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Mediclaim Policy

Medical inflation is on a rise. Lifestyle diseases are increasing too. Getting hospitalized on an emergency basis without having health cover can exhaust your savings in no time. Buying a mediclaim policy can provide you with the required financial assistance in case of hospitalization. The policy provides coverage against medical expenses that you may incur during the policy period. With a valid mediclaim, you can also receive tax benefits under section 80D of the Income Tax Act, 1961.

Difference between mediclaim and health insurance

Feature

Mediclaim Policy

Health Insurance

Meaning

Mediclaim policy provides coverage for medical expenses and hospitalization only

Health insurance provides coverage for medical expenses such as daily allowance, ambulance charges, etc.

Coverage

The scope of coverage is narrow, covering hospitalization expenses arising out an illness or an accident

The scope of health insurance is not limited to hospitalization only; it also provides coverage against critical illness, ambulance charges, day care procedures, etc.

Premium

Premium offered under this type of insurance is low since the coverage is narrow

The premium for this type of insurance is on higher side as the coverage is comprehensive

Add-on covers

You cannot choose to buy add-on covers with mediclaim policy

You can opt for various add-ons such as maternity, critical illness, worldwide coverage, etc.

must dot
5 Lac coverage starting from only ₹257/Month*
5 Lac coverage starting from only ₹257/Month*
  • Tax Benefit
    Tax Benefit
    Up to 75000**
  • Claim Support
    Claim Support
    Everyday 10AM-7PM
  • 45 Lacs+
    45 Lacs+
    Happy Customers

*Standard Terms and Conditions Apply.

**Tax benefits are subject to changes in Income Tax Act.

What is mediclaim?

A mediclaim is a type of insurance that provides you coverage against the rising medical expenses; it covers you in case of hospitalization up to the sum insured. The insured individual can opt to receive coverage on a cashless basis either by being hospitalized at a network hospital or submitting medical bills to avail reimbursement. You can purchase a medical policy for your family for a period of one year or two depending on the insurance company. This type of insurance is valid for a period of 1 year after which the policyholder has to renew it on a timely basis.

Inclusions and exclusions of mediclaim insurance

A mediclaim policy provides the below coverage:

Inclusions of mediclaim insurance

  • Hospitalization charges: This includes organ donor expenses, room rent, cost of medicines, doctor fees, etc.
  • Pre and post hospitalization expenses: Pre and post hospitalization charges ranging from 30 days-90 days are covered. These usually include follow-up checks, lab tests, consultation fees, etc.
  • Fees charged by medical professionals: Fees of the doctor, surgeon, nurse, etc. are covered under mediclaim insurance.

Exclusions of mediclaim insurance

Exclusions refer to the medical conditions that are not covered under a mediclaim policy.

  • Pre-existing medical conditions
  • Pregnancy and childbirth
  • Vaccination
  • Plastic surgery
  • Cost of hearing aid, contact lenses, etc.
  • Dental treatments
  • Cosmetic surgery and obesity related treatments
  • Hospitalization caused due to alcohol

Documents required to purchase mediclaim insurance

To purchase mediclaim insurance for you and your family, you need to submit the below documents:

  • Duly filled proposal form
  • Identity proof
  • Address proof
  • Medical records are required by the insurance company

Mediclaim policy benefits

Given below are the benefits of mediclaim policy

  • Mediclaim insurance is one of the affordable ways to combat against the rising healthcare costs
  • Buying a mediclaim policy can prevent you against financial stress caused due to medical emergency like an accident
  • Get the benefit of cashless hospitalization at network hospitals where the insurance company directly settles the bill with the hospital
  • Buying a mediclaim policy enables the policyholder to receive tax benefits under section 80C of the Income Tax Act, 1961

Factors to consider when buying mediclaim policy

Given below are the factors that you need to consider at the time of buying mediclaim insurance

Sum Insured : Sum insured is the maximum coverage that you can receive in the event of hospitalization. Opting for a higher sum insured in today’s times is important as medical inflation is on a rise and so are lifestyle diseases. With mediclaim insurance for you and your family, you will be covered only up to the specified sum insured.

Network hospitals : You can receive cashless coverage at network hospitals that have partnered with the mediclaim insurance company. This means that at the time of hospital admission, employees don’t have to worry about hospital charges as the bills are directly settled with the insurer. This way, you don’t have to bother about managing funds in times of distress and can easily rely on the coverage offered. Therefore, when buying mediclaim insurance, it is necessary for employers to check on the list of hospitals that the insurance company has partnered with.

Claim settlement ratio: This ratio is the amount of claims settled by the insurance company out of the total claims received. Any ratio above 90 is considered to be a good ratio. The ratio determines the effectiveness of the company in resolving claims. Hence, checking on this ratio before making the purchase is imperative.

Room rent limit: this is nothing but the per day cost of occupying a room or bed in a hospital for 24 hours. Mediclaim policies generally come with a room rent limit defined as % of sum insured or a specific amount which can be Rs.3,000- Rs.5,000 per day depending on the policy sum insured. In case if you choose for a room that costs higher than the room rent mentioned in the policy then he will have to bear the remaining costs out of your pocket.

Co-payment: When choosing group health cover, it is imperative that you check on co-payment. With the co-payment clause, you have to pay out a part of the claim out of your pocket. For instance, if the hospital bill is Rs. 1 lakh and the copayment mentioned in the policy is 10% then you have to pay Rs. 10,000 out of his pocket and the remaining amount of Rs. 90,000 will be paid by the mediclaim insurance company.

Mediclaim Insurance Claims Process

Below mentioned is the claim process for mediclaim policy

Reimbursement claim: Under this type of claim, you have to first pay for the hospital bills and then get the same reimbursed from the insurance company. All you need to do is attach the bill copies with the claim form and the insurance company will then settle the bills post verification of the documents submitted.

Cashless claim: Under this type of claim, you can enjoy a cashless claims facility wherein you don’t have to pay anything at the time of hospitalization. In case of planned hospitalization, pre authorization form has to be submitted and in case of emergency hospitalization, the health ID card has to be provided at the hospital.

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Save Tax upto ₹75000*
Under Section 80D

*Tax benefits are subject to changes in Income Tax Act.

FAQ About Mediclaim Policy

  • How does a cashless mediclaim policy help me?

    Cashless mediclaim helps you deal with medical emergencies by paying for your hospital bills. In a cashless mediclaim policy, all the medical bills are directly settled by the insurance company provided the amount falls within the sum insured limit. This leaves the insured tension free.

  • Can I avail of cashless treatment in any hospital?

    Every insurance company has tie-ups with hospitals that are known as network hospitals. You can avail cashless treatment only at the network hospitals. If you are hospitalised in a non-network hospital, then you will be required to pay the hospital bill out of your own pocket and later file a reimbursement claim to the insurer.

  • What all factors are responsible for affecting premiums paid towards cashless mediclaim policy?

    Premiums paid towards cashless Mediclaim insurance are dependent upon several factors. Given below is the list of some major factors that can possibly affect the premium paid towards your cashless mediclaim policy:

    • Pre-existing health conditions
    • Age
    • Self-destructive habits like drug abuse and alcohol
    • Medical history of family
    • Profession
    • Marital Status, and others
  • What is the meaning of ‘free-look period’ in cashless mediclaim policy?

    A free look period is the time period given to the new policy buyers under a cashless Mediclaim policy in order to understand and agree with the terms and conditions mentioned in the policy document. In case, they disagree with some terms and conditions mentioned in the policy, then they can terminate it without requiring to pay any penalties. Generally, most of the cashless Mediclaim policy comes with a free look period of 15 days within this duration, a policyholder can cancel the policy if they disagree without any fines or penalties. However, it is important to mention the reason for cancellation of the insurance policy.

  • Are there any tax benefits available under the cashless Mediclaim policy?

    Yes, as per the section 80D of the Income Tax Act, premiums that are paid towards cashless Mediclaim policy can be claimed as tax deductions. Premiums paid towards the insurance plans that offer coverage to self, spouse, children and parents are eligible for availing tax deductions.

  • Why should I buy a mediclaim plan?

    A mediclaim policy provides financial support to the insured person in case he/she needs to be hospitalized for medical treatment that may be required to an accident or pre-defined disease.  During any medical emergency, a cashless mediclaim policy acts as a blessing as it provides complete financial security and peace of mind. 

  • What all is covered under a mediclaim plan?

    Following are the features that covered under a mediclaim plan- 
    Room rental for a medical facility for  both a standard ward or ICU.
    Expense charged by specialist, specialists, and other clinical experts associated with the treatment.
    Direct fees charged during hospitalization 

  • What are the features of a mediclaim plan?

    Following are the features of a mediclaim plan- 
    A mediclaim policy covers hospitalization and medical treatment costs incurred due to an accident or pre-defined disease, to the plan's assurance. 
    Under a mediclaim you can include family members
    You can file a cashless claim under a mediclaim policy by getting medical treatment at a network hospital.

  • Does mediclaim policy cover Coronavirus?

    Yes, mediclaim policy covers CoronaVirus. Medical expenses will be covered by all standard health insurance policies if you are hospitalized for a minimum of 24 hours for Covid-19 treatment.

  • What are network hospitals under a mediclaim plan?

    A network hospital under a mediclaim plan is one that has an agreement with an insurance company that provides cashless treatment to the insured. If you receive treatment in a network hospital, your insurance provider will cover your hospitalization expenses. 

  • How to purchase a mediclaim plan in India 2022?

    You can purchase a mediclaim plan online and offline from the insurance provider of your choice. You can visit the insurance company’s branch office to purchase the mediclaim policy. You can also choose to purchase the online from the insurance company’s website. 

  • Can I purchase a mediclaim policy online?

    You must buy a mediclaim plan online because of the following reasons:
    Safe and secure payment methods, with no chance of fraud. 
    The convenience of seeing and comparing the top-rated medical insurance plans from the comfort of your own home in just a few clicks.
    Premium payments can be made using a variety of methods, including debit card, credit card, and net banking.
    Mediclaim plan customization is simple and premiums are calculated instantly.
    Digital documents are used thus no paperwork is involved.

  • Does mediclaim policy provide tax benefits?

    You can save taxes under a Mediclaim plan in the following ways:
    A policyholder is eligible for a tax credit of up to Rs. 75,000 under section 80 D of the Income Tax Act.
    For each financial year, a mediclaim plan for parents can provide an additional tax deduction of up to Rs. 25,000.
    According to section 80D of the Income Tax Act, you can also claim tax benefits for your basic medical health check ups once a year. It can cost as much as Rs. 5,000 every year.
    Purchasing a Mediclaim plan will allow you to gain a tax deduction of up to Rs. 25,000 on the premium paid towards your Mediclaim plan during each budgetary year.

  • What are the types of cashless mediclaim policy?

    You can choose any of the following types of cashless mediclaim policy as per your requirements:
    1. Senior Citizen Mediclaim Policy
    2. Individual Mediclaim Plan
    3. Critical Illness Plans
    4. Personal Accident Plans
    5. Hospital Daily Cash Benefit Policy

  • Are add-on covers available under mediclaim policy?

    No, add on covers are not available under a mediclaim policy. 

  • What are the exclusions of a mediclaim policy?

    Following are the exclusions of a mediclaim policy- 
    It does not cover childbirth complications,suicide injuries, HIV AIDS and any healthcare problem diagnosed within 30 days of policy insurance.
    Dental and Vision
    Maternity
    Alternative Medicine
    Sports
    Mental Health
    Outpatient Prescriptions

  • How to make reimbursement for the mediclaim process for mediclaim plan?

    In order to make a reimbursement claim,you must inform your insurance provider of your hospitalization. This can be done via email or by calling the customer service number provided by your insurance carrier.
    After you have received treatment, collect all the relevant documents from the hospital.
    Along with the expenses, do not forget to include a claim form and a discharge card. The insurance company would then verify the claim.
    The insurer would reimburse the amount after the approval was issued.

  • What is the maximum sum assured for mediclaim policy?

    The minimum sum covered for mediclaim policy is Rs. 1 lakh, with a maximum limit of Rs. 5 lakh. Within these limits, the policyholder may choose any Sum Insured in multiples of 50,000.

  • How does cashless mediclaim policy work?

    In case of a medical emergency the insured person requires to be hospitalized for the treatment, the mediclaim policy will provide financial aid to fulfil the hospitalisation expenses. 

  • What is the maximum number of claims allowed under mediclaim policy?

    There is no defined number of minimum and maximum claims allowed for the policy. However, the insured person can make claims for up to the sum assured of the mediclaim policy. 

  • Can I cancel my mediclaim policy and if yes will I get my premium back?

    Yes, you can cancel your mediclaim policy and get a refund, you will get a refund only if you have made no claims during the policy year. You can cancel your mediclaim policy anytime. 

  • How to port a mediclaim policy?

    To port your mediclaim policy, you need to inform your insurance company about the same and follow the instructed process. The portability process may differ from one insurance provider to another.

  • How to get a mediclaim policy?

    You can purchase a mediclaim policy online and by visiting the nearest branch office of your preferred insurance provider. You can visit the official website of your preferred insurance provider and purchase the mediclaim. You can also purchase a mediclaim policy from InsuranceDekho. 

  • How to calculate mediclaim policy premium?

    The premium for your mediclaim policy is calculated on the basis of a number of factors including the plan chosen, the sum assured opted, your medical history, tenure of the plan, etc.

  • How to choose the right mediclaim policy?

    There are a few factors that can help you choose the right mediclaim policy, these factors are number of network hospitals, availability of shorter waiting period, coverage for daycare treatments, no co-payment clause, availability of lifelong renewability. Consider these mentioned factors to choose the right mediclaim policy. 

  • What is the mediclaim policy for employees?

    Mediclaim policy for employees refer to group/corporate health insurance policy availed by an organization or company to provide health insurance benefits to its employees.

  • What is a group mediclaim policy?

    Under a group mediclaim policy an employer will provide mediclaim coverage to its employees and will add benefits to their remuneration such as the benefits of cashless hospitalization or the reimbursement on hospitalization expenses.     

  • What is overseas mediclaim policy?

    An overseas mediclaim policy provides coverage against the risk of being hospitalized and its expenses in a foreign country. This type of mediclaim policy covers medical expenses incurred for the hospitalization while the insured person is outside of India. It covers both inpatient and outpatient expenses. 

  • What is the eligibility criteria to purchase a mediclaim policy in India ?

    An individual between the age of 18 to 65 years can purchase a mediclaim policy in India. 

  • What do I need to do after I get hospitalized?

    Once you have been hospitalized you must immediately inform your insurance provider so the reimbursement claim or cashless treatment can be initiated at the correct time. 

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