Mediclaim Policy

The rising cost of healthcare, driven by medical inflation, has rendered medical services expensive. If you find yourself hospitalized due to a medical emergency, the resulting bill can quickly deplete your lifelong savings. Acquiring a mediclaim policy presents the optimal solution to cover the expenses of costly medical treatments without jeopardizing your savings.

What is a Mediclaim Policy?

A Mediclaim policy functions as a type of health insurance specifically designed to cover medical expenses incurred during hospitalization. It provides coverage for hospitalization expenses up to the predetermined sum insured limit. Additionally, Mediclaim insurance extends the benefit of cashless treatment at the insurer’s network hospitals and is available on both an individual and floater sum insured basis.

Benefits of Obtaining a Mediclaim Policy

Given the escalating prevalence of lifestyle diseases, the associated costs of hospitalization and healthcare have skyrocketed. Purchasing a mediclaim policy offers crucial financial support during hospitalization in the event of a medical emergency. Explore the numerous advantages of investing in a mediclaim policy outlined below:

Cost-effectiveness: A mediclaim policy provides a cost-effective means of accessing healthcare services without depleting your savings.
Cashless Treatment: The policy includes a cashless hospitalization facility at all network hospitals of your insurance company, eliminating out-of-pocket expenses during a medical emergency.
Alleviates Financial Stress: By offering monetary assistance during a medical emergency, the policy mitigates the financial burden on the policyholder and their family.
Individual and Family Floater Cover: Both individual and family floater policies are available in the market to cater to diverse needs.
Hospitalization Expenses: Mediclaim policies cover in-patient hospitalization expenses, encompassing OT expenses, doctor’s fees, nursing charges, medicine costs, etc., incurred due to illness or accidental injury.
Lifelong Renewability: Depending on the chosen policy, a mediclaim policy may offer an option for lifelong renewability to the policyholder.
Additional Benefits: The policy comes with various supplementary benefits, such as coverage for ICU charges, room rent, etc.
Tax Exemption Benefits: Policyholders can avail of tax benefits under section 80D on the annual premium paid for the mediclaim policy.

List of Best Mediclaim Policies in India

While numerous insurance companies in India provide a variety of mediclaim policies, here are some of the top choices you may want to consider:

Mediclaim Policies	Sum Insured (Rs)	Network Hospitals
Aditya Birla Mediclaim Policy	2 lakh – 2 crore	10500+
Bajaj Allianz Mediclaim Policy	3000 – 50,000 per day	8000+
Care Health Insurance Mediclaim Policy	25 lakh – 1 crore	21100+
Cholamandalam Mediclaim Policy	5 – 25 lakh	10500+
Digit Mediclaim Policy	2 lakh – 3 crore	10500+
Future Generali Mediclaim Policy	2 – 5 lakh	8000+
IFFCO Tokio Individual Mediclaim Policy	50,000 – 20 lakh	7000+
Kotak Mahindra Mediclaim Policy	2 – 25 lakh	7000+
Liberty Mediclaim Policy	2 – 15 lakh	5800+
Magma HDI Mediclaim Policy	2 lakh – 1 crore	7200+
ManipalCigna Mediclaim Policy	4 – 5 lakh	8500+
National Mediclaim Policy	1 – 10 lakh	6000+
New India Assurance Mediclaim Policy	1 – 15 lakh	3100+
Niva Bupa (Formerly known as Max Bupa) Mediclaim Policy	3 lakh – 1 crore	8600+
Oriental Individual Mediclaim Plan	1- 50 lakh	3300+
Raheja QBE Mediclaim Policy	1 – 50 lakh	5000+
Reliance Mediclaim Policy	1 – 5 lakh	9100+
Royal Sundaram Mediclaim Policy	5 – 25 lakh	10000+
SBI Mediclaim Policy	10 – 30 lakh	20000+
Star Mediclaim Policy	1 – 5 lakh	14000+
Tata AIG Mediclaim Policy	3 – 20 lakh	7200+
United India Mediclaim Policy	4 – 5 lakh	3000+
Universal Sompo Mediclaim Policy	1 – 50 lakh	6000+
Zuno (Formerly Edelweiss) Mediclaim Policy	1 lakh – 1 crore	6000+

Types of Mediclaim Policies in India

In India, there are various types of mediclaim policies catering to different health needs. These policies ensure that individuals can access medical treatment with peace of mind. Let’s explore the different types of mediclaim plans:

Individual Mediclaim Policy:
- This policy provides health insurance coverage exclusively to the policyholder.
- Only one person can avail the medical insurance benefits against the premium paid.
- Numerous health insurance companies offer individual mediclaim plans in India.
Family Floater Mediclaim Policy:
- A family floater mediclaim policy extends coverage to the policyholder and their family members, including parents, spouse, and children.
- Under this policy, a single sum insured amount is available to all family members on a floater basis, providing a collective coverage.
Senior Citizen Mediclaim Policy:
- Specifically designed for individuals above the age of 60, this policy covers hospitalization expenses incurred by elderly people.
- The coverage of senior citizen health insurance policies is customized to address the unique health needs of seniors.

Comparison Between Mediclaim Policy and Health Insurance:

Categories	Mediclaim Policy	Health Insurance
Meaning	Reimburses actual medical expenses during hospitalization only.	Covers medical expenses beyond hospitalization, including day care procedures, OPD expenses, and pre-post hospitalization expenses. Provides a lump sum on the diagnosis of covered critical diseases, regardless of medical expenditure.
Scope of Coverage	Has a narrow focus, covering hospitalization expenses due to accidents or illnesses.	Encompasses a broader range, including hospitalization expenses, ambulance charges, day care procedures, critical illness, etc.
Premium	Typically has a lower premium due to limited coverage.	Generally, has a higher premium as it offers comprehensive coverage.
Add-on Covers	Does not offer any add-on covers.	Comes with various add-on covers like maternity benefits, critical illness cover, worldwide coverage, etc.

What is Covered in a Mediclaim Policy?

A mediclaim policy offers coverage for various expenses associated with medical treatment:

Hospitalization Charges:
- Covers direct charges incurred during hospitalization, including OT charges, diagnostic procedures, blood, oxygen, medicines, chemotherapy, x-ray, radiotherapy, donor expenses, pacemakers, etc.
- Provides coverage for both sickness and accidental hospitalization.
Hospital Room Charges:
- Fully reimburses charges for a regular ward or intensive care unit through cashless hospitalization at network hospitals.
Fees Charged by Medical Professionals:
- Compensation for fees charged by doctors, surgeons, nurses, anesthetists, etc., while admitted to the hospital.

What is Not Covered in a Mediclaim Policy?

Certain circumstances can lead to claim denial:

Pre-existing ailments are not covered until the waiting period is over.
Medical conditions or critical illnesses diagnosed within 30 days of the policy commencement date are not covered.
Specific ailments like joint replacement surgery are excluded for 2 to 4 years.
Expenses from dental surgeries unless requiring hospitalization, birth control, hormonal treatment, complications during childbirth, ectopic pregnancies, suicide attempts, congenital anomalies, addiction to alcohol or drugs, and HIV AIDS are not covered.

Check the policy documents for a comprehensive list of exclusions.

Factors to Consider While Buying a Mediclaim Policy:

Consider the following factors when purchasing a mediclaim policy:

Individual and Family Floater:
- Individual plans provide coverage for a specific amount per person, while family floater plans cover the entire family for a fixed sum assured.
- Note the implications for family floater plans when the primary person exits or dies.
Sum Insured (Coverage Amount):
- Consider factors like inflation, rising healthcare costs, and location when choosing the coverage amount.
- Higher coverage may be necessary for metropolitan areas or when covering multiple family members.
Co-payment Option:
- Some plans include a co-payment clause, where the insured bears a percentage of the claim amount.
- Check the co-payment terms, typically ranging from 10% to 30%.
Exclusions:
- Be aware of medical expenses covered after a waiting period or not covered at all.
- Check exclusions such as HIV infection, drug or alcohol addiction, and specific diseases covered after a waiting period.
Network Hospitals:
- Verify the list of network hospitals for cashless settlement of hospitalization expenses.
- Ensure the availability of network hospitals in your area before purchasing the policy.
Renewability Age:
- Check if the policy offers a lifetime renewability option, especially crucial for older individuals.
- Confirm the renewability age to ensure continued coverage despite age.
Pre-existing Disease:
- Assess the waiting period for coverage of pre-existing diseases.

Opt for a policy that provides coverage for pre-existing diseases at the earliest possible time.

Mediclaim Policy Claim Process:

There are two types of claims that can be raised under a mediclaim policy: cashless claim and reimbursement claim. The procedures for each are outlined below:

1. Cashless Claim Procedure:

Cashless claims ensure that a patient receives treatment in a network hospital on a cashless basis, with the insurer settling the bill directly. The insured doesn’t need to make any payments to the hospital. Follow these steps to raise a cashless claim:

Visit an empanelled hospital of your insurance company for treatment.
Obtain a pre-authorization form from the insurance desk at the hospital.
Fill the form accurately 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 approval, the company will inform the hospital of the covered amount.
Receive treatment, sign discharge documents, and the insurer will pay the hospital bill directly.

2. Reimbursement Claim Procedure:

For a reimbursement claim, inform your insurance company about hospitalization through email or customer service. After treatment, collect all medical documents from the hospital. To claim reimbursement, submit hospital bills, payment receipts, medicine bills, original discharge card, and claim form to your insurer. The company will review the claim and pay the reimbursement after approval.

Documents Required While Buying a Mediclaim Policy:

The following documents are necessary when purchasing a mediclaim policy:

Duly filled proposal form
Proof of age (Aadhaar card, passport, voter ID, etc.)
Identity proof (passport, Aadhaar card, driving license, etc.)
Address proof (driving license, passport, Aadhaar card, etc.)
Passport-size photograph
Pre-policy medical test reports

FAQs:

Explore frequently asked questions regarding mediclaim policies:

What does the best mediclaim policy cover?
- It covers hospitalization expenses, including OT charges, medicines, oxygen, blood, diagnostic tests, and technologically advanced treatments.
Does a mediclaim policy cover coronavirus?
- Yes, as per IRDAI regulations, medical insurance providers are mandated to cover coronavirus-related hospitalization expenses.
How do I claim benefits from my mediclaim policy?
- Benefits can be claimed through reimbursement or cashless claim processes. Inform the insurer, submit required documents, and follow the specified procedure.
How to select the right mediclaim policy?
- Compare policies online, considering factors like coverage, co-payment, exclusions, network hospitals, and renewal options.
What is the age criterion to buy a mediclaim policy?
- The age criterion varies among insurers, typically covering individuals between 18 and 65 years, with some plans offering lifetime renewability.
What do I need to do after I get hospitalized?
- Inform the TPA, fill the claim form, and submit necessary documents for reimbursement. For cashless claims, follow the pre-authorization process.
Does mediclaim cover accidents?
- Yes, any hospitalization expenses due to accidents are covered under a basic mediclaim policy.
What is a cashless mediclaim policy?
- In a cashless mediclaim policy, the insurer settles hospitalization expenses directly with the hospital, eliminating the need for the insured to make payments.
Which mediclaim policy covers LASIK surgery?
- LASIK surgery is generally not covered under most mediclaim policies. Check with the insurer for specific coverage options.
What is a group mediclaim policy?
- A group mediclaim policy is offered by companies to employees, covering family members in some cases. The employer pays the premium, and coverage may be limited.
What is an overseas mediclaim policy?
- An overseas mediclaim policy covers emergency hospitalization expenses when traveling abroad.
When can you file a claim after buying a policy?
- Claims for illnesses arising during the initial 30 days of policy purchase are generally not accepted. However, accidental hospitalization expenses are covered during this period.
How is a mediclaim policy different from health insurance?
- A mediclaim policy covers hospitalization expenses only, while health insurance includes broader coverage, such as doctor fees, room rent, and additional benefits like critical illness cover and maternity cover.