Buy Mediclaim Policy: Complete Guide to Mediclaim Insurance Policy in India
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In the vast healthcare landscape, one term that resonates with every Indian is "Mediclaim Policy." With the rising costs of medical treatments and the uncertainty that life brings, having a robust Mediclaim policy is not just a financial decision but a crucial step towards securing your health and well-being. In this article, we will shed light on Mediclaim policies in India, providing you with insights to make informed choices for you and your loved ones.
What is a Mediclaim Policy?
Mediclaim Policy, often interchangeably used with health insurance, is a financial protection plan that covers medical expenses incurred due to illness or injury. In India, where healthcare costs are rising, a Mediclaim policy protects against unexpected medical bills. These policies can be availed from various insurance providers, each offering a range of plans catering to diverse needs.
Key Benefits of Buying a Mediclaim Policy in India
Here is a list of benefits of buying a mediclaim policy in India.
1. Financial Security: Shielding Your Wallet
Having a Mediclaim 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
It guarantees that you do not incur new debt or spend out your savings as you heal and recover.
2. Affordable Access to Quality Healthcare
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.
3. Tax Benefits: A Win-Win Proposition
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.
4. Cumulative Bonus: Rewards for Health
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.
5. Wide Coverage and Customization Options
Mediclaim policies in India come 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.
6. Cashless Claim Settlement: Convenience at Your Fingertips
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.
7. Family Floater Plans: Comprehensive Coverage for All
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.
Types of Mediclaim Policies in India
Here are various types of mediclaim policies available in India.
Individual Health Insurance
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.
Family Floater Health Insurance
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.
Senior Citizen Health Insurance
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.
Critical Illness Insurance
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.
Maternity Health Insurance
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.
Group Health Insurance
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.
Unit-Linked Health Insurance Plans (ULHP)
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.
Top-up and Super Top-up Plans
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.
Mediclaim Policy vs. Health Insurance: Key Differences
In the realm of healthcare financing, two terms often find themselves in the spotlight - Mediclaim Policies and Health Insurance. While both are designed to offer financial protection during medical emergencies, understanding the difference between health insurance and mediclaim is crucial for making informed decisions. Take a look.
| Criteria | Mediclaim Policy | 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 |
What is Covered
What is Not Covered
What is Covered in a Mediclaim Insurance Policy?
Here are the key coverages of a Mediclaim Policy.
Hospitalisation Expenses
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.
Pre and Post-Hospitalization Expenses
Many policies extend coverage to expenses incurred before and after hospitalisation, such as diagnostic tests, consultations, and follow-up treatments.
Day Care Procedures
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.
Ambulance Charges
Emergency situations often require swift transportation to a medical facility. Mediclaim policies usually cover ambulance charges, easing the financial burden during critical moments.
Domiciliary Hospitalisation
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.
Organ Donor Expenses
If you undergo an organ transplant, a comprehensive mediclaim policy may cover the expenses related to the organ donor's medical procedures.
Maternity Cover
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.
Critical Illness Cover
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.
What is Not Covered in a Mediclaim Insurance Policy?
Here is a list of things not covered under a Mediclaim Policy.
Pre-existing Conditions
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.
Alternative Treatments
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.
Cosmetic Procedures
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.
Non-Allopathic Treatments
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.
Waiting Periods
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.
Hazardous Activities
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.
Essential Factors to Consider When Buying a Mediclaim Policy
Here are the factors to consider when buying a mediclaim policy.
Comprehensive Coverage
Look for a policy that offers comprehensive coverage, encompassing hospitalisation expenses, pre and post-hospitalization costs, ambulance charges, and more.
Check for coverage of critical illnesses, as these can lead to substantial financial burdens. A policy that includes a wide range of illnesses ensures holistic protection.
Cashless Facilities
Opt for a policy that provides cashless facilities across a network of hospitals. This feature eliminates the need for upfront payments during hospitalisation, easing the financial strain on the policyholder.
Familiarise yourself with the list of network hospitals associated with the insurance provider to ensure convenient access to quality healthcare.
Waiting Periods and Exclusions
Go though the waiting periods for specific illnesses and pre-existing conditions. Different policies may have varying waiting periods, and understanding these is crucial to avoiding any surprises.
Be aware of exclusions in the policy. Knowing what is not covered helps manage expectations and prevents misunderstandings during a claim.
Renewal Age and Lifetime Renewability
Opt for a policy with a higher renewal age and lifetime renewability. This ensures that you can continue to enjoy coverage even in your senior years.
Policies with lifetime renewability provide long-term security, especially as healthcare needs tend to increase with age.
Sub-Limits
Be mindful of sub-limits on certain medical expenses, such as room rent, doctor's fees, and surgical charges. Choose a policy with minimal or no sub-limits for maximum coverage.
Affordability
While comprehensive coverage is essential, ensure that the premium is affordable for your budget. Evaluate different plans to strike a balance between coverage and cost.
Claim Settlement Ratio (CSR)
Ideally, you must go for an insurance company that has a high claim settlement ratio. This is one of the factors that indicate how likely an insurer is to settle a claim. However, it is important to note that CSR depends upon multiple factors like fraudulent claims, misinformations, etc. Thus, CSR could be one of the factors to choose an insurance company, however, not the ultimate one.
Pre-existing diseases
These are health issues that you may suffer from before buying a health plan. These are important as the insurance company may customise your coverage based on the severity of the diseases you suffer from. At ACKO, you can get coverage for your pre-existing diseases without waiting periods if you disclose them while buying the ACKO Platinum Health Plan.
How to Choose the Best Mediclaim Policy in India
The best mediclaim policy in India would depend on the kind of feature. Key factors to consider are:
Coverage
Some key areas to look at when selecting a health policy are hospitalisation, pre and post-hospitalization, and daycare treatments.
Network Hospitals
Make sure that the insurer has a large number of hospitals in the network for cashless treatment.
Sum Insured
Choose an appropriate level of sum insured to accommodate the cost of required treatment.
Premiums
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.
Inclusions and Exclusions
Learn what is included and what conditions may take a while to get coverage for.
Claim Process
One should select companies that offer a simple process to file claims.
Documents Required While Buying a Mediclaim Policy
Let's look at the essential documents you need when buying mediclaim health insurance in India
| Document type | Description |
| Identity Proof | Aadhar card, passport, voter ID, or driver's licence - have one of these up-to-date documents for identity verification. |
| Address Proof | Provide a valid address proof such as utility bills, Aadhar card, passport, or rent agreement, ensuring it matches your provided details. |
| Age Proof | Submit your birth certificate, passport, Aadhar card, or 10th-grade mark sheet for age verification, as premiums often vary by age. |
| Income Proof | If opting for higher coverage, be ready with income proof like salary slips, tax returns, or an employer's certificate. |
| Medical Check-up Reports | For certain age groups or coverage amounts, medical check-up reports are essential. Carry them along with any prescribed medications during the application. |
| Previous Medical History | Transparently disclose pre-existing conditions, surgeries, or ongoing treatments to ensure comprehensive coverage. |
| Passport-size Photographs | Have a few passport-sized photos ready, as they are commonly required for identification purposes in your policy documents. |
| Proposal Form | Complete the proposal form accurately, providing details about your health, lifestyle, and coverage preferences. |
Step-by-Step Guide to Filing a Cashless Claim for Mediclaim Policy
Here are the steps to file a cashless claim in Mediclaim Policy.
Choose Network Hospitals: Select a hospital from your insurer's network. Access the list online or through customer service.
Notify the Insurer: Inform your insurer in advance for planned hospitalisation or within 24 hours for emergencies.
Verification: The insurer reviews your case, verifying eligibility and treatment plans.
Authorisation Letter: Upon approval, you receive an authorisation letter, outlining the approved amount for treatment.
Hospital Admission: With the letter, proceed with admission. The hospital manages the treatment expenses.
Claim Settlement: Post-treatment, the hospital submits bills to the insurer, who settles directly, minimising your financial burden.
Step-by-Step Guide to Filing a Reimbursement Claim for Mediclaim Policy
Here are the steps to file a claim for reimbursement.
Initiate the Claim: For planned hospitalisation, inform your insurer beforehand. In emergencies, notify them within 24 hours. Collect all necessary documents, including medical reports and bills.
Document Checklist: Ensure you have a complete set of documents, such as the claim form, discharge summary, original bills, and prescriptions, to minimise the risk of claim rejection.
Fill the Claim Form: Accurately fill in all sections of the claim form. Use digital platforms for online submissions, if available.
Timely Submission: Submit your claim promptly to avoid delays. Adhere to the insurer's stipulated time frame.
Follow-up: Regularly follow up with the insurer to check the status of your claim. Be proactive in providing any additional information requested.
Understand Policy Terms: Familiarise yourself with policy terms, including limits, exclusions, and waiting periods, to avoid claim rejection.
Frequently Asked Questions (FAQs)
Here are some of the most frequently asked questions about mediclaim policy
How does a Mediclaim policy work?
Mediclaim policies offer financial cover in case of hospitalisation due to an accident or sudden illness. Hence, you don’t have to pay from your pocket for medical expenses which require hospitalisation for more than 24 hours. You can either opt for a cashless hospitalisation through a network hospital or you could pay and then submit for reimbursement.
How to choose the best Mediclaim policy?
Before buying a Mediclaim policy, finalise if the policy is for an individual or a family floater plan. Also, check for the renewability age and if the policy covers pre-existing diseases. You can also check some of the online health insurance companies about the features and benefits and select the right policy.
Why choose a Mediclaim policy?
With medical expenses on the rise, a Mediclaim policy will cover you in case of hospitalisation as well as domiciliary care during the tenure of the policy. With a Mediclaim policy, you don’t have to pay from your pocket in case of unexpected hospitalisation.
How do I claim the benefits of my mediclaim policy?
To claim your mediclaim benefits, follow these simple steps:
Inform Your Insurer: Notify your insurance provider about the incident at the earliest.
Submit Required Documents: Provide all necessary documents, such as medical reports and bills.
Fill Claim Form: Complete the claim form accurately.
Follow-Up: Stay updated on your claim's status by regularly checking with your insurer.
What is the age criterion to buy a mediclaim policy?
Typically, the age criterion for purchasing a mediclaim policy ranges from 18 to 65 years. However, this can vary among insurance providers, so it's advisable to check with them directly.
Does mediclaim cover accidents?
Yes, most mediclaim policies cover accidents. Whether it's a minor injury or a major mishap, your mediclaim can provide financial support for medical expenses related to accidents.
Which mediclaim policy covers LASIK surgery?
Not all mediclaim policies cover LASIK surgery. However, some specialised health insurance plans offer coverage for vision correction procedures. It's crucial to check the policy details or consult with your insurer to confirm LASIK coverage.
Which mediclaim policy covers dental treatment?
While basic mediclaim policies may not cover routine dental treatments, some comprehensive health insurance plans or dental insurance policies specifically cater to dental expenses. Usually, dental treatment is covered if it is medically necessary as a result of an accident.
When can you file a claim after buying a mediclaim policy?
Typically, there is a waiting period after purchasing a mediclaim policy before you can file a claim. This waiting period varies among policies and can range from 30 days to a few years.
What is cashless Mediclaim policy?
Medical expenses arising out of your or your family’s hospitalisation will be paid directly by the insurance company to the hospital where you have availed the treatment. Cashless Mediclaim policy can be availed only with the insurer’s network hospitals.
What is group Mediclaim policy?
It covers all insured employees of a company or organisation in the case of hospitalisation or domiciliary care during the policy period.
How to renew a Mediclaim policy?
New-age insurance companies have gone online. You can visit their website to pay the renewal amount for the Mediclaim policy. Or, you can visit the respective insurance company’s branch to renew the Mediclaim policy.
Is Domiciliary hospitalisation covered under the Mediclaim policy?
For a domiciliary hospitalisation, one must fulfil certain conditions. This includes medical treatment should more than 3 days and the condition of the patient is such that he/she cannot move to a hospital for treatment or if accommodation is not available in a hospital. Additionally, there are some exclusions under the domiciliary hospitalisation. Read the policy wordings to understand illnesses that are not covered.
What is a floater Mediclaim policy?
Under this type of Mediclaim policy, all members of your family who have been included in the policy share the sum insured. Family members include self, parents, spouse, and children.
What is an overseas Mediclaim policy?
This type of Mediclaim policy covers you in case of an accident or illness when travelling overseas.
Does a Mediclaim policy cover dental treatment?
Not every Mediclaim policy covers dental treatment. However, you need to check with the insurance provider if they have a Mediclaim policy which includes dental as well.
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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