A mediclaim policy compensates for hospitalization expenses incurred on treatment, surgery or accidental injury. A Mediclaim differs from health insurance in some ways. While the former covers expenses pertaining to hospitalization, the latter is more comprehensive and covers medical expenses which might include services beyond hospitalization.
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In layman terms, for filing a Mediclaim, an actual hospitalization has to take place and for filing a health insurance claim, a medical eventuality is required which necessarily does not mean that an actual hospitalization has to happen. A normal mediclaim policy will cover expenses arising out of hospitalization.
The minimum age at which a Mediclaim can be applied for is 5 years and the upper age limit is 60 years. Mediclaim draws a staunch line and does not cover dental expenses, cosmetic surgeries, pregnancy, childbirth or sexually transmitted diseases.
With the ever-rising healthcare costs, senior citizen mediclaim policy for the elderly is almost inevitable. Generally, the entry age for senior citizen health insurance is 61 years and many insurance providers limit the entry age to 69 years. Thus, sooner you get a Mediclaim policy, better the benefits would be. The chances of the policy getting rejected would also be less. After a two-year waiting period, cover for pre-existing diseases will also be offered.
The cover for alternative medical treatment methods like Ayurveda and Homeopathy can be added to the policy plan as add-ons. The premium of senior citizen Mediclaim is generally high since the entry age is high and the premium amount varies according to the pre-existing disease. Some companies offer life-long cover for senior citizens while others may not require medical tests until the age of 69, based on some terms and conditions.
New India Assurance Senior Citizen Mediclaim plan offers medical protection to people aged between 60-80 years.
|Sum Insured (in Rs.)||60 to 65 years||66 to70 years||71 to 75 years||76 to 80 years|
|1 lakh||Rs. 3850||Rs. 4250||Rs. 4700||Rs. 5150|
|1.5 lakhs||Rs. 5720||Rs. 6310||Rs. 6980||Rs. 7650|
10% for voluntary deductibles of Rs.10, 000/-
If your spouse is covered you get a family discount of 10%
If the policyholder intends to file a claim under this plan:
The policyholder shall submit all the original bills, documents, and receipts to the TPA upon which the claim is based. You need to furnish all the information, additional information and any other assistance as required by the TPA.
Medical Practitioner sanctioned by the third-party Administrator shall be permitted to examine the policyholder or the insured members if it is required as part of the claim (subjected to the case and type of claim and illness). The cost of assessment shall be borne by the insurer itself)
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