What is Mediclaim?

Mediclaim policy is a kind of health insurance that covers your medical expenses in case of any health emergency up to the sum insured. The Insurer pays for the treatment cost be it an accident or illness that led to hospitalization including in-patient cover, day-care treatment, room rent etc. It offers cashless treatment facilities at network hospitals and is available on both individual & floater sum insured basis.

Benefits of Buying a Mediclaim Policy

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:

Cost-effective- A mediclaim policy is a cost-effective way of availing healthcare services without exhausting your savings.
Cashless Treatment- Cashless hospitalization facility is available in all network hospitals of your insurance company, which eliminates any out-of-pocket expenses in case of a medical emergency.
Eases Financial Stress– It lowers the financial burden on the policyholder and his/her family by offering monetary assistance during a medical emergency.
Individual and Family Floater Cover- Both individual and family floater policies are available in the market.
Hospitalization Expenses- Mediclaim policies cover in-patient hospitalization expenses, such as OT expenses, doctor’s fees, nursing charges, medicine costs, etc. incurred due to an illness or accidental injury.
Lifelong Renewability- A mediclaim policy can also offer a lifelong renewability option to the policyholder depending on the opted policy.
Additional Benefits- It comes with several additional benefits, such as ICUs charges, room rent, etc.
Tax Exemption Benefits- Tax benefits under section 80D can be availed on the policy premium that is paid every year.

List of Best Mediclaim Policies in India

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 (Rs)	Network Hospitals	Renewability
Aditya Birla Mediclaim Policy	10- 30 lakh	8700+	Lifelong
Bajaj Allianz Mediclaim Policy	1.5- 50 lakh	6500+	Lifelong
Bharti AXA Mediclaim Policy	3,4,5 lakh	4500+	Lifelong
Care Health Insurance Mediclaim Policy	3 lakh- 60 lakh	16500+	Lifelong
Cholamandalam Mediclaim Policy	2- 15 lakh	6500+	Lifelong
Digit Mediclaim Policy	2- 25 lakh	6400+	Lifelong
Edelweiss Mediclaim Policy	5 lakh- 1 crore	3200+	Lifelong
Future Generali Mediclaim Policy	Vital: 3,5,10 lakh Superior: 15,20,25 lakh Premier: 50 lakh- 1 crore	6000+	Lifelong
IFFCO Tokio Individual Medisheild Mediclaim Policy	50,000- 5 lakh	6400+	Lifelong
Kotak Mahindra Mediclaim Policy	2-1 crore	5000+	-
Liberty Mediclaim Policy	Up to 1 crore	5000+	Lifelong
Max Bupa Mediclaim Policy	3 lakh- 1 crore	7400+	Lifelong
ManipalCigna Mediclaim Policy	2.5- 50 lakh	6500+	-
National Mediclaim Plus Policy	2- 50 lakh	6000+	Lifelong
New India Assurance Mediclaim Policy	1- 15 lakh	3000+	Lifelong
Oriental Individual Mediclaim Plan	1- 10 lakh	4300+	Lifelong
Royal Sundaram Mediclaim Policy	2- 1.5 crore	5000+	Lifelong
Reliance HealthWise Mediclaim Policy	1- 5 lakh	7300+	Up to 75 years
Raheja QuBE Mediclaim Policy	1- 50 lakh	5000+	Lifelong
Star Health Mediclaim Policy	1- 25 lakh	11000+	Lifelong
SBI Mediclaim Policy	1- 3 lakh	6000+	Lifelong
Tata AIG Mediclaim Policy	2- 10 lakh	7200+	Lifelong
United India Mediclaim Policy	1- 10 lakh	7000+	-
Universal Sompo Mediclaim Policy	Up to 5 lakh	4000+	Lifelong

See More Plans

*Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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Types of Mediclaim Policies in India

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:

Individual Mediclaim Policy

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.
Family Floater Mediclaim Policy

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

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.

Health Insurers

Aditya Birla Health Insurance

Bajaj Allianz Health Insurance

Bharti AXA Health Insurance

Care Health Insurance

Cholamandalam Health Insurance

Digit Health Insurance

Edelweiss Health Insurance

Future Generali Health Insurance

Health Insurance Companies Expand

Comparison Between Mediclaim Policy and Health Insurance

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.

What is Covered in a Mediclaim Policy?

A mediclaim policy provides coverage for the following expenses:

Hospitalization Charges

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.
Hospital Room Charges

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.
Fees Charged by Medical Professionals

Compensation is provided for fees charged by the doctor, surgeon, nurse, anaesthetist, etc. while admitted to the hospital.

What is Not Covered in a Mediclaim Policy?

Every mediclaim policy has some limitations. Mentioned below are the circumstances where your claim can be denied:

A mediclaim policy will not cover pre-existing ailmentsuntil the waiting period gets over.
Any medical condition or critical illnesses that are diagnosed within 30 days of the policy commencement date are not covered.
Specific ailments, such as joint replacement surgery, etc.,are not covered for 2 to 4 years as per the terms of the policy
Expenses incurred on dental surgeries unless it requires hospitalization
Birth control and hormonal treatment
Complication during childbirth and ectopic pregnancies
Suicide attempt
Congenital anomaly
Addiction to alcohol or drugs
HIV AIDS

You can read the policy documents to know the complete list of exclusions.

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.

Factors to Consider While Buying a Mediclaim Policy

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:

1. Individual and Family Floater:

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.

2. Sum Insured (Coverage Amount):

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.

3. Co-payment Option:

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.

4. Exclusions:

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.

5. Network Hospitals:

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.

6. Renewability Age:

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.

7. Pre-existing Disease:

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.

Mediclaim Policy Claim Procedure

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 Claim Procedure:

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:

Visit an empanelled hospital of your insurance company to receive the treatment
Obtain a pre-authorization form from the insurance desk at the hospital.
Duly fill the form with correct information and get it stamped by the hospital
The hospital will send the form to the Third Party Administrator (TPA) or the insurer for approval.
After carefully examining the form, the company will approve the treatment and send a fax back to the hospital stating the amount covered by them.
Get treated and sign all documents during discharge
Your insurer will pay the hospital bill amount.

Reimbursement Claim Procedure:

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.

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.

Documents Required While Buying a Mediclaim Policy

The following documents are required at the time of buying a mediclaim policy:

Dully filled proposal form
Proof of age, such asAadhaar card, passport, voter ID card, etc.
Identity proof, such as passport, Aadhaar card, driving license, etc.
Address proof, such as driving license, passport, Aadhaar card, etc.
Passport-size photograph
Pre-policy medical test reports

How Policybazaar Can Help You to Buy 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.

FAQ’s

Q: What does a best mediclaim policy cover?

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.
Q: Does a mediclaim policy cover coronavirus?

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.
Q: How do I claim the benefits of my mediclaim policy?

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).
Q: How to select the right mediclaim policy?

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.
Q: What is the age criterion to buy a mediclaim policy?

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.
Q: What do I need to do after I get hospitalized?

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.
Q: Does mediclaim cover accidents?

Ans: Any hospitalization expenses incurred by the insured due to an accident is covered under your basic mediclaim policy.
Q: What is a cashless 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.
Q: Which mediclaim policy covers LASIK surgery?

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.
Q: Which mediclaim policy covers dental treatment?

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.
Q: What is a group mediclaim policy?

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.
Q: What is overseas mediclaim policy?

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.
Q: When can you file a claim after buying policy?

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.
Q: How is a mediclaim policy different from health insurance?
Ans: The main differences between a mediclaim policy and a health insurance policy are as follows:
- A mediclaimpolicy covers only hospitalization expenseswhereas a health insurance policy covers in-patient hospitalization expenses, accidental hospitalization expenses, doctor fees, room rent, etc.
- A mediclaim policy doesn’t offer add-on benefits that a health insurance policy offers, such ascritical illnesscover, maternity cover, personal accident cover, etc.