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Medical inflation has made healthcare services expensive. If you end up getting admitted to a hospital due to a medical emergency, the hospital bill will exhaust your lifelong savings in no time. Buying a mediclaim policy is the best way to pay for your costly medical treatment without losing your savings.
A Mediclaim policy is a kind of health insurance that covers your medical expenses incurred during hospitalization only. It offers medical coverage for hospitalization expenses up to the sum insured limit. Mediclaim insurance also offers cashless treatment facilities to the policyholder at the insurer's network hospitals and is available on both individual & floater sum insured basis.
With the increasing number of lifestyle diseases today, the cost of hospitalization and healthcare expenses are touching the roof. By buying a mediclaim policy, you can get financial support during hospitalization in case of a medical emergency. Take a look at the numerous benefits of buying a mediclaim policy below:
Although there are many mediclaim policies offered by different insurance companies, below are some of the best mediclaim policies in India that you can consider buying:
|Mediclaim Policies||Sum Insured
|Aditya Birla Mediclaim Policy||2 lakh – 2 crore||11000+|
|Bajaj Allianz Mediclaim Policy||3000 – 50,000 per day||8000+|
|Care Mediclaim Policy||25 lakh – 1 crore||22900+|
|Cholamandalam Mediclaim Policy||5 - 25 lakh||11000+|
|Digit Mediclaim Policy||2 lakh – 3 crore||16400+|
|Future Generali Mediclaim Policy||2 - 5 lakh||8000+|
|HDFC ERGO Mediclaim Policy||5 lakh - 2 crore||12000+|
|IFFCO Tokio Mediclaim Policy||50,000 - 20 lakh||7000+|
|Kotak Mahindra Mediclaim Policy||2 – 25 lakh||7700+|
|Liberty Mediclaim Policy||2 – 15 lakh||6000+|
|Magma HDI Mediclaim Policy||2 lakh – 1 crore||8400+|
|ManipalCigna Mediclaim Policy||4 - 5 lakh||8500+|
|National Mediclaim Policy||1 - 10 lakh||6000+|
|New India Assurance Mediclaim Policy||1 - 15 lakh||8000+|
|Niva Bupa (Formerly known as Max Bupa) Mediclaim Policy||3 lakh - 1 crore||10000+|
|Oriental Individual Mediclaim Plan||1- 50 lakh||3300+|
|Raheja QBE Mediclaim Policy||1 - 50 lakh||5000+|
|Reliance Mediclaim Policy||1 - 5 lakh||9100+|
|Royal Sundaram Mediclaim Policy||5 - 25 lakh||10000+|
|SBI Mediclaim Policy||10 - 30 lakh||23000+|
|Star Mediclaim Policy||1 - 5 lakh||14000+|
|Tata AIG Mediclaim Policy||3 - 20 lakh||10000+|
|United India Mediclaim Policy||4 - 5 lakh||14000+|
|Universal Sompo Mediclaim Policy||1 - 50 lakh||12000+|
|Zuno (Formerly Edelweiss) Mediclaim Policy||1 lakh - 1 crore||10000+|
*Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.
There are different types of mediclaim policies available in India. You can choose the policy as per your health needs and avail medical treatment with peace of mind. Let’s have a look at the various types of mediclaim plans:
An individual mediclaim policy offers health insurance coverage to only the policyholder. Only one person can avail the medical insurance benefits against the premium paid under this type of policy. Several health insurance companies provide individual mediclaim plans in India.
A family floater mediclaim policy provides coverage to the policyholder along with his/her family members, including parents, spouse, and children. Under this type of policy, a single sum insured amount is available to all the family members on a floater basis.
Senior citizen mediclaim policy is designed to cover hospitalization expenses incurred by elderly people who have crossed the age of 60 years. The senior citizen health insurance policy coverage are customized to cover the health needs of senior citizens.
PS - The starting price is indicative and may vary basis additional details.
The following table shows the differences between a mediclaim policy and a health insurance policy:
|Categories||Mediclaim Policy||Health Insurance|
|Meaning||It reimburses your actual medical expenses incurred during hospitalization only.||It covers medical expenses incurred in addition to hospitalization expenses, such as day care procedures, OPD expenses, pre-post hospitalization expenses, etc.
It also gives you a lump sum amount on diagnosis of any covered critical disease, irrespective of your medical expenditure.
|Scope of Coverage||It has a narrow scope of coverage as it covers hospitalization expenses arising out of an accident or illness only.||It has a wider scope of coverage as it covers hospitalization expenses, ambulance charges, day care procedures, critical illness, etc.|
|Premium||The policy premium is low due to limited coverage.||The policy premium is higher than the mediclaim policy as it offers comprehensive coverage.|
|Add-on Covers||It does not offer any add-on covers.||It comes with various add-on covers, such as maternity benefit, critical illness cover, worldwide coverage, etc.|
A mediclaim policy provides coverage for the following expenses:
It covers all the direct charges incurred during hospitalization, such as OT charges, diagnostic procedures, blood, oxygen, medicines, chemotherapy, x-ray, radiotherapy, donor expenses, pacemakers, etc. It provides coverage for sickness as well as accidental hospitalization.
Charges of a regular ward or intensive care unit are fully recompensed or taken care of by the insurance company with cashless hospitalization at network hospitals.
Compensation is provided for fees charged by the doctor, surgeon, nurse, anaesthetist, etc. while admitted to the hospital.
Every mediclaim policy has some limitations. Mentioned below are the circumstances where your claim can be denied:
You can read the policy documents to know the complete list of exclusions.
If you haven’t bought a mediclaim policy and are planning to apply for one, we recommend you to check the below factors to make sure that you buy the best policy. These factors can also be used to compare different insurance plans available in the market. Take a look:
In an individual plan, each individual is insured for a specific amount, whereas in a family floater plan, the whole family is insured for a fixed sum assured. In the case of the family floater, when the primary person dies or reaches the exit age, the policy is closed and other younger members can’t renew the policy. But in an individual plan, an individual remains insured on an individual sum insured basis even if the eldest member of the family attains the exit age or dies during the policy tenure.
Whilae 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 cover your loved ones also in the policy, you might want to opt for a higher sum insured.
Various mediclaim plans come with a co-payment clause. Co-payment is usually a percentage of the claim amount that the insured has to bear while raising a claim before the insurance provider settles the remaining amount. The co-payment can range from 10% to 30% based on the insurance provider. Thus, check for any co-payment under your mediclaim policy before buying.
There are a few medical expenses that are either covered after a certain time or not covered at all under a mediclaim policy. For instance, HIV infection, drug or alcohol addiction, etc. are not covered under the mediclaim policy, but specific diseases like removal of kidney stones, gall bladder surgeries, etc. are covered after a certain waiting period. You must check the exclusions carefully before buying the policy.
One of the most important benefits of choosing a mediclaim policy is the ease of the cashless settlement of hospitalization expenses at network hospitals. Every insurance provider has network hospitals where cashless hospitalisation can be availed. Therefore, you must check the network hospitals list of the insurance company near your area before you purchase the policy.
Some policies come with a lifetime renewability option allowing you to renew your policy irrespective of your age. This is essential for older people because it is tough to get insurance at that age. Therefore, you must check the renewability option of your policy before buying a mediclaim policy.
Almost all insurance companies cover pre-existing diseases after a waiting period. While buying a mediclaim policy, you must check the pre-existing waiting period as the best mediclaim insurance plan will cover pre-existing diseases as soon as possible.
There are two types of claims that you can raise under a mediclaim policy – cashless claim and reimbursement claim. Take a look at the claim procedure below:
Cashless claims ensure that a patient is treated in a network hospital on a cashless basis as the insurer settles the bill amount directly with the hospital. It means that the insured doesn’t have to pay a penny to the hospital for the treatment. Follow the steps given below to raise a cashless claim:
In the case of a reimbursement claim, it is important to inform your insurance company that hospitalization has taken place or is likely to take place soon. You can do so by sending an email or calling the customer service of your insurance provider.
Once you have received the treatment, collect all the medical documents from the hospital. To get a reimbursement, you need to submit all hospital bills and payment receipts, including medicine bills to your insurer along with the original discharge card and claim form. The insurance company will review your claim and will pay the reimbursement amount after claim approval.
The following documents are required at the time of buying a mediclaim policy:
Policybazaar.com is a one-stop platform to find the best mediclaim in India. By giving your basic details, you can get free premium insurance quotes of various insurance companies online on Policybazaar.com and compare them with a click of the mouse.
Moreover, you can also use our medicaim premium calculator to compute the premium for a policy before buying and thus, can plan your financial goals effectively. With a proper comparison, you can instantly buy the best mediclaim policy at an affordable rate anytime anywhere.
Ans: It covers hospitalization expenses, including OT charges, medicine cost, oxygen, blood or other expenses incurred during the treatment. It also covers the cost of diagnostic tests and technologically advanced treatment.
Ans: As per the IRDAI regulations, medical insurance providers are mandated to cover coronavirus-related hospitalization expenses under all mediclaim policies. Some insurance providers are also offering specific coronavirus health insurance policies to the people. However, it is better to check with your insurer if they cover the COVID-19 treatment cost.
Ans: There are two ways to claim the benefits of your mediclaim policy- reimbursement claim and cashless claim. To get reimbursement for your hospitalization expenses, you need to inform the insurer or the TPA regarding your hospitalization. You need to keep all the medical bills, fill all the details in the claim form and submit them to the insurer. The insurer will verify the claim and make the payment.
In cashless claim, you need to fill the pre-authorization form, which the hospital will submit to the TPA. After approval from TPA, you can receive the benefits and the insurer will settle your hospital bills directly with the hospital (up to the sum insured limit).
Ans: You can easily select the right mediclaim policy from a plethora of health insurance plans available online by comparing them with each other. You can easily compare and buy mediclaim policies from top health insurance companies on Policybazaar.com. You can select the right type of medical plan for yourself and your family and get your policy instantly.
Ans: The age criterion to buy a policy usually varies from one insurer to another. It is usually available for people between the age group of 18 and 65 years and even covers newborn babies starting from 91 days. Some plans offer lifetime renewable facilities. You must check the eligibility criteria of a mediclaim policy before choosing a plan.
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 and submit it with all the required documents to the TPA or the insurer. The claim amount is paid to you once all the documents are submitted to the insurer in case of reimbursement claim. For cashless claims, the insurer settles the bill with the hospital if a pre-authorization is granted before commencing your treatment.
Ans: Any hospitalization expenses incurred by the insured due to an accident is covered under your basic mediclaim policy.
Ans: In a cashless mediclaim policy, the health insurance company settles your hospitalization expenses directly with the hospital. You do not need to pay anything during discharge from the hospital if you have not incurred any non-covered expenses.
Ans: LASIK surgery is usually not covered under most 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 purchasing a mediclaim policy.
Ans: Dental treatments are not covered under mediclaim policies unless it is resulting from an accidental emergency. However, some insurers may cover dental treatment as an add-on benefit on an extra premium amount.
Ans: A group mediclaim policy is usually offered by companies to their employees, which can be extended to their family members, including the spouse, children, and parents in some cases. The premium is paid by the employer on behalf of the employees. The policy can be customized on the payment of an extra premium to suit the interest of the insured members. However, the coverage of a group mediclaim policy is limited and therefore, it is important to have a separate health insurance policy as well.
Ans: As the name suggests, an international or overseas mediclaim policy is a type of medical insurance policy that covers emergency hospitalization expenses when travelling overseas or abroad.
Ans: Most of the insurers do not accept claims for illnesses arising during the initial 30 days of policy purchase. However, it covers accidental hospitalization expenses during the first 30 days of policy commencement.
Ans: The main differences between a mediclaim policy and a health insurance policy are as follows:
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*We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30-minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881. Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. As per the Insurance guidelines, you are allowed to cancel the policy with-in 15 days from the date of Issuance of policy. For more details, please read the Plan Brochure carefully or talk to our advisor at the time of purchase.
**All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws.
##On ground claim assistance is available in 114 cities
~No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.
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