Mediclaim Policy

• Cost-effective - A mediclaim policy is a cost-effective way of availing healthcare services without exhausting your savings. This is because it pays for your medical expenses in case you get admitted to a hospital.
• Access to Quality Healthcare – Not everyone can afford the best medical treatment as it is expensive. With this mediclaim insurance policy, you can access top-quality medical treatment at the best hospital in your city without worrying about paying hefty bills.
• Eases Financial Stress – It lowers the financial burden on you and your family by offering monetary assistance during a medical emergency. This way you can focus on getting better while your insurer takes care of your medical expenses.
• Beat Medical Inflation – Healthcare facilities are getting costlier every year due to medical inflation. As a result, many people settle for inferior treatment or delay it due to lack of money. Health insurance plans can help you beat medical inflation by increasing your sum insured during renewals. 
• Cashless Treatment – Cashless hospitalization facilities are available at all hospitals of your choice under the ‘Cashless Everywhere’ benefit. This eliminates the hassle of making upfront payments for hospitalization expenses in case of a medical emergency.
• Tax Exemption Benefits - Tax benefits under section 80D of the Income Tax Act can be availed on the mediclaim policy premium paid by the policyholder.

• Individual Mediclaim Policy

  An individual mediclaim policy offers hospitalization coverage to the policyholder. Only one person can avail the medical insurance benefits against the premium paid under this type of policy. Several health insurance companies in India provide individual mediclaim plans.

• Family Floater Mediclaim Policy

  A family floater mediclaim policy covers the hospitalization expenses of the policyholder along with his/her family members, including parents, spouse, children, parents-in-law, and grandparents. Under this family health insurance policy, a single sum insured amount is available for use by all the insured family members on a floater basis.

• Senior Citizen Mediclaim Policy

  A senior citizen mediclaim policy is designed to cover hospitalization expenses incurred by elderly people who have crossed the age of 60 years. The coverage of a senior citizen health insurance policy is customized to cater to the health needs of senior citizens.

• Critical Illness Mediclaim Policy

  A critical illness mediclaim policy provides coverage for hospitalization expenses resulting from critical illness, such as cancer, heart attack, kidney failure, stroke, etc. This critical illness insurance policy pays a lump sum amount to the policyholder on the first diagnosis of a listed critical illness.

• Maternity Mediclaim Policy

  A maternity mediclaim policy covers the medical expenses of pregnant women and future mothers incurred during childbirth. This maternity insurance policy pays for various pregnancy-related hospitalization expenses, including the cost of normal and caesarean delivery, pre & post-natal expenses, pregnancy complications, and medical termination of pregnancy. It comes with a waiting period of as low as 3 months, depending on the policy.

• Parents Mediclaim Policy

  A parents mediclaim policy has been designed to provide medical coverage to ageing parents. This health insurance for parents covers the hospitalization expenses incurred by parents due to a planned treatment or a medical emergency.

• Women Mediclaim Policy

  A women mediclaim policy covers the medical expenses incurred by women on hospitalization. This health insurance for women caters to the health needs of women, including breast cancer, cervical cancer, gynaecological problems, etc.

• Coronavirus Mediclaim Policy

  A coronavirus mediclaim policy pays for hospitalization expenses if the insured is diagnosed with COVID-19. While some coronavirus health insurance plans are available on an individual sum insured basis, others are available on a floater sum insured basis.

• Hospital Room Rent

  It covers the charges of staying in a regular ward in a hospital on a single or twin-sharing basis. Intensive Care Unit (ICU) charges are also fully recompensed by the insurance company.

• Fees Charged by Medical Professionals

  It pays for the fees charged by the doctor, surgeon, nurse, anaesthetist, etc., while admitted to a hospital.

• Cost of Consumables

  It covers the cost of consumables or non-medical items incurred by the insured during hospitalization. They include the cost of cotton, surgical blades, gowns, syringes, hospital admission charges, etc.

• Expenses incurred on dental surgeries unless they require hospitalization
• Birth control and hormonal treatment
• Intentional self-injury or suicide attempt
• Treatment for addiction to alcohol or drugs
• Cosmetic or plastic surgery
• Infertility treatments

Note: You can read the policy documents to know the complete list of exclusions.

2. Sum Insured:

The policy sum insured or coverage amount should be considered before buying. The higher is the sum insured, the higher will be the premium. However, you must consider factors, such as the rate of inflation, surging healthcare costs, etc., while choosing the coverage amount. Moreover, the healthcare costs in a metropolitan city are way higher than in tier-2 or tier-3 cities, and so choosing a higher sum insured is recommended.

3. Entry Age:

Every mediclaim policy comes with an entry age limit. Before shortlisting a policy, check the entry age limits for the policy to determine if you are eligible to buy it or not. For family floater policies, check if your members can buy the policy.

4. Scope of Coverage:

While buying a mediclaim policy, you must choose a policy with comprehensive coverage. Look for a plan that covers ambulance charges, pre-hospitalization expenses, post-hospitalization expenses, etc., apart from in-patient hospitalization expenses. The wider is the coverage, the more will be the expenses covered by your insurer.

5. Pre-existing Disease Waiting Period:

All insurance companies cover pre-existing diseases after a waiting period of up to 3 years. The shorter is the waiting period, the sooner you can claim your medical expenses. Therefore, while buying a mediclaim policy, you must check the pre-existing disease waiting period.

6. Sub-limits:

Some mediclaim insurance policies may come with sub-limits. For instance, if your policy comes with a room rent limit of 1% of the sum insured, then your insurer will not pay beyond that amount. Hence, make sure to check if the mediclaim policy you plan to buy comes with any sub-limits.

7. Co-payment:

Several mediclaim plans come with a co-payment clause. Co-payment is usually a percentage of the claim amount that the insured has to bear while raising a claim before the insurance provider settles the remaining amount. Usually, co-payment ranges from 10% to 30% based on the plan and, thus, should be checked before buying a mediclaim policy.

8. Exclusions:

Every mediclaim policy comes with a few medical expenses that are not covered. For instance, treatment of drug or alcohol addiction, cosmetic or plastic surgery, OPD expenses, etc., is not covered under a mediclaim policy. Therefore, you must check the exclusions carefully before buying the policy.

9. Insurer’s Claim Settlement Ratio:

Before buying a mediclaim policy, you must check the Claim Settlement Ratio (CSR) of the insurance company. The CSR can help you understand how likely the insurer is to settle your claim. The higher is the CSR, the greater are your chances of getting your claim settled. A company with a high CSR of 80% and above is considered good..

3. Premium

Choose a mediclaim policy that offers your desired coverage within your budget. You can compare different plans based on their coverage to know which ones fall into your budget.

4. Exclusion

To choose the ideal mediclaim policy, you must check what a policy does not cover. It can help you eliminate plans that do not offer your desired coverage. 

5. Claim Process

The ideal mediclaim policy comes with an easy claim process. An insurer with a simple claim procedure and a quick claim settlement time is a better pick than insurers with a complicated and time-consuming process.