Mediclaim policy takes care of your medical expenses up to the sum insured amount in case of a medical emergency, except for the critical illness expenses. The policyholder can avail of both cashless and reimbursement claim benefits. The policy also offers tax-exemption benefits under section 80D of the Income Tax Act of India, 1961.
What is Mediclaim?
A Mediclaim is a type of insurance policy that covers medical expenses of the insured in case of a medical emergency. A mediclaim policy covers the policyholder with benefits such as dare-care facility, critical illness cashless hospitalization etc. The premium for policy coverage is decided based on certain factors such as health of the insured, age, gender etc.
Features and Benefits of Mediclaim Policy
Amid the increasing number of lifestyle diseases, hospitalization expenses and healthcare it is inevitable to buy a mediclaim policy almost inevitable. It offers a cushion in case of an emergency. At the same time, it offers numerous other benefits such as
A cost-effective way of availing healthcare services
Cashless hospitalization facility
Lowers the financial burden
Eliminates out-of-pocket expenses
Offers peace of mind
The insurance provider manages the hospitalization expenses
Both individual and family floater mediclaim policies are available
Tax benefits on the premium paid every year
List of Best Mediclaim Policies in India
Although there are many mediclaim policies offered by different insurance companies.
Below is the List of Top Mediclaim Policies in India that you Can Consider:
Religare Medilcaim Policy
Max Bupa Mediclaim Policy
Star Health Mediclaim Policy
HDFC ERGO Health Mediclaim Policy (formerly known as Apollo Munich Mediclaim Policy)
HDFC Ergo Mediclaim Policy
Aditya Birla Mediclaim Policy
Religare Mediclaim Policy
Rs. 3 Lakh to Rs. 60 Lakh
Max Bupa Mediclaim Policy
Rs. 3 Lakh to Rs. 1 Crore
Star Health Mediclaim Policy
Rs. 1 Lakh to Rs. 25 Lakh
HDFC ERGO Health Mediclaim Policy (formerly known as Apollo Munich Mediclaim Policy)
Rs. 3 Lakh to Rs. 50 Lakh
HDFC Ergo Mediclaim Policy
Rs. 3 Lakh to Rs. 10 Lakh
Aditya Birla Mediclaim Policy
Rs. 2 Lakh to Rs. 2 Crore
Types of Mediclaim Policies
There are different types of mediclaim policies that are available. You can choose a mediclaim policy as per your needs and enjoy your peace of mind. Let’s have a look at the various types of mediclaim plans:
Individual Mediclaim Policy
An individual mediclaim policy offers health coverage to only the policyholder. Only one person can avail the medical insurance benefits against the premium paid. There are a number of health insurance companies that provide individual mediclaim plans in India.
Family Floater Mediclaim Policy
A family floater mediclaim policy provides coverage to an individual, which is extendible to other family members including parents, spouse, and children.
There are two types of claims available under Mediclaim policy-
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.
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.
Mediclaim Policy Coverage
The coverage varies from one policy to another, but usually, the following expenses are covered:
It covers all the all direct charges incurred during hospitalization such as OT charges, diagnostic procedures, blood, oxygen, medicines, chemotherapy, x-ray, radiotherapy, donor expenses, pacemakers etc.
Expenses incurred on specified technically -advanced treatments like cataract surgery etc. that do not require hospitalization for more than 24 hours.
Pre and post-hospitalization expenses
Expenses incurred on hospitalization for a period of 30 days before admission and up to 60 days after discharge including ambulance cover are reimbursed.
Hospital Room Charges
Charges of regular wards or Intensive-Care-Unit are fully recompensed, or taken care of with cashless hospitalization in the network hospitals.
Fees Charged by Medical Professionals
Compensation is provided for fees charged by the doctor, surgeon, nurse, anesthetist etc.
What is Not Covered in a Mediclaim Policy?
Every mediclaim policy has some limitations. Mentioned below are the circumstances that can deny you claim-
A mediclaim policy will not cover pre-existing ailments.
Any medical condition or critical illnesses that are diagnosed within 30 days of the policy commencement date are not covered. You can read the policy documents to know the details of the plan.
Specific ailments that are not covered in the plan
Expenses incurred on dental surgeries unless it requires hospitalization
Birth control and hormonal treatment
Complication during childbirth and ectopic pregnancies
Factors to Consider while Finalising a Mediclaim Policy
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.
Sum Insured (the Coverage Amount):
While choosing the coverage amount or the sum assured, it is recommended to take various factors such as rate of inflation, surging healthcare cost, etc. into consideration. Moreover, if you’re living in any metropolitan city, the costs of hospitalisation will be way higher than in rural areas. Likewise, if you opt for the sum insured of your loved ones also, you might want to take higher sum insured into consideration.
Various mediclaim plans come with co-payment clause. The co-payment is usually a percentage sum that the insured has to bear while raising a claim before the insurance provider settles the rest. Such co-payments can range from 10% to 30% based on the insurance provider.
Every mediclaim plan is tailor-made so as to cover medical risks of the policyholder. Nevertheless, there are a few exclusions, which are either covered after a certain term or not covered at all. Conditions taking place due to reasons such as HIV infection, drug or alcohol addiction, suicide attempt, congenital diseases, etc. are not covered under the mediclaim policy. However, expenses related to hysterectomy, removal of kidney stones, gall bladder surgeries, and maternity, etc. are covered after a certain waiting period.
One of the most important benefits of choosing mediclaim policy is the ease of the cashless settlement of the expenses incurred during hospitalisation. Every insurance provider has network hospitals and while seeking hospitalisation in any of such hospitals, you can avail cashless treatment if the treatment/hospitalisation is within the coverage scope. This aids in getting financial relief at the most crucial and critical times. Therefore, you must check out the network hospitals near your area, which have tie-ups with the insurance provider you want to purchase the policy from.
Although, policy offers coverage for one year only, but in reality, it is a relationship between you and the insurance company. So, your health Insurance policy 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.
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 heart 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.
Ans: A mediclaim policy is a kind of health insurance policy that offers compensation for the insured person’s healthcare expenses up to the sum insured amount. The policy covers medical emergencies, an illness or an accident that requires hospitalization. Basically, it helps you to focus on treatment and healing rather than worrying about the cost of treatment.
Ans: It covers hospitalization expenses including OT charges, medicines, oxygen, blood or any other test that is required for the treatment. It also covers day-care treatment expenses, diagnostic tests, and technologically advanced treatment. The pre and post hospitalization expenses are covered for a period of 30 days before getting admitted and 60 days of getting discharged.
Ans: There are two ways to claim the benefits of your mediclaim policy- reimbursement claim and cashless claim. To get reimbursement you need to inform the insurer or the TPA regarding the hospitalization. Along with the hospitalization expenses you also need to keep all the medical bills to claim your medical reimbursements. For cashless claim settlement, you need to fill all the details in the claim form and submit the same to the insurer. And the insurer will settle your hospital bills directly with the hospital (up to the sum insured limit).
Ans: The exclusions vary from one mediclaim policy to another and from one insurance provider to another. Most of the mediclaim policies do not cover expenses incurred on pre-existing diseases before completion of the waiting period, suicidal attempts, cosmetic surgeries, any act of criminal intent. You can check the policy wordings for the detailed list of exclusions.
Ans: You can easily select the right mediclaim policy to choose as there are a plethora of health insurance plans available online. You can easily compare and buy mediclaim policies from top health insurance companies on our website. There are plans that ensure the best coverage at an affordable premium. You can select the right type of medical plan for yourself and your family.
Ans: The age a criterion usually varies from one insurer to another. It is usually between the age group of 18 and 65 years and even covers new-born babies starting from 91 days. Some plans offer lifetime renewable facilities.
Ans: The first thing you need to do is immediately inform the TPA regarding the hospitalization, along with the details of your policy, hospital, and the treatment you need to undergo. You need to fill the claim form that includes details like your policy number, the name of the hospital and the treatment undertaken. After that, you need to submit all the documents to the TPA department at the hospital. The claim is then taken forward once all the documents are submitted to the insurer.
Ans: Check out some of the best mediclaim policies in India here: 1. Religare mediclaim policy 2. Max Bupa Mediclaim Policy 3. Apollo Munich Mediclaim Policy 4. Star Health Mediclaim Policy 5. HDFC Ergo Mediclaim Policy There are a number of other mediclaim policy that you can buy as per your requirement.
Ans: Mentioned below are some of the best mediclaim policies in India for your family: 1. Bajaj Allianz Medical Insurance- Family Floater Health Guard Plan 2. Manipal Cigna Health Insurance - Family Floater Pro-Health Protect Plan 3. Star Health Insurance- Family Health Optima Insurance Plan 4. SBI Health Insurance- Smart Health Insurance Oriental Insurance- Happy Family Floater Policy.
Ans: Below are some of the best cashless mediclaim policies in India: 1. Apollo Munich Medical Insurance 2. ICICI Lombard Health Insurance 3. Max Bupa Health Insurance 4. Reliance Health Insurance 5. Religare Health Insurance 6. Future Generali Health Insurance 7. New India Assurance Health Insurance.
Ans: Below are some of the best mediclaim plans for your parents: 1. Star Health Red Carpet Plan 2. Religare Car Freedom Senior Citizen Health Plan 3. Bajaj Allianz Silver Plan 4. Apollo Munich Easy Health Plan 5. Max Bupa Heartbeat Plan 6. Oriental Hope Health Plan Star Health Red Carpet Plan.
Ans: Pre-existing diseases are covered after the completion of waiting period by the following health insurance companies in India: 1. Max Bupa Health Insurance 2. HDFC Ergo Health Insurance 3. Bharti AXA Health Insurance 4. Bajaj Allianz Health Insurance 5. TATA AIG Health Insurance 6. Reliance Health Insurance 7. National Health Insurance 8. Iffco Tokio Health Insurance 9. Manipal Cigna Health Insurance 10. Royal Sundaram Health Insurance.
Ans: In a cashless mediclaim policy, the health insurance company settles the hospitalization expenses directly with the hospital. You do not need to pay anything up to the sum insured amount (unless there are deductibles).
Ans: LASIK surgery is usually not covered under most of the mediclaim policies. However, if you meet certain criteria you can get the claim benefits. Please check with your insurance provider regarding LASIK surgery cover before making the purchase or on the policy wordings.
Ans: Dental treatments are not covered under basic health plans unless it is an accidental emergency. However, some insurers cover dental treatment as an add-on benefit. You need to pay an extra premium to get dental treatment cover (if any).
Ans: Below are some of the best mediclaim policies that cover pregnancy in India: 1. Royal Sundaram Master Product - Total HealthPlus 2. Apollo Munich Easy HealthFamily Floater Plan 3. Max Bupa Heartbeat Family Floater Plan 4. Manipal Cigna Pro-Health Plus HealthInsurance Plan 5. Star Health Wedding Gift Pregnancy Cover.
Ans: A group mediclaim policy is usually offered by companies to their employees and can be extended to their family members including spouse, children, and parents in some cases. The premium is paid by the employer on behalf of the employees and can customize on payment of extra premium to suit the interest of the insured members. The coverage is limited; therefore, it is important to have a separate health insurance policy as well.
Ans: It is easy to port your mediclaim policy. You can inform your health insurance provider 45 to 60 days ahead of the expiry of your current health plan. You would need to fill portability from, provide details of your previous health insurer and then apply for portability.
Ans: Most of the insurers do not accept claims for illnesses arising during the initial 30 of policy purchase. However, it covers accidental hospitalization expenses during the first 30 days of policy commencement.
Ans: The main difference between a mediclaim policy and a health insurance policy are as follows: 1. A mediclaimcovers only hospitalization expenses. Whereas a health insurance policy covers pre-post hospitalization expenses, accidental cases, hospitalization expenses, ambulance charges, doctor fees, etc. 2. A mediclaim policy doesn’t offer add-on benefits that health insurance policy offers- critical illnesses cover, maternity cover, personal accident cover, etc.
Ans: There are many types of mediclaim policies available in India and the details are given below: 1. Family Floater Policy- This policy offer to you and your family members under a single sum assured. 2. Individual Mediclaim- It basically compensates the insured individual from unforeseen hospitalization expenses. 3. Group Medicliam- This type of policy offers coverage to a group of individuals under a single plan. Most employers buy this group or employer mediclaim policy for its employees.
Written By: PolicyBazaar - Updated: 19 February 2020
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