Mediclaim Policy: Definition, Benefits, Types, & More

Mediclaim Policy Guide - BimaBandhu

Out of the common fears amongst the masses in India, there is the fear of facing healthcare emergencies and the resulting financial burden. Medical inflation has made healthcare services unaffordable to many. This is why, many individuals look forward to buying mediclaim early in their lives. Buying the best mediclaim policy is important to pay for medical treatments whenever required without losing your hard-earned savings. 

Let’s cover mediclaim in detail to help you make an informed decision. 

What is Mediclaim? 

Mediclaim policy is similar to health insurance and covers medical expenses of the insured in case of health emergencies. The chosen insurer will pay for the treatment required for illness or accident up to the chosen sum insured. It also covers the hospitalization expenses, which include day-care treatment, room rent, in-patient cover, to name a few.  

You can also avail cashless treatment at network hospitals under your mediclaim policy. Apart from buying mediclaim for yourself, you can also purchase a mediclaim policy for family to get the insurance benefits whenever they need quality healthcare treatment. 

What are the Benefits of Buying a Mediclaim Policy? 

Lifestyle diseases are on the rise in India, along with the cost of getting good quality healthcare treatment. With a mediclaim policy by your side, you can get the much-needed financial backing from your insurer in case of any healthcare emergency.  

Given below are some of the primary benefits of purchasing a mediclaim policy: 

  • Buying mediclaim is synonymous with a cost-effective method of paying for healthcare services without losing all your savings. 
  • You can get cashless treatment in network hospitals related to your insurer, thus eliminating the need for out-of-pocket expenses. 
  • Mediclaim can help lower your financial burden by providing monetary assistance when it is needed the most. 
  • It is available as both individual and family floater policies. 
  • It covers the in-patient hospitalization expenses incurred due to an accidental injury or illness. 
  • You can renew your mediclaim policy every year throughout your lifetime (depending on the policy chosen) 
  • You can save tax in terms of the mediclaim premium paid every year, under Section 80D. 

Which Types of Mediclaim Policy are Available in India? 

You can choose from the following types of mediclaim policies available in the country as per your health condition and long-term needs: 

  • Individual mediclaim policy to provide health insurance benefits to the insured individual only 
  • Family floater mediclaim policy to cover an individual along with his/her family members under one plan 
  • Senior citizen mediclaim insurance policy to cover medical needs of the elderly people above the age of 60 years 

Also Read: A Comprehensive Guide to Family Floater Health Insurance 

Mediclaim Policy Vs. Health Insurance – Comparison 

The following table illustrates the comparison between a mediclaim policy and a health insurance plan: 

Parameter  Mediclaim Policy  Health Insurance 
Benefit  Reimburses or pay for the actual medical treatment expenses incurred during in-patient hospitalization only  Covers medical expenses incurred, in addition to expenses related to hospitalization, such as OPD expenses, day-care treatment expenses, etc.  
Scope  Narrow  Comparatively wider 
Premium  Low because of limited cover  Higher than mediclaim because of extensive coverage 
Add-ons   Not available  Available 

 What is Covered in a Mediclaim Policy? – Inclusions 

In general, mediclaim provides insurance coverage for the following expenses: 

  • Direct expenses incurred during hospitalization – both for sickness and accidental care 
  • Hospital room rent – both for regular ward or ICU 
  • Fee charged by doctor, surgeons, and other medical professionals involved in the treatment 

What is not Covered in a Mediclaim Policy? – Exclusions 

The limitations of mediclaim policies are generally defined in terms of their exclusions. A mediclaim policy does not cover: 

  • Pre-existing ailments until the waiting period is over 
  • Any healthcare problem or critical illness diagnosed within 30 days from the date of policy issuance 
  • Dental surgeries unless they require hospitalization 
  • Childbirth complications 
  • Suicide injuries 
  • Congenital Anomaly 
  • HIV AIDS 

**To know the complete list of inclusions and exclusions of your mediclaim policy, you are advised to read the policy documents. 

What are the Factors You Should Consider While Buying a Mediclaim Policy? 

If you have plans to buy a mediclaim policy for yourself or your loved ones, you must know about various factors that can help you compare policies. These include: 

  • Type of mediclaim policy 

In an individual mediclaim policy, the insured gets full coverage of the selected insured amount. On the other hand, the whole family shares the chosen sum insured in a family floater plan. 

  • Sum Insured 

Select adequate sum insured or mediclaim coverage amount by considering medical inflation and overall rate of inflation. 

  • Co-payment clause 

Check for the co-payment clause in your policy which usually says that you need to bear a partial cost of medical expenses in case of any emergency. The co-payment, in general, ranges from 10-30%, based on the chosen policy and insurance company. 

  • Network hospitals 

Check the list of network hospitals where you can avail cashless treatment benefits to look for the ones near you before you buy the policy. 

  • Pre-existing disease coverage 

Check for the pre-existing disease waiting period after which you can file a claim for the treatment of such diseases. 

You May Like to Read: All About Waiting Period in Health Insurance 

  • Renewability Age 

Ask your insurer if you can get the lifetime renewability option for policy renewal irrespective of your age. This is important as it becomes difficult to find a suitable mediclaim policy at old age.  

How to File a Claim Under Your Mediclaim Policy? 

You can raise/file a claim under your mediclaim policy in two ways: 

Cashless Claim 

This type of claim implies that the insurer will settle the bills directly with the network hospital. The insured does not need to pay anything for the required treatments.  

Given below are the steps to file a cashless claim: 

  • Visit any of the network hospitals listed in your policy 
  • Ask for a pre-authorization form from the insurance desk. 
  • Fill the form correctly and get it stamped by the hospital. 
  • The hospital will pass it to the insurer or TPA (Third Party Administrator) for approval. 
  • Post claim approval, the insurer will inform the hospital about the amount covered under the policy. 
  • You can get the treatment and sign the required documents at the time of discharge. 

Reimbursement Claim 

For reimbursement claims, you need to inform the insurer about the hospitalization via email or call. After receiving the treatment, collect all the medical documents including bills, reports, and payment receipts, and then submit them all to your insurer with the claim form. 

After reviewing your claim, the insurer will reimburse the expenses incurred as per the policy terms post claim approval. 

What are the Documents required to Buy a Mediclaim Policy? 

You need the following documents to buy mediclaim: 

  • Proposal form 
  • Age proof 
  • Identity proof 
  • Address proof 
  • Pre-policy medical test reports 

A wide range of mediclaim policies is available by multiple insurers in India. Given below are some of the popular policies you may consider buying: 

  • Aditya Birla Mediclaim Policy 
  • Bajaj Allianz Mediclaim Policy 
  • Care Health Insurance Mediclaim Policy 
  • Bharti AXA Mediclaim Policy 
  • Digit Mediclaim Policy 
  • Cholamandalam Mediclaim Policy 
  • Edelweiss Mediclaim Policy 
  • IFFCO Tokio Individual Medishield Mediclaim Policy 
  • Future Generali Mediclaim Policy 
  • Kotak Mahindra Mediclaim Policy 
  • Liberty Mediclaim Policy, and many others 

Disclaimer: We do not endorse or rate any particular insurer or policies. 

How Can BimaBandhu Help You a Mediclaim Policy? 

BimaBandhu is an all-inclusive insurance information portal that can help you find the most suitable insurance policies, including mediclaim. By reading our well-detailed guides about different types of insurance policies, you can feel confident to make the right choice. You can also use mediclaim premium calculators online to plan for other financial goals in life. 

Why Should You Buy a Mediclaim Policy Online? 

  • Convenience of comparing different policies before buying one 
  • Security of payments provided you choose a trusted insurer or aggregator 
  • Easy to pay premium using multiple payment modes 
  • Easy to customize the mediclaim policy 

Mediclaim Policy FAQs 

 

What can I get under the best mediclaim policy? 

You will get coverage for various hospitalization expenses as defined in the policy document. 

Does mediclaim cover Coronavirus treatment? 

All the insurers are mandated by the IRDAI to cover hospitalization related to Coronavirus under their mediclaim policies. However, you are advised to ask your insurer about the related coverage. 

How can I claim the benefits of a mediclaim policy? 

You can do this by filing either a cashless claim or reimbursement claim for the same. Please refer to the steps given above. 

How to select the most suitable mediclaim policy? 

Start with comparing different policies online in terms of their features, benefits, types, and premium. 

It usually varies from one insurance company to another. In general, people falling between the age group of 18 to 65 years can easily buy a mediclaim policy.  

Which is the best mediclaim policy in India? 

It would be best to compare different mediclaim plans and select the one that best fits your needs.  

Are accidental injuries covered under mediclaim? 

Hospitalization expenses incurred to the insured in case of an accident are covered under mediclaim insurance. 

What is a cashless mediclaim? 

In cashless mediclaim, the chosen insurer settled your hospitalization expenses with the hospital directly. 

Is LASIK surgery covered under mediclaim insurance? 

It is generally not covered under most of the mediclaim policies. Ask your insurer for more details. 

What is a group mediclaim policy? 

Corporates and organisations buy group mediclaim policies for health benefits. Here, the employer pays the premium to cover all of their employees under one plan.  

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