Mediclaim policy is a type of health insurance, which covers medical expenses arising out of illnesses or accidents. Like the other policies, a Mediclaim policy charges a premium value that comes with a defined policy period and needs to be renewed to avail of the benefits of the policy. You can avail of a mediclaim health cover for a pre-specified sum insured, along with tax benefit under section 80D of the Income Tax Act, 1961. Such relaxation under the tax law can also be availed for the family members under the Family-floater Mediclaim policy.
Mediclaim policy is one of the must-have insurance plans as it offers numerous benefits to the insured. Let's find out the advantages of mediclaim policy in general.
It provides smooth cashless hospitalization.
It is financial support for you during your medical emergencies.
It saves you from the frowning of the financial burdens.
Different companies have the facility to buy mediclaim policies online, which saves time and energy.
It also offers tax exemptions under the Income Tax Act, 1961.
You can avail different cost-effective healthcare services.
Senior citizens are given extra benefits under the Senior Citizen Mediclaim Policy.
Pre and post-hospitalization medical expenses are also covered by mediclaim policies with certain conditions.
Expenditures for availing regular ward or Intensive Care Unit (ICU) are fully reimbursed by the insurer.
Day-care expenses are also covered by the mediclaim policies.
It covers COVID-19 treatment expenses.
|Name of the Mediclaim Policy||Entry Age||Sum Insured (Rs.)||Renewability|
|National Mediclaim Plus Policy||18-65 years||2 lakhs-50 lakhs||Lifelong Renewal|
|New India Premier Mediclaim Policy||18-65 years||15 lakhs-1 crore||NA|
|Oriental Individual Mediclaim Policy||18-65 years||1 lakh-10 lakhs||Lifelong Renewal|
|Future Generali Mediclaim Policy||Day one up to any age||3 lakhs-1 crore||Lifelong Renewal|
|Chola Healthline Policy||18-65 years||2 lakhs-25 lakhs||Lifelong Renewal|
|Bajaj Allianz M-Care Health Policy||18-65 years||10,000-75,000||Lifelong Renewal|
|Bharti AXA Smart Super Health Assure||5 years-65 years||1 lakh-4 lakhs||Lifelong Renewal|
**Last Updated on 04-02-2021
To safeguard your financial well-being in the face of medical expenses, different health insurance companies in India have brought various policies. The major ones are as follows.
Individual mediclaim policyFamily-floater mediclaim policySenior citizen mediclaim policyCritical illness mediclaim policy Overseas mediclaim policyLow-cost mediclaim policyGroup Mediclaim Policy
To understand the policies in great detail, we should move forward one by one.
An Individual Mediclaim policy is a kind of health cover that is designed to provide reimbursement for the various medical expenses to a single person, under a single plan. All the benefits that the policy covers are meant to be enjoyed by that person only. The premium cost of this type of policy is decided after examining the different aspects of that person like age, health and lifestyle conditions, and many more. It is one of the most popular types of health insurance schemes that are enjoyed by many people in India.
Family-Floater Mediclaim policy is a kind of health insurance cover that offers the entire family compensation for different medical expenditure only on the payment of a single premium, under fixed sum insured. The insured sum can be utilized for multiple hospitalizations of the family members.
This policy covers you, your children, and your spouse on a floater sum insured basis. Some companies also give coverage to the dependent parents under this policy. This plan can also be customized according to your convenience and requirements.
For senior citizens, any kind of health insurance plan plays a pivotal role to save them from a financial crisis due to medical treatment. Senior Citizen Mediclaim policy is a kind of health cover that generally provides benefits to people aged between 60 and 80 years. Often the consumers are needed to undergo medical check-up (as prescribed by the insurer) to detect any pre-existing disease or ailment.
This policy often offers some unique benefits for the consumers, such as cashless hospitalization cover, daycare expenses, pre-existing disease cover, room and boarding expenses, and many more. The unique benefits might vary from company to company.
When a person is diagnosed with any critical illness, (s)he has to pay a lump sum amount of money for the treatment. Critical Illness Mediclaim policy is a savior for this kind of situation as it is designed to cover critical illness expenditure and it offers the insured cost as the lump sum to the insured so that (s)he can start the treatment without any issues.
Unlike other mediclaim policies, this one provides a higher claimable amount and offers unique coverage to different critical diseases. The illnesses that are generally covered by the Critical Illness Mediclaim policy are as follows.
Note: This list may vary from company to company based on their proposed plans.
Traveling to a new country always comes with pleasure and anxiety because of the unforeseen odds. Overseas Medical Insurance is there to make your foreign trip worry-free as it is a health cover for the globetrotter (be it a business trip or leisure travel, or education trip), against the risk of hospitalization expenses abroad. The policy covers medical expenditures (inpatient and outpatient as well).
Most of the companies, under this policy, exclude pre-existing diseases, pregnancy, miscarriage, suicide, or attempt to suicide, among others.
This policy is for the people who seek low sum insured health insurance plans. This type of policy is very popular among the people because of its nature and as the cost of the premium amount is lower than other mediclaim policies. Another important fact about this type of policy is that it offers health cover to the unprivileged section of society. Generally, small and medium-scale industry employers buy this policy to cover their employees' medical expenses at a low cost.
This is a very common type of mediclaim policy that is offered to the employees of most of the industries in India. Group Mediclaim policy can also be offered to the members of large clubs or associations, but mostly it is seen to be used in the corporate world. The employer buys and pays a single and common premium of this health cover for all the employees. A small percentage is deducted from the salaries of the employees as the premium payment costs of the health cover. This mediclaim policy is very affordable and beneficial for the policyholders.
Here are some factors you need to keep in mind while buying a mediclaim policy.
Depending on your needs, you should select the coverage amount. There is no point in selecting a mediclaim policy of 2 lakhs SI if you are suffering from critical illnesses (as they demand higher medical expenses).
Co-pay & Deductibles
Under this clause, the insured has to pay a certain amount of the claim and the rest is covered by the insurer. So, look into the amount or percentage of the co-pay & deductibles.
If you wish to enjoy a cashless claim, choose the company that has nearby network hospitals under its umbrella.
Type Of The Policy
If you rarely travel abroad, there is no point in availing of an overseas mediclaim policy. Remember your need and then choose the type of policy.
Each mediclaim insurance company has a certain waiting period before which you cannot claim any medical expenses and there is a different waiting period for pre-existing diseases. So, carefully go through these exceptions.
Terms & Conditions
Insurance companies have some common and unique terms & conditions. Read them carefully and understand before availing of any policy.
Different companies offer different renewability ages. For most of the companies, the renewability age is life-long, whereas some have restrictions. So, it is advisable to check it before buying.
The basic differences between a mediclaim policy and health insurance are as follows.
|Mediclaim Insurance||Health Insurance|
|It only covers medical expenses if you are hospitalised.||It is comprehensive insurance and offers coverage beyond hospitalisation expenses like ambulance charges, OPD expenses, Ayush treatment expenses, etc.|
|It's not flexible in nature.||It's highly flexible and can be customized according to the needs.|
|It doesn't offer add-ons for extra protection.||It houses plenty of add-ons like critical illness cover, maternity cover, among others.|
|The hospitalisation cover is limited to 5 lakhs.||It has an extensive coverage amount, which varies as per age, city, etc.|
**Last Updated on 04-02-2021
Read More: Mediclaim policy Vs Health Insurance
Follow the below-mentioned steps to smoothly claim under the mediclaim policy.
Inform the insurer about the hospitalization before the admission (if the admission to the hospital is pre-planned). In case of emergency hospitalization, you have 24 hours to inform them.
You can ask the insurer for the claim form or else you can also download it from the official website or mobile app (if the company has any). Go through the instructions very carefully.
Before the discharge from the hospital, collect all the documents like receipts, bills, prescriptions, discharge papers, copies of the report, and so on.
Fill up the claim form carefully and attach all the required documents as asked by the insurer or written in the instructions of the claim form. No discrepancy will be entertained by the insurer in terms of the documents.
The procedure might take up to 45 days to get completed and in the meantime, you can be asked to provide some more documents.
Claims can be of two types - Cashless Claim and Reimbursement Claim. Both the procedures are almost the same with some differences. Let's take a look at it.
If you choose to make a cashless claim, you need to get admitted to one of the authorized network hospitals of the company. After the treatment is done, the hospital will directly send the bills to the company to settle it. This is the most convenient claim method for most of the mediclaim policyholders.
Under this, you have to pay the bills initially to the hospital, and then file for the reimbursement. After all the verification is over, the company will approve or reject the claim request.
In general, the necessary documents for the settlement of the claim are as follows.
Note: For safety, keep all the documents in original and photocopy forms. Apart from the above-mentioned documents, you might be asked to provide more documents.
The general exclusions are as follows.
Pre-existing illnessDental treatment (unless it requires hospitalisation)Sexually transmitted diseasesBirth control or hormonal treatments Cosmetic surgery and obesity-related treatmentsMaternity expensesNon-medical expenditures like service charges, administrative charges, toiletries, and so on Ailment or diseases contracted within a set period (30 days) from the policy purchase date
Note: There might be more or fewer exclusions varying from company to company.
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1. What is the age limit to buy a mediclaim policy?
Generally, it covers the age range from 18 years to 65 years. But it varies from one company to another and one plan to another. Some policies even cover newborn babies from the age of 91 days.
2. Does mediclaim cover accidents?
Most of the mediclaim policies do not cover accidents. There are separate personal accident insurance plans for it.
3. How can I port my mediclaim policy?
You just need to contact your insurer 45-60 days before the expiry of your current mediclaim policy. Then the respective insurer will guide you in further steps.
4. When can I file a claim after buying a mediclaim policy?
Generally, most of the companies do not allow filing a claim within the first 30 days after buying a mediclaim policy.
5. What are the major factors that affect the premium for Mediclaim policy?
The major factors are age, medical history, NCB, nature of work, etc.
6. Can I buy more than one mediclaim policy?
Yes, you can buy more than one mediclaim plan depending on your medical preferences.
7. Can I renew my policy after the expiry date of the policy?
Yes, you can. But you need to renew it within 30 days from your expiry date. This period is called the ‘Grace Period'. If you miss to renew it within the grace period, your policy will lapse.
Note: The grace period may vary from company to company.
8. What is the maximum number of claims that I can file in one year?
Any number of claims is permitted during the policy period unless the number of claims is specifically mentioned in the policy details. However, the sum insured is the maximum limit under the policy.
9. Can I pay the premium of my mediclaim policy in installments?
Generally, the premium is paid every year. But many companies provide the facility of installments on a monthly, quarterly, or half-yearly basis.
10. Will I be eligible for tax benefits if I buy a mediclaim policy?
Yes! Buying a mediclaim policy will earn you the eligibility to claim tax benefits under Section 80D of the Income Tax Act, 1961.
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