What is Mediclaim Policy: Features and Benefits of Mediclaim Health Insurance
Mediclaim policy helps bear the expenses of medical treatment, hospitalisation and predetermined illnesses up to a certain limit. It provides a financial shield against an unforeseen medical emergency by reimbursing up to the sum insured.
Before buying a Mediclaim policy, check the details about Mediclaim health insurance – its features, benefits, types, exclusions and how to claim. Keep reading!
Why Buy Mediclaim Health Insurance?
1. Offers Protection Against Health Emergencies
Mediclaim policy proves to be extremely resourceful in cases of sudden illness or accidental hospitalisation. The plan covers hospitalisation expenses up to the coverage amount. In addition, most of these policies cover the treatment costs incurred before and after hospitalisation.
2. Allows you to Deal with Medical Inflation
India’s healthcare costs are steadily increasing. Resultantly, health emergencies will most likely leave a hole in one’s pocket unless the individual prepares for it well beforehand. In such a circumstance, mediclaim insurance plans extend a financial cushion, thus allowing one to be prepared for contingencies.
3. Meets Inadequate Insurance Cover
Individuals with an inadequate sum insured amount under their health insurance policies may opt to have a mediclaim in place to ensure optimum coverage.
Features and Benefits of Mediclaim Plans
Now that you understand mediclaim meaning and its necessity let’s delve into some of its features and benefits.
- Cost-effectiveness
Mediclaim insurance allows you to avail of healthcare services in a cost-effective manner. - Wide coverage
A mediclaim plan covers pre-and post-hospitalisation costs. Additionally, it may comprise emergency assistance services, such as ambulance charges. - High sum insured
Most mediclaim policies provide a high sum insured, which can be as much as Rs. 50 lakh, if not more. - Various types of cover
Mediclaim insurance is available in both individuals as well as family floater policies. - Suitability
This type of insurance is well-suited for any individual, regardless of age. In fact, the usual entry-exit age for adults is 18 years and 80 years, respectively. Furthermore, some plans provide cover to newborns. - Cashless treatment
These plans come with a cashless hospitalisation facility in their network hospitals. As a result, an individual can easily do away with out-of-pocket expenses during a medical emergency. - Day-care hospitalisation
These plans also include expenses towards a treatment that does not call for 24-hours hospitalisation. - Lifelong renewability
Depending on the insurer, a mediclaim policy may also allow a lifelong renewability option. - Reduces financial stress
Mediclaim policies are designed to lower a policyholder’s financial stress. - Tax benefits
A policyholder can avail of tax benefits under Section 80D of the Income Tax Act, on the premium paid towards his/her mediclaim policy every year. - Extra benefits
Some mediclaim insurance plans also include annual check-ups and expenses incurred in alternative treatments and ICUs.
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What are the Types of Mediclaim?
It is very important to know about the types of mediclaim available such that you can choose from the various options available in hand and see what suits you.
Types of Mediclaim are as follows:
1. Individual Mediclaim Plan
This kind of mediclaim insurance provides health coverage only to an insured person. Therefore, when you opt for an individual plan, only the insured individual can avail of its benefits against the paid premium.
2. Family Floater Mediclaim Policy
A family floater policy offers coverage to an individual, which can also be extended to his/her family member, such as spouses, children, and parents. So, when you opt for this type of mediclaim coverage, you not only protect yourself from health emergencies but your family as well.
3. Critical Illness Mediclaim
This kind of policy provides much-needed coverage against critical illnesses such as cardiovascular diseases, kidney failure, and cancer. Moreover, such a plan allows you to meet the increasing cost of treatment, which is higher in case of life-threatening ailments.
4. Senior Citizen Mediclaim Plan
These plans cover expenses incurred on hospitalisation for the elderly. A senior citizen mediclaim plan is, therefore, suitable for those aged 60 years or above.
What is the Claim Procedure for Mediclaim Policy?
Over the years, the claim procedure for mediclaim insurance has steadily become more streamlined and hassle-free. Typically, the settlement process takes place through either of the following two methods:
1. Cashless Claims
Under this facility, an insurer settles the entire claim or a part of it if the insured is treated in any of the network hospitals. When you have mediclaim insurance, you are eligible to make cashless claims in the following ways:
2. Cashless Emergency Hospitalisation
For an emergency hospitalisation in the event of a critical illness or accident, you must show your mediclaim ID at a network hospital to enable admission into the institution. Thereafter, you are required to submit a pre-authorisation request form to your insurer within 4 hours of hospitalisation to initiate the claim settlement procedure.
3. Cashless Planned Hospitalisation
In case your hospitalisation is pre-planned, you must submit the afore-mentioned pre-authorisation request form at least 72 hours prior to hospitalisation. By doing this, you can be assured of hassle-free and seamless claim settlement.
4. Cash Reimbursement
The process for claim settlement under the reimbursement option unfolds in the following manner:
- Step 1: Inform your insurer about your hospitalisation in any of their network hospitals. Here, the insurance company will ensure that the medical situation aligns with its terms and conditions before approving your claim settlement request.
- Step 2: Keep track of all the medical expenses incurred during hospitalisation that qualify for cash reimbursement. Then, produce the bills to support your claim.
- Step 3: If a new health complication arises, you have to initiate a separate process for claim settlement. For example, let’s say you initiate a claim settlement process on medical tests for cardiovascular disease. However, the underlying cause of your ill health is diagnosed as chronic bronchitis. In this case, you need to seek another approval from your insurer.
Your claim will be reimbursed once your insurer scrutinises the submitted proof of expenses. This process can take about 15-25 business days.
Coverage under Mediclaim Policy
The coverage of a mediclaim policy varies between insurers. That said, such a plan usually covers the following expenses:
- Hospitalisation charges
- Room rent
- Day-care expenses
- Pre and post hospitalisation costs
- Charges for medical professionals
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Documents Required to Purchase a Mediclaim Health Insurance
- Age Proof – Voter ID, Aadhaar card, driving license, birth certificate, passport, and 10th & 12th mark sheet.
- Identity Proof – Aadhaar card, passport, voter ID, PAN card, and driving license.
- Address Proof – Passport, rent agreement, utility bills, driving license, Aadhaar card, and PAN Card.
- Medical Reports – Medical screening reports (if required by the insurer)
- Passport size photographs
What is the Difference between Health Insurance and Mediclaim Policy?
| Basis of Differentiation | Health Insurance | Mediclaim Policy |
| Coverage | It offers comprehensive coverage that extends further than hospitalisation expenses. These can include OPD charges, annual health check-ups, compensation for loss of income, etc. | It provides coverage against hospitalisation, pre-specified illnesses, or accident-related treatment up to the sum insured. |
| Add on covers | There are several add-ons covers, such as maternity benefits, critical illness cover, accidental disability coverage, etc. | Mediclaim policies do not come with add-on covers. |
| Flexibility | Health insurance offers a high level of flexibility to individuals who can customise the plan as per their preference. | Mediclaim lacks the flexibility that health insurance plans offer. |
Factors to Consider Before Purchasing a Mediclaim Policy
Finalising a mediclaim policy purchase from a number of options can be a tough task. Therefore, we suggest that you take the following points into account before purchasing a plan:
1. Type of Plan
Based on your requirement, you can either opt for an individual mediclaim policy or its family floater variant. Moreover, you must note that family floater plans are cost-effective options compared to purchasing individual policies for each family member.
2. Sum Insured
When choosing a plan, it is advisable to weigh in several factors, such as surging healthcare costs and the rate of inflation. In addition, the cost of hospitalisation in a metropolitan city is higher than that in a rural area. So, keeping these points in mind, you should opt for a plan with a high sum insured, which will provide you with higher coverage against medical emergencies.
3. Network Hospitals
Check the number of network hospitals your insurer has. The more the better. Network hospitals make it easy to make cashless claims where the medical expenses are taken care of by the insurer directly with the hospital.
4. Pre-Existing Disease
Check the waiting period for the pre-existing diseases. The less the waiting period the better for you to get insurance coverage for pre-existing disease.
5. Exclusions
Check the list of exclusions in the Mediclaim Policy. Medical expenses concerning alcohol and drug abuse, HIV, self-harm, etc. are not included.
6. Age of Renewability
After a certain age, renewing your health insurance may not be allowed. However, many Mediclaim health insurance plans have a lifetime renewability option. Check with your insurer to know if that option is available.
Final Word
A thorough understanding of mediclaim meaning and its various aspects will help you make an informed decision when purchasing this insurance. Alternatively, you can opt for comprehensive health insurance from leading insurers, such as Navi Insurance.
Buy health insurance in a matter of mere seconds and make cashless claims in just 20 minutes with the support of over 10,000 network hospitals in India. Download the Navi app now and get your policy in under 2 minutes.
FAQs
Ans: Mediclaim policies offer the facility of in-patient cashless hospitalisation, which covers various sorts of medical costs, including medical expenses.
Ans: Although the exact amount will vary based on one’s requirements and preferences, a minimum cover of Rs. 5 lakh is generally recommended.
Ans: Every Mediclaim policy comes with a waiting period, during which an insurer does not accept claims for illnesses. Most insurance companies refuse to accept claims for the initial 30 days of policy purchase. However, some plans cover accidental hospitalisation expenses during this period. So, it is wise to check such details before buying a plan.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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