Mediclaim Policy

What is Mediclaim?

A Mediclaim is a kind of health insurance that covers your medical expenses in case of any health emergency up to the sum insured. A Mediclim policy also offers cashless treatment facilities to the policyholder at insurer's 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:

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

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.

Comparison Between Mediclaim Policy and Health Insurance

The following table shows the differences between a mediclaim policy and a health insurance policy:

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.

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.

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