Mediclaim Policy

Mediclaim Policy

Mediclaim helps you stay stress-free and financially secure during difficult times. Policyholders can opt for either cashless or reimbursement claims. These policies also offer tax benefits. Mediclaim insurance provides financial assistance during medical emergencies and hospitalization. It covers insured individuals against medical expenses during the policy period and offers tax benefits under Section 80D of the Income Tax Act, 1961.

Medical inflation makes healthcare services increasingly expensive. In a medical emergency requiring hospitalization, the resulting bills can quickly deplete your savings. Buying a mediclaim insurance policy is an effective way to cover costly medical treatments without exhausting your savings.

What is Mediclaim?

Mediclaim is a reliable option to manage significant expenses arising from unforeseen medical emergencies. Mediclaim insurance protects the insured against rising healthcare expenses due to hospitalization from illness or accident, often without out-of-pocket costs.

In simple terms, mediclaim involves insurance companies collaborating with a network of hospitals across the country. This collaboration allows for cashless treatment, where hospital and treatment expenses are settled directly by insurance providers on behalf of policyholders. Cashless claim service is highly beneficial during a medical emergency.

What Are the Benefits of Mediclaim Insurance?

A mediclaim policy is a must-have insurance plan as it offers numerous benefits to the insured. Let’s find out the advantages of a mediclaim policy in general:

• Provides cashless hospitalization.
• Offers financial support during medical emergencies.
• Alleviates financial burdens.
• Facilitates online purchase of policies, saving time and effort.
• Offers tax benefits under the Income Tax Act, 1961.
• Enables access to cost-effective healthcare services.
• Provides additional benefits under Senior Citizen Mediclaim Policies.
• Covers pre- and post-hospitalization medical expenses, subject to certain conditions.
• Reimburses expenses for regular ward or Intensive Care Unit (ICU).
• Covers day-care expenses.
• Covers COVID-19 treatment expenses.

Difference Between Health Insurance and Mediclaim

Health insurance and mediclaim are often used synonymously; however, they differ in nature. Mediclaim insurance policies work on an indemnity basis, meaning any medical expense incurred by the policyholder is reimbursed by the insurer. Health insurance plans typically pay a lump sum if the policyholder encounters situations like critical illness or accidents. To understand the differences, refer to the table below:

Best Mediclaim Policies in India

Below is a list of a few of the best mediclaim policies available in India. Take a look and choose your ideal mediclaim insurance policy.

What Are the Types of Mediclaim Policies in India?

To safeguard your financial well-being against medical expenses, various health insurance companies in India offer different policies. The major types are:

• Individual mediclaim policy
• Family-floater mediclaim policy
• Senior citizen mediclaim policy
• Critical illness mediclaim policy
• Overseas mediclaim policy
• Low-cost mediclaim policy
• Group Mediclaim Policy

Let’s explore each policy type in detail.

Individual Mediclaim Policy

An Individual Mediclaim policy is a health cover designed to reimburse medical expenses for a single person under one plan. All policy benefits are exclusively for the insured individual. The premium is determined by factors such as the individual’s age, health, and lifestyle. It is one of the most popular health insurance schemes in India.

Family-Floater Mediclaim Policy

A Family-Floater Mediclaim policy is a health insurance cover that compensates the entire family for medical expenditures under a single premium and a fixed sum insured. The sum insured can be utilized for multiple hospitalizations of family members.

This policy covers you, your children, and your spouse on a floater sum insured basis. Some companies also cover dependent parents under this policy. This plan can be customized to your convenience and requirements.

Senior Citizen Mediclaim Policy

For senior citizens, a health insurance plan is crucial to prevent financial crises due to medical treatment. A Senior Citizen Mediclaim policy is a health cover that typically provides benefits to individuals aged between 60 and 80 years. Consumers often need to undergo a medical check-up (as prescribed by the insurer) to detect any pre-existing diseases or ailments.

This policy often offers unique benefits such as cashless hospitalization, daycare expenses, pre-existing disease cover, and room and boarding expenses. Specific benefits may vary by company.

Critical Illness Mediclaim Policy

When a person is diagnosed with a critical illness, they often face significant treatment costs. A Critical Illness Mediclaim policy is designed to cover critical illness expenditures, providing the insured with a lump sum amount to begin treatment without financial strain.

Unlike other mediclaim policies, this one provides a higher claimable amount and offers specific coverage for various critical diseases. Common illnesses covered by Critical Illness Mediclaim policies include:

• Cancer
• Kidney failure
• Heart attack
• Aorta graft surgery
• Paralysis
• Stroke
• Major organ transplant
• Coronary artery bypass surgery
• Multiple sclerosis
• Primary pulmonary arterial hypertension.

Note: This list may vary by company based on their plans.

Overseas Mediclaim Policy

Traveling to a new country can bring both pleasure and anxiety due to unforeseen circumstances. Overseas Mediclaim Insurance makes your foreign trip worry-free by covering hospitalization expenses abroad for business, leisure, or education. The policy covers both inpatient and outpatient medical expenditures.

Most companies, under this policy, exclude pre-existing diseases, pregnancy, miscarriage, suicide or attempted suicide, among others.

Low-Cost Mediclaim Policy

This policy is for individuals seeking low sum insured health insurance plans. This policy type is popular due to its affordable premium compared to other mediclaim policies. It also offers health cover to underprivileged sections of society. Small and medium-scale industry employers often purchase this policy to cover their employees’ medical expenses at a low cost.

Group Mediclaim Policy

This is a common mediclaim policy offered to employees in most Indian industries. Group Mediclaim policies can also be offered to members of large clubs or associations, but are predominantly used in the corporate world. The employer purchases and pays a single premium for this health cover for all employees. A small percentage may be deducted from employee salaries as premium payment. This mediclaim policy is affordable and beneficial for policyholders.

What Are the Things to Remember While Buying a Mediclaim Policy?

Here are some factors you need to keep in mind while buying a mediclaim policy:

• Coverage

  Select the coverage amount based on your needs. For instance, a ₹2 lakh sum insured may be insufficient if you have critical illnesses requiring higher medical expenses.

• Co-pay & Deductibles

  Under this clause, the insured pays a certain portion of the claim, with the insurer covering the rest. Review the co-pay and deductible amounts or percentages carefully.

• Network Hospitals

  To avail cashless claims, choose an insurer with a strong network of hospitals conveniently located near you.

• Type of the Policy

  Choose the policy type based on your specific needs. For example, an overseas mediclaim policy may not be necessary if you rarely travel abroad.

• Waiting Period

  Each mediclaim insurance company has a waiting period before claims can be made, and a separate waiting period for pre-existing diseases. Review these conditions carefully.

• Terms & Conditions

  Insurance companies have common and unique terms and conditions. Read and understand them carefully before purchasing any policy.

• Renewability Age

  Different companies offer varying renewability ages. While many offer lifelong renewal, some have restrictions. It is advisable to check this before buying.

Mediclaim Policy vs. Health Insurance

The basic differences between a mediclaim policy and health insurance are as follows:

Read More: Mediclaim Policy vs. Health Insurance

What’s the Claim Procedure Under Mediclaim Insurance?

Follow the below-mentioned steps to smoothly claim under the mediclaim policy:

1. Inform the Insurance Company

   Inform the insurer about planned hospitalization in advance. For emergency hospitalization, you typically have 24 hours to notify them.

2. Claim Form

   Obtain the claim form from the insurer, their official website, or mobile app. Read the instructions carefully.

3. Documents

   Before discharge, collect all necessary documents such as receipts, bills, prescriptions, discharge papers, and copies of reports.

4. Documents Submission

   Fill out the claim form carefully and attach all required documents as specified by the insurer or in the claim form instructions. Discrepancies in documents will not be entertained.

5. Additional Requirement

   The procedure may take up to 45 days to complete, and you might be asked to provide additional documents during this period.

Cashless Claim vs. Reimbursement Claim

Claims can be of two types: Cashless Claim and Reimbursement Claim. Both procedures are almost the same with some differences. Let’s take a look at it.

• Cashless Claim

  For a cashless claim, you must be admitted to one of the insurer’s authorized network hospitals. After treatment, the hospital directly sends the bills to the company for settlement. This is often the most convenient claim method.

• Reimbursement Claim

  Under a reimbursement claim, you initially pay the hospital bills and then file for reimbursement. After verification, the company will approve or reject the claim request.

Required Documents for the Claim

In general, the necessary documents for the settlement of the claim are as follows:

• Bills and receipts of the hospital.
• Copies of the medical report, discharge paper, admission form, and prescription.
• Medical certificate or form signed by the doctor.
• Duly filled claim form.
• Copy of the policy form.
• Patient’s discharge summary.
• In case of an accident, Medico-Legal Certificate and an FIR or any police report.
• Address proof and age proof.

Note: Keep all documents in both original and photocopy forms for safety. You may be asked to provide additional documents beyond those listed.

What Are the Exclusions of a Mediclaim Policy?

The general exclusions are as follows:

• Pre-existing illness
• Dental treatment (unless it requires hospitalization)
• Sexually transmitted diseases
• Birth control or hormonal treatments
• Cosmetic surgery and obesity-related treatments
• Maternity expenses
• Non-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: Exclusions may vary by company.