years

80 yearsLifelong on continuous renewal
Policy Term (Years)10401 / 2 / 3
Premium Paying TermRegular Pay

FAQs

What is Health Insurance?

Health insurance is a policy that covers a host of medical and surgical expenses of an insured individual, provided certain conditions are met.

Mera Mediclaim Plan is a cost-effective, tax-advantageous, combi policy by PNB MetLife which provides an extensive health insurance coverage along with a comprehensive life insurance policy, inclusive of an inbuilt terminal illness. The plan provides several additional benefits, along with a promising value of the sum insured by the insurer.

Yes, the Mera Mediclaim Plan covers the family. In terms of the health component, the annual medical checkups of the family members are conducted for free on a cashless basis in the authorized network hospitals. Also, upon policy termination, the death benefit is directly paid to the nominee or family. The plan also offers floater coverage to provide insurance to family members.

There is no fixed rule to determine health insurance coverage. However, the amount should ideally be dependent on factors such as general health of the insurer, residential city, history of family illnesses, nature of the job, current income, future liabilities, tax advantageous, etc.

Some of the advantages of buying mera mediclaim plan include:

  • More competitive rates with lower premiums 
  • Ease of comparison of features and policy terms
  • Convenience of purchase and better service
  • Simple process and easy documentation

Unlike a traditional health insurance plan that only provides medical coverage, the Mera Mediclaim Plan offers health insurance, along with a comprehensive life insurance cover. The combi policy also offers other attractive features such as automatic recharge, No Claim Bonus, No Claim Super Bonus, and double sum insured for accidental hospitalization.
Moreover, the plan provides free medical checkups, cashless treatment across 7500+ network hospitals, and covers IPD + Daycare charges, pre and post-hospitalization costs, floater, donor, ambulance expenses, and others. Further, it provides coverage for alternative treatment methods such as homoeopathy, Ayurveda, etc.

Yes, a claim can be rejected if the following conditions are true:

  • The ailment, injury or the nature of the problem is not covered under the policy
  • The claim is not filed in the proper time with adequate documentation
  • The information presented is false, misleading, inaccurate, or missing such as a pre-existing health condition
  • Claims made for self-infliction
  • Claims made for value over the sum insured

The cashless hospitalization benefit can be obtained by filing and submitting a pre-authorization form at the hospital desk or downloaded from Third Part Administrator’s official website.

Up to 150% increase in sum insured in 5 claim-free years with No Claims Bonus & No Claim Bonus – Super (Optional Cover)

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