All You Need to Know About Mediclaim Policy in India

A Mediclaim policy is a type of health insurance policy where the insurance company reimburses the expenses incurred by the insured for treatment of their medical condition. If you have purchased a mediclaim policy, you can request reimbursement by submitting the bills to the insurance company. Also, if you have opted for cashless treatment option, you need not worry about paying the bills. The insurance company will directly settle the bill with the hospital. However, to benefit from the cashless facility, you must seek treatment from one of the network hospitals of the insurer. One of the critical features of a mediclaim policy is that it is valid for a limited period, and you must renew the policy at the end of the term to continue to get the benefits of the policy. 

What are the features of a Mediclaim policy?

In the purview of the sedentary lifestyle, people are at a high risk of suffering from various diseases. Purchasing a medical policy can help you get financial assistance in the hour of need. Today, a lot of people prefer buying a mediclaim policy because of the following reasons:

  • You can avail of the cashless facility at network hospitals 
  • Mediclaim is available for both individual and family
  • It provides tax benefits on the annual premium

What are the types of Mediclaim policies?

There are various types of Mediclaim policies available in the market. You can choose a policy, depending on your specific requirement. The popular types of Mediclaim policies are: 

  • Individual policy –

    As the name suggests, an individual policy is for one person, and only the designated person can avail of the benefits listed under the policy.

  • Family Floater Policy –

    In a family floater policy, the coverage is given to one individual, who can further extend this to his or her entire family. 

  • Senior Citizen Policy –

    This policy is designed especially for people who are more than 60 years. This policy covers the hospitalisation expenses of that age group. 

  • Critical Illness Mediclaim –

    While battling life-threatening diseases like cancer, kidney failure, heart diseases, etc. the hospital expenses quickly deplete your savings. A critical illness policy helps in curbing those expenses by paying a lump sum amount on diagnosis of the disease. 

  • Mos-Bite Protector Policy –

    This policy pays a lump sum amount if you are diagnosed with any vector-borne diseases like Malaria, Dengue fever, Chikungunya and Zika virus.

  • Personal Accident Policy –

    It offers protection against accidental death, permanent total disability, permanent partial disability and temporary total disability.

What is the inclusion in a Mediclaim policy?

The inclusions of a mediclaim policy vary from insurer to insurer. But, generally, most insurance companies include the following expenses:

  • Hospital Charges –

    This includes expenses like oxygen cylinder, blood, organ donor expenses, room charges, organ donation, tests etc. 

  • Day Care Treatment –

    This covers the treatment that doesn’t require hospitalisation and the patient is released in less than 24 hours. 

  • Pre and Post Hospitalisation –

    Mediclaim policies also cover the expenses that are incurred before and after the insured is hospitalised. There are several expenses related to the treatment, before and after the hospitalisation. Mediclaim covers that as well. 

  • Hospital Stay –

    If you are admitted in a hospital, the bed charges can run into several thousand. Mediclaim policy covers the money spent on private rooms, wards or ICU. 

  • Consultation fees/ Doctor’s Charges –

    Mediclaim policies also cover doctor’s consultation charges or the charges to meet a specialist. 

Exclusions in Mediclaim Policy

As comprehensive as a Mediclaim policy can be, there are certain aspects of treatment that are not included in the policy. Some of the common exclusions include:

  • Pre-existing illnesses are covered after the completion of waiting period
  • Plastic Surgery and Cosmetic Surgery
  • External devices like hearing aid or contact lenses.  

Irrespective of the type of Mediclaim policy you buy, make sure to read the policy documents carefully and understand the terms and conditions. Knowing the terms and conditions will help you make an informed buying decision and you will get the best coverage to suit your needs.

How to choose the right mediclaim insurance policy?

It’s okay to be a little confused when purchasing a mediclaim insurance policy, especially if you are a first time buyer. Insurance is not everyone’s cup of tea and selecting the right plan can be tricky. Keeping this in mind, we have highlighted 3 basic pointers that will help you with your decision-making process & ensure you buy the right mediclaim policy.

What kind of plan do you want?

There are many different kinds of plans to choose from. To begin with, you will have to choose between indemnity & fixed benefit plans. Indemnity plans provide compensation for your medical expenses, whereas fixed benefits plans offer a pre-decided payout in case you suffer from any condition covered by the policy.

Experts suggest that you get an indemnity plan as your base. Then you can add fixed benefit plans such critical illness cover, hospital daily cash, etc. to ensure all-around protection against medical emergencies.

When it comes to indemnity plans, you again have two options. You can either go for an individual plan or purchase a family floater policy. Individual plans offer extensive coverage but they can be a little costly. Family floater plans on the other hands are more affordable but the coverage has to be shared by all the included members. You will have to make a choice based on your needs.

Choose the right sum insured

The next step is to decide the sum insured you need. This will depend on several factors such as your current fitness levels, your family’s health record, your age, your lifestyle habits, etc. You should get a higher sum insured if you live in a metro city as medical expenses tend to be a little higher in urban areas.

Get instant quotes

Once you know what kind of plan you want and how much you want to be covered for, you should go ahead and apply for instant quotes online. Just log onto our website, enter a couple of simple details about yourself and voila - you will have a premium quotation in seconds. You can choose the right add-ons and customize the plan until the coverage & the cost are perfect for you & your budget.

What to keep in mind when buying a mediclaim policy?

As you might know, there are several mediclaim insurance plans that you can choose from. Each of these plans will offer you a different set of features & benefits. This can make the task of choosing between all the available options a little difficult. But worry not! We have highlighted 5 important things you can keep in mind when comparing plans that will help you make the right choice.

  • Look for plans with a wider network of cashless hospitals

Once you decide on the coverage you want, you can start comparing the different plans available in the market. You can begin by shortlisting health insurance providers with a wider network of cashless hospitals. This is because plans that are backed by a higher number of network hospitals provide you with easier access to cashless treatments during a medical emergency. This allows you to focus on getting better instead of worrying about your hospital bills. In this regard, we at IFFCO-Tokio have a network of over 6400 cashless hospitals in India. In case of any untoward medical emergency, you can get treatment at any one of these hospitals & we will settle the bills on your behalf.

  • Claim settlement ratio

The claim settlement ratio is a very simple concept. It is the percentage of claims the insurance company is able to successfully settle out of the total number of claims it receives in a year. You should go for a plan & insurance provider that has a higher claim settlement ratio. This will ensure that your claim is more likely to be settled in case of a medical emergency. In the 2019 financial year, we settled 8.61 lakh claims at a claim settlement ratio of 92.65%.

  • Limits and capping

Hospital bills are made of up a number of different head of expense such as ambulance charges, room-rent charges, and so on. Most plans limit the amount of compensation they will provide for each of these expenses. For example, your room-rent compensation may be limited to 1% of the sum insured. Therefore, irrespective of your total sum insured, one may still have significant out-of-pocket expenses in case of hospitalization. Therefore, you should look at plans that have lower/no limits and caps. This will help you get more compensation in case of a claim.

  • Shorter waiting periods

All health insurance plans will have a waiting period for pre-existing conditions and a few named illnesses. This waiting period can range from 1 to 4 years. During this time frame, your plan will not cover any medical expenses related said illnesses. It goes without saying that you should look for a plan that has a lower waiting period. Some plans also have a feature known as premium loading – this is where you pay a higher premium to reduce the waiting period of your mediclaim insurance policy. If this is financially viable for you, then it is a smart way to get rid of the waiting period and enjoy complete protection.

  • Premium

Last but not least, the best mediclaim insurance policy will be light on your pocket. You can shortlist a handful of plans based on the pointers mentioned above and then compare them based on their premium amounts. This way, you get a plan that meets your coverage needs and also fits within your budget. Some buyers focus only on premiums when comparing plans.  This might help them find a mediclaim insurance policy that is extremely affordable, but compromises on other important features. Such a plan can hurt you in case of a medical emergency.

How to buy a mediclaim insurance policy?

There are two ways you can buy a mediclaim insurance policy from IFFCO-Tokio. You can visit any one of our branch offices or contact any of our agents in your area.. Rest assured you will receive all the help & guidance you require to purchase the right mediclaim insurance policy. The second way is to head to our website and buy the mediclaim policy online. This is a much easier process as you have to simply follow the 3 steps mentioned below and you will have the coverage you need.

1. Fill in your details: Once you land on our website, just type in a couple of basic details and hit the enter button. You might have to enter your name, number, email address, age, gender, etc.

2. Customize your coverage: Our health insurance calculator will analyse your details and provide quotation for your mediclaim policy. You can then customize the quotation as per your needs. You can include add-ons, change the co-payment amount, and fine-tune numerous other aspects of your plan.

3. Buy: Once you are satisfied with the coverage on offer and the premium of the plan, you can proceed to the payment stage. Here, you will have to enter a few more details about yourself and possible upload one or two documents. Then simply make the payment and the coverage of the plan will begin.

Why buy a mediclaim insurance policy online?

For some buyers, health insurance is something that must be bought face-to-face. If this is the case with you, then remember that our branches are always open to you. Visit us during office hours and our insurance experts will be more than happy to hand-hold you through the buying process. However, if you are looking for a modern way to buy your mediclaim policy, then just head on over to our website and make the purchase online. You will enjoy several benefits by doing so, some of which include:

Ease: Everything is easier with the internet, even buying a mediclaim insurance policy. Just complete the 3 easy steps mentioned above and you will instantly have complete coverage against medical emergencies. You do not have to expend your energy driving through traffic to visit one of our branches. Instead, you can buy a plan with a tap here and a click there!

Quickness: When you buy mediclaim policy online, you cut out the travel time to and from the branch. This in itself should help you save a good amount of time. Not to mention, the online buying process can be completed in a matter of minutes. All this ensures that you get the coverage you need quicker.

Convenience: You really have to go out of your way to buy a mediclaim insurance policy from a branch or agent. You need squeeze time out of your busy day or put off some personal commitments in order to buy a plan in the real world. However, in the digital world, you can buy a plan at any time of the day or night that is convenient for you. It doesn’t matter if it is a Sunday afternoon or a public holiday either. The internet gives you round the clock access to health insurance coverage.

Paperless: This is good not just from an environmental point of view but also because you do not have to deal with physical form filling or documentation. Everything is online – you can type out your details, upload scanned copies of your documents and receive the policy document in your email inbox!