A mediclaim policy can provide a helping hand during emergencies especially when healthcare costs are at an all time high. It is not just a financial backup but mediclaim plans are a way to ensure that you get timely treatment at top hospitals. In this article, let’s deep dive into the best mediclaim policy in India and check what all is covered.
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Mediclaim Policy, also known as health insurance, is a useful financial tool that helps you during a medical emergency. Having this back-up is important as healthcare costs are rising and with a mediclaim policy you don’t have to worry about arranging the money for paying hospital bills.
Under a mediclaim policy you can get coverage for hospitalisation, ICU charges, surgery costs, etc. in case you or an insured family member suffer from an accident or an illness. You can buy a mediclaim policy either online or offline through the traditional way.
Mediclaim can offer a bunch of benefits that make your treatment easy and affordable in the time of need. Here is a list of benefits of buying a mediclaim policy in India.
Having a medical insurance policy provides financial security when you fall sick and need medical help. This policy covers hospitalisation, surgical costs, laboratory tests, diagnostic procedures, post-hospitalisation care, etc. It guarantees that you do not incur new debt or spend out your savings as you heal and recover.
India boasts a diverse healthcare landscape, offering a spectrum of medical services. However, quality healthcare often comes at a price. Mediclaim policies facilitate access to a network of hospitals and healthcare providers, ensuring that you receive timely and quality medical care without compromising on your financial stability. Many policies also cover outpatient expenses, making preventive healthcare more affordable.
In the realm of financial planning, Mediclaim policies bring an added advantage – tax benefits. Under Section 80D of the Income Tax Act, the premiums paid towards health insurance policies for self, family, and parents are eligible for tax deductions (depending upon the tax regime). This dual benefit of safeguarding your health and saving on taxes makes Mediclaim policies a smart financial choice.
Mediclaim policies often come with the incentive of a cumulative bonus, wherein the sum insured increases for every claim-free year. This encourages policyholders to adopt a healthier lifestyle and preventive healthcare practices. Such characteristics, apart from promoting wellness, also help reduce long-term costs.
The best mediclaim policy comes with diverse coverage options, allowing individuals to choose plans that align with their specific health needs. From maternity benefits to coverage for critical illnesses, insurers offer a range of add-ons and customisation features. This flexibility ensures that your Mediclaim policy caters to your unique healthcare requirements.
Cashless claim settlement has revolutionised health insurance in India. With a Mediclaim policy, you can avail cashless hospitalisation where the insurer settles bills directly with the hospital, eliminating upfront payments and ensuring a stress-free experience during a medical crisis.
Family floater plans under Mediclaim policies provide comprehensive coverage for the entire family under a single policy. This proves cost-effective and convenient, especially for families with varying health needs. The sum insured can be used by any family member as needed, offering a holistic approach to family healthcare.
Mediclaim insurance can be of various types. You need to choose the one that is suitable to you and fits the budget without compromising on the coverage. Here are various types of mediclaim policies available in India.
Individual health insurance policies are tailored for a single person. This policy offers coverages like hospitalisation expenses, pre and post-hospitalisations costs, and day-care procedures. This policy is ideal for people with less number of dependents.
In a country where family is a cornerstone, family health insurance policies offer a comprehensive solution. Covering the entire family under a single policy, it provides a sum insured that can be used by any insured family member. This type of policy is cost-effective and convenient, especially for families with multiple members.
Special mediclaim plans for women are designed to suit their healthcare needs like gynaecological assistance. Some plans may also offer coverage for women-specific illnesses like breast or cervical cancer, etc.
With age comes wisdom, but it also brings an increased likelihood of health issues. Senior citizen health insurance policies are designed to cater to the specific healthcare needs of the elderly. These policies usually cover pre-existing illnesses and come with features like shorter waiting periods and higher sum insured options.
Life is unpredictable, and so is health. Critical illness policies provide a lump sum amount if the insured is diagnosed with a specified critical illness. This amount can be used to cover the high costs associated with treatments, medications, and lifestyle changes that may follow such a diagnosis.
For those planning to start a family, maternity health insurance is a crucial consideration. These policies cover expenses related to maternity care, delivery, and newborn care. They often come with waiting periods, so planning ahead is essential.
Many companies provide their employees with group health insurance in their professional lives. It also serves as an employee benefit and takes care of the workforce to ensure healthy and efficient working conditions.
Combining insurance with investment, ULHPs offer a dual advantage. A part of the premium is allocated for health coverage, while the rest is invested in market-linked funds. This type of policy is suitable for those looking to build wealth while ensuring health protection.
In the era of ever-increasing medical costs, top-up and super top-up plans act as supplementary coverage. They come into play when the basic health insurance coverage is exhausted. These plans offer an additional layer of financial protection without a substantial increase in premium.
While both, Mediclaim Policies and Health Insurance offer financial help during medical emergencies, understanding the difference between mediclaim and health insurance is necessary for better coverage. Here are the differences.
| Criteria | Mediclaim Policy Details | Health Insurance |
| Coverage | Limited to hospitalisation expenses | Wider coverage including pre and post-hospitalization, maternity, and more |
| Scope of Coverage | Typically covers inpatient treatments | Encompasses inpatient, outpatient, and preventive care |
| Sum Insured | Generally lower than Health Insurance | Higher sum insured options available |
| Premiums | Lower premiums but limited coverage | Higher premiums for broader coverage |
| Pre-existing Conditions | Often excluded or has a waiting period | Covered after a waiting period, varying by insurer |
| Add-ons/ Riders | Limited additional coverage options | Extensive add-ons for customised protection |
| Maternity Coverage | Hospitalisation included | Maternity coverage (add-on) |
| Critical Illness Cover | May not be included | Optional |
Mediclaim policies typically cover hospitalisation expenses, including room rent, nursing charges, and other related costs. The coverage varies based on the sum insured and the type of policy.
Many policies extend coverage to expenses incurred before and after hospitalisation, such as diagnostic tests, consultations, and follow-up treatments.
Modern medical advancements have enabled several procedures that don't require prolonged hospital stays. Good mediclaim policies cover a range of day care procedures, ensuring you're protected even for treatments that don't demand extended hospitalisation.
Emergency situations often require swift transportation to a medical facility. Mediclaim policies usually cover ambulance charges, easing the financial burden during critical moments.
Some policies provide coverage for treatments taken at home when hospitalisation is not feasible. This is particularly beneficial for patients with conditions that make it challenging to be admitted to a hospital.
If you undergo an organ transplant, a comprehensive mediclaim policy may cover the expenses related to the organ donor's medical procedures.
While not universal, many policies offer maternity coverage, including pre and post-natal expenses. It's crucial to check the waiting period and other conditions associated with this coverage.
Some policies come with an option to include critical illness cover, offering financial protection in the event of a severe medical condition such as cancer, heart attack, or stroke.
One of the most common exclusions in mediclaim policies is coverage for pre-existing conditions. Insurance providers typically impose a waiting period before these conditions are covered, ranging from 1 to 4 years. It's essential to thoroughly understand these waiting periods and exclusions to avoid any surprises during a medical emergency.
While modern medicine is often covered, alternative treatments such as Ayurveda, Homeopathy, and Naturopathy are generally not included in standard mediclaim policies. Individuals seeking coverage for these treatments may need to explore specialised policies or opt for riders that specifically cater to alternative therapies.
Mediclaim policies usually exclude coverage for elective or cosmetic procedures, including plastic surgery, hair transplant, and weight loss treatments. Insurance is primarily designed to address medical necessities rather than aesthetic preferences, so managing expectations regarding coverage for such procedures is essential.
Treatments received from non-allopathic practitioners, such as traditional healers or non-registered medical practitioners, are typically not covered. Ensure that your chosen healthcare provider is recognised by the insurance company to avoid claim rejections.
Certain medical conditions and treatments may have a waiting period before coverage becomes effective. Pregnancy-related expenses, for instance, often have an initial waiting period. Understanding these waiting periods is crucial for planning and managing healthcare expenses effectively.
Engaging in hazardous activities such as adventure sports or extreme recreational activities may lead to claim rejections. Insurance providers may consider such activities as an increased risk, and policyholders are advised to disclose all relevant information to avoid disputes during the claims process.
Here are the factors to consider when buying a mediclaim policy.
The best mediclaim policy in India would depend on the kind of feature. Key factors to consider are.
Some key areas to look at when selecting a health policy are hospitalisation, pre and post-hospitalization, and daycare treatments.
Make sure that the insurer has a large number of hospitals in the network for cashless treatment.
Choose an appropriate level of sum insured to accommodate the cost of required treatment.
While searching for the most suitable insurance plans, always bear in mind that you should pay both reasonable amounts for the premiums and get adequate coverage at the same time.
Learn what is included and what conditions may take a while to get coverage for.
One should select companies that offer a simple process to file claims.
Filing a claim against your medical policy becomes easier if you have an online policy. You can do so in two ways, either by filing a cashless claim or a reimbursement claim. Here are the step-by-step instructions on how to file each of these types of claims.
Here are the steps to file a cashless claim in Mediclaim Policy.
Post-treatment, the hospital submits bills to the insurer, who settles directly, minimising your financial burden.
Here are the steps to file a claim for reimbursement.
Familiarise yourself with policy terms, including limits, exclusions, and waiting periods, to avoid claim rejection.
Let's look at the essential documents you need when buying mediclaim health insurance in India.
At ACKO, you can easily buy a suitable mediclaim policy that will act as the ultimate financial back-up in case of a medical emergency. Since you buy directly from us, you get our medical plans at a cheaper cost as compared to a traditional insurance company. Simply scroll up, add a few details, and we will instantly show you a quote. It is that quick!
Here are some of the most frequently asked questions about mediclaim policy
Disclaimer:
*Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
**In case the pre-existing disease surfaces after a policy is issued. However, at the time of claim, if it is found that the policyholder did not disclose any known pre-existing diseases while buying the policy, the claim may get rejected.
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