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 the need. Today, a lot of people prefer buying a mediclaim policy because of the following reasons:

  • You can avail 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 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 lumpsum 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.