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Cashless Hospitalization
Don't let medical expenses become a burden on your wallet. Compare and find the best Mediclaim plan at PolicyBazaar.
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About the Product

Guide To Buy Best Mediclaim Policy 

Mediclaim policy is a hospitalization benefit that is offered by both public and private sector general insurance companies in India. The mediclaim insurance policy takes care of expenses following hospitalization/domiciliary hospitalization in case of any of the following situations-

      • In case of sudden illness or surgery
      • In case of an accident
      • In case of any surgery during the policy tenure

 

Comparison between Mediclaim Policy and Health Insurance

Mediclaim Policy

Health Insurance

It reimburses your actual medical expenses

It gives you a lump-sum amount on diagnosis of any of the pre-specified critical disease, irrespective of your medical expenditure

It has much wider scope than critical illness  because it covers hospitalization and treatment towards accident

It covers only certain diseases like heart attack, kidney failure, paralysis, etc.

The policy is taken to defray the hospitalization expenses incurred at the time of hospitalization

It not only pays expenses of critical illness but also compensate for financial loss that may arise due to critical illness

 

How does Mediclaim Policy work?

There are two types of claims available under Mediclaim policy-

      • Cashless Procedure= Cashless is a mechanism wherein a patient is treated in a network hospital, then insurer settles either the part of the claim or the entire claim with the hospital. It means, a patient doesn’t need to pay a penny to the hospital for the treatment. There are certain procedures which you need to follow to ensure the smooth claim process.

At the first level, all empanelled hospitals will have an insurance desk in their premises. A policyholder has to obtain a pre-authorization form from this desk, which has to be dully filled with correct information because any missed detail will only delay the entire process. This filled form needs to be stamped by the hospital and the doctor and then it has to fax across Third Party Administrator (TPA) or the insurer. After carefully examining the form, the company will approve a certain sum and send a fax back to the hospital saying that ‘X’ amount has been sanctioned for the treatment.

 

Let us understand this procedure with an example. If the hospital has given a treatment cost of Rs 4 lakh, the insurer and TPA will rework and for instance, approve Rs 3 lakh for treatment. Now, they will inform the hospital that they will reimburse expenses up to Rs 3 lakh only under cashless and if the total cost would be more than this limit, they will look at it later. However, at the time of discharge, the total billing amount comes at Rs 3.60 lakh. In this case, the policyholder has two options. The first option is, he will send all discharge letters and final bill copy to the insurer and wait for the revert. No doubt, it will take time. The other option is, policyholder himself pays the remaining amount, which is Rs 40,000 in this case, and then he submits those original bill receipts to the policy provider to get reimbursement of Rs 40,000.

 

      • Reimbursement= In the case of reimbursement, it is pivotal to inform your insurance company that a hospitalization has been taken place or likely to take place in a near future. Either you could that by sending an email or by making a call. To get reimbursement, you need to submit all payment receipts, including bills of those medicines which you have bought from outside chemist.  You need to make sure that original discharge card, final bills and payment receipts should be in one place, so that they can be submitted to the insurance company to get reimbursement.

 

3 Checklists Before Buying a Mediclaim Plan

If you haven’t bought a mediclaim policy and are planning to apply for the one, then it is highly recommended to check below points to make sure that you buy best policy. These factors can also be used to compare different insurance plan options available in the market.

      • Individual and family floater= In individual plan, each individual is insured for a specific amount, whereas, in family floater, the whole family is insured for a fixed sum assured. In case of family floater, when the primary person dies or reaches a specific age, the policy is closed even other members who are still younger can’t renew the policy. In Individual plan, the individual is insured on separate parameters. The attainment of specific age will not impact insurance coverage of other family members.

 

      • Renewability age= Although, policy offers coverage for one year only, but in reality, it is a relationship between you and the insurance company. So, your health plan should cover as you age because it is tough to get insurance at that age. If your policy doesn’t provide you coverage at that point of time then buying such a policy will not give peace of mind.

 

      • Pre-existing disease= This is relevant only if you have a pre-existing disease at the time of taking insurance plan. It also covers those diseases which might arise from a pre-existing disease. For example, if you have diabetes at the time of taking the plan and later develop heart problem, then even the heat problem will be considered as a pre-existing disease. Almost all insurance companies have a clause that states that a pre-existing disease will be covered only if the plan has been renewed for a certain number of years. A best mediclaim insurance plan covers pre-existing diseases as soon as possible.

 

Are you looking for a Mediclaim Policy? Let Us Help You!

In today’s fast paced life where everything can be done online from ordering dinner to attending college, is it any wonder that many people choose to buy mediclaim insurance online? Bridging the gap between insurers and insured, PolicyBazaar is a one stop platform to find top mediclaim policies. Your quest to find a good plan will come to an end at PolicyBazaar where after giving basic details, like name, annual income, occupation, etc; you will get free Mediclaim premium quotes of various policies, which can be compared at a click of the mouse. While you compare mediclaim insurance plans, always pay attention towards overall limits, depth of coverage and empanelled hospitals. Moreover, after selecting a policy, you can use our Mediclaim premium calculator to compute your premium and thus, you can plan your financial goals effectively. Make a proper comparison and instantly buy a best mediclaim policy at affordable rates.

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Frequently Ask Question

What is Mediclaim Policy?

Ans:

A mediclaim policy provides a financial cover for medical and hospitalization expenses, in case of illness/injury.

Why Mediclaim Policy?

Ans:

For the simple reason that during an unforeseen medical emergency, a mediclaim cover acts as the much needed financial cushion thereby saving the insured and his/her family from any financial contingency.

What are its Key Features?

Ans:

A mediclaim policy offers unique features to the insured. For every claim free year, the insured gets to enjoy a raise in the sum assured for the same premium. When the insured switches from one insurer to another, he/she doesn't have to part away with the waiting period benefits. This feature is called as insurance portability. The policyholder also gets the tax benefits under section 80D(D).

Documents Required(if any)

Ans:

Age Proof
Identity Proof
Address Proof
Income Proof
Duly Filled Proposal Form
You may need to undergo Medical Tests in some cases

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