Mediclaim Policy: Compare & Buy Best Mediclaim Policy in India | ACKO

• Coverage for in-patient hospitalisation
• Option to choose cashless treatment
• Tax benefits
• Multiple options for sum insured as per your budget (ranging from ₹1 lakh to ₹1 crore)
• Low premium which may start from ₹10/day

As per IRDAI, insurance companies settled 2.7 crore claims worth ₹83,493 crore in FY24. It shows that a lot of people got financial help for medical treatments with a mediclaim policy.

Breaking it down simply:

• Medi = Medical treatment
• Claim = Getting money back from your insurance

Nowadays, 'mediclaim' and 'health insurance' are used interchangeably. However, mediclaim specifically refers to coverage for hospital bills, usually on an indemnity basis, so it reimburses the costs you incur on treatment.

Financial Security Against Medical Emergencies

Hospital bills in India can quickly add up, sometimes anywhere between ₹50,000 to ₹5 lakh depending on the city and treatment. A mediclaim policy helps during medical emergencies and protects your savings against unexpected medical costs.

Cashless Treatment Facility

With most insurers, you can get cashless treatment at over 10,000 hospitals across India. Just submit your health card, and the hospital bills are taken care of directly. You just have to pay a small portion of the hospital bill.

Tax Benefits Under Section 80D

• Self, spouse, children (below 60 years): ₹25,000
• Parents below 60 years: Additional ₹25,000
• Self/Parents (60+ years - Senior Citizen): ₹50,000 each
• Maximum Total Deduction: Up to ₹1 lakh

Cumulative Bonus for Claim-Free Years

You might get a bonus if you do not raise a claim. The insurance company may offer a bonus of 5% to 10% of your sum insured. So, if you are healthy and lead a stress-free life, then you can get more benefits.

Pre and Post-Hospitalisation Coverage

Mediclaim plan covers more than hospital bills. It can also cover medical expenses 30 to 90 days before you’re admitted and 60 to 120 days after you are discharged. This coverage can include tests, follow-ups, or medicines.

 Day Care Procedures Coverage

Mediclaim policies cover over 500 day-care procedures, treatments like dialysis, chemotherapy, cataract surgery, and angioplasty, that don’t need an overnight stay. You don't need to get admitted for 24 hours to raise a claim.

Individual Mediclaim Policy

This one covers just you, with a dedicated sum insured. Perfect if you are a young professional or do not have dependents.

Suitable for: Singles aged 18 to 45

Family Floater Mediclaim Policy

With a mediclaim policy, you and your family members can share the sum insured. This can include you, spouse, kids, and parents. This is a better option than buying one plan for each member.

Suitable for: Families with 2 to 6 members

Senior Citizen Mediclaim Policy

Made for those aged 60 and above. Covers age-related health issues, sometimes skips medical check-ups, and offers higher coverage options.

Suitable for: Parents and grandparents

Critical Illness Mediclaim

A critical illness mediclaim offers a lump sum if you are diagnosed with a major critical illness. Some of the commonly covered illnesses are cancer, kidney failure, stroke, etc.

Suitable for: People with a family history of serious illnesses or those who want extra financial cushioning beyond hospital expenses.

Maternity Mediclaim Policy

Covers pregnancy expenses, including delivery (normal or C-section), pre- and post-natal care, and sometimes even the newborn. Waiting periods usually range from 9 months to 4 years.

Suitable for: Couples planning to have a baby

Group Mediclaim Policy

Employees of companies offer mediclaim as a part of employee benefit. Employees and their immediate family members are insured under this plan.

Suitable for: Corporate employees

Top-up and Super Top-up Mediclaim

A smart, cost-effective way to boost your existing coverage. It kicks in once your base policy’s deductible is crossed.

Suitable for: Someone who is looking for higher coverage without paying a huge premium.

Covered (Inclusions)

• ✅ Room rent and ICU charges
• ✅ Doctor and surgeon fees
• ✅ Diagnostic tests (X-ray, MRI, blood tests)
• ✅ Medicines and consumables
• ✅ Operation theatre charges
• ✅ Anaesthesia costs
• ✅ Ambulance charges (up to a limit)
• ✅ Day care procedures (500+)
• ✅ Pre-hospitalisation expenses (30-60 days)
• ✅ Post-hospitalisation expenses (60-180 days)
• ✅ Organ donor expenses
• ✅ AYUSH treatments (Ayurveda, Yoga, Naturopathy, Unani, Siddha, Homeopathy)

Not Covered (Exclusions)

• ❌ Cosmetic/plastic surgery (unless accident-related)
• ❌ Dental treatment (unless due to accident/hospitalisation)
• ❌ Self-inflicted injuries
• ❌ Treatment for alcohol/drug abuse
• ❌ Injuries from hazardous activities
• ❌ Expenses within initial waiting period (30 days)
• ❌ Pre-existing diseases during waiting period (3 years max as per IRDAI 2024)
• ❌ Congenital diseases
• ❌ War, nuclear activity-related injuries
• ❌ Experimental treatments

1. No Upper Age Limit: Now anyone can get health insurance, no matter their age. Senior citizens aren’t left out anymore.
2. Shorter Waiting Period for Pre-existing Conditions: If you have conditions like diabetes or hypertension, the maximum waiting period is now 3 years instead of 4.
3. Reduced Moratorium Period: Insurers can’t reject claims for non-disclosure after 5 years of continuous coverage, down from 8 years, unless there’s fraud involved.
4. No Sub-limits on AYUSH Treatments: Alternative medicine treatments are fully covered now, with no hidden caps.
5. Faster Cashless Claims: Cashless claim approvals must happen within 1 hour of request.
6. Quick Discharge Authorization: Hospitals must get final discharge approvals within 3 hours.

These updates are designed to make health insurance smoother, faster, and fairer for everyone.

Assess Your Healthcare Needs

• Current health status
• Family medical history
• Number of dependents to cover
• City of residence (tier-1 cities have higher medical costs)

Determine Adequate Sum Insured

• Metro (Delhi, Mumbai, Bangalore): ₹10-25 lakh minimum
• Tier-2 cities: ₹5-15 lakh
• Tier-3 cities/Rural: ₹3-10 lakh

Pro tip: Consider medical inflation of 14% annually when choosing sum insured.

Compare Mediclaim Premium

Use a mediclaim premium calculator to compare premiums across insurers. Factors affecting premium:

• Age of insured
• Sum insured
• Number of family members
• Pre-existing conditions
• City zone
• Policy tenure

Verify Network Hospitals

Ensure sufficient network hospitals in your city for cashless treatment.

Understand Waiting Periods

• Initial waiting period: 30 days
• Pre-existing disease: 3 years (max)
• Specific diseases: 2-3 years
• Maternity: 9 months to 4 years

Input Parameters:

1. Age of policyholder(s)
2. Number of members
3. Sum insured required
4. City/Zone]
5. Pre-existing conditions (if any)

Cashless Mediclaim: How It Works

There could be two situations when you need to raise a cashless claim. First is in case of an emergency, and secondly, in case of a planned hospitalisation. Here are the steps for both.

Emergency Situation

• Go to a network hospital if possible and get admitted
• Inform the insurance company about the hospitalisation within 24 hours

The TPA may ask for a few basic details like policy number from you and treatment-related details from the hospital. Once approved, the insurer will pay the bill.You may have to contribute a small percentage of the total bill.

For Planned Hospitalisation

• Let your insurer know 48 to 72 hours before admission.
• Submit the pre-authorisation form at the hospital’s TPA desk.
• The insurer approves it, within 1 hour thanks to IRDAI rules.
• Check in with your health card and start treatment.
• Bills are handled directly by the insurer.
• Discharge approval comes within 3 hours.
• You pay only for anything not covered by your policy.

Mediclaim Reimbursement: If You Visit a Non-Network Hospital

• Pay the hospital bills yourself.
• Collect all important documents:

-Original bills and receipts
-Discharge summary
-Prescriptions
-Diagnostic reports
-Policy copy

• Fill out the claim form within 30 days of discharge.
• Submit it to your insurer or TPA.
• The insurer verifies the documents and processes your claim, usually within 30 days.
• Reimbursement is credited straight to your bank account.

You can save on taxes when you pay for a mediclaim policy. Here’s how:

• Pay your premium through online transfer, cheque, or other non-cash methods.
• Claim the deduction when filing your Income Tax Return.
• Keep your premium receipts handy as proof.

What you can claim:

• Self + Family (below 60 years): Up to ₹25,000
• Self + Family (senior citizens): Up to ₹50,000
• Parents (below 60 years): Additional ₹25,000
• Parents (senior citizens): Additional ₹50,000
• Preventive health check-ups: ₹5,000 (counts within the above limits)

If everyone insured is a senior citizen, the maximum total deduction can go up to ₹1,00,000.

At Purchase

• Identity proof (Aadhaar, PAN, Passport)
• Age proof (Birth certificate, 10th marksheet)
• Address proof
• Passport-size photographs
• Medical reports (if required)

For Claims

• Duly filled claim form
• Policy copy
• Hospital bills (original)
• Discharge summary
• Doctor's prescriptions
• Diagnostic test reports
• Payment receipts
• Pre-authorization form (for cashless)

1. Most policies give a 30-day grace period for annual or half-yearly premiums.
2. Renew on time to keep all your benefits intact.
3. Your no-claim bonus stays safe if you renew without delay.
4. Waiting periods for pre-existing conditions continue counting with uninterrupted coverage.
5. Not happy with your insurer? Port your policy and switch while keeping all benefits.

• Affordable plans because of 0% GST on health insurance
• 100% digital experience when you buy, renew, or claim insurance
• No confusing paperwork as the process is digital
• Cashless treatment nationwide with 11,500+ network hospitals
• Cheaper plans as there is no middleman, we sell directly to you
• No hidden costs with transparent pricing

1. Enter your age and city
2. Select family members to cover
3. Choose sum insured
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