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Mediclaim Policy

Medical inflation makes individuals dread medical emergency costs - , a Mediclaim insurance policy is therefore the best answer. The policy provides a financial blanket and covers the cost for medical consultations, diagnosis and treatments.

Here is information on a medical insurance plan and its benefits:

What is a Mediclaim Policy?

A Mediclaim policy is a health insurance plan which covers medical costs incurred on hospitalisation. The plan pays for hospitals costs covered under its scope - it thus provides financial security in the face of a medical contingency.

Salient features of a Mediclaim Policy

There are certain aspects of Mediclaim insurance policies which are important to know. These are as follows:

  • Sum insured - sum insured represents the maximum coverage an insurance company would pay in case of a medical emergency. Choose the required sum insured up to the maximum limit allowed under the plan.
  • Premium - the premium charged depends on the age of the insured, the number of members covered, sum insured and the coverage features.
  • Members covered - a Mediclaim plan covers either the policyholder or family members including a spouse, dependent children and dependent parents. There are individual Mediclaim plans and family floater ones.
  • Tenure - a Mediclaim plan is offered for a term of one year. In other words, the plan is to be renewed on a yearly basis. The latest features offer a continuous tenure of 2 or 3 years where the premium for each year is paid in one instalment at the time of buying the plan.
  • Claim process - under Mediclaim plans there are two types of claim settlement – cashless and reimbursement. Under the cashless policy, the insurance company settles claims directly with the hospital. Under reimbursement, the insured pays for medical expenses from their own pocket which the insurance company later reimburses directly to their account.
  • Tax benefit - Mediclaim insurance plans allow a tax deduction under Section 80D. Premiums paid for self and family qualify for deduction up to Rs.25, 000. This limit increases to Rs.50, 000 for senior citizens. An individual can claim an additional deduction of up to Rs. 50,000 for a separate policy bought for dependent senior citizen parents.

Also Read: Tax benefits in Health Insurance

What is covered by Mediclaim Insurance Plans?

The coverage under Mediclaim policies differ across plans. However, some coverage features are standard across all plans which include the following:

  • Inpatient hospitalisation - this coverage covers expenses incurred on hospitalised for a continuous period of 24 hours or more. Expenses like room rent, doctor's fees, surgeon's fees, nurse's fee, anaesthetist's fee, medicines, blood and oxygen costs, etc. are covered under inpatient hospitalisation.
  • Pre and post-hospitalisation - expenses incurred before hospitalisation are called pre-hospitalisation expenses. These expenses are covered for 30 to 90 days depending on the plan. Expenses incurred after being discharged from the hospital are called post-hospitalisation expenses. These expenses are covered for 60 to 180 days depending upon the plan.
  • Ambulance costs - costs incurred for an ambulance transport are covered up to a specified limit.
  • Day care treatments - medical advancements have made it possible for patients to walk in a hospital, get a procedure done and be discharged within 2-3 hours. For example, a cataract surgery does not require inpatient hospitalisation of 24 hours or more. Such medical procedures are covered as day care treatments under mediclaim plans.

Besides these common coverage features, the best Mediclaim insurance plan provides a host of other coverage and benefits. These are: AYUSH treatments - cover alternative forms of non-allopathic treatments like Ayurveda, Unani, Siddha and Homeopathy.

  • Organ donor expenses - expenses incurred in harvesting an organ from a donor for an organ transplant surgery are covered.
  • Domiciliary treatments - if treatments are taken at home either because there are no vacant hospital beds or because the insured cannot be shifted to the hospital, such domiciliary treatments are covered.
  • Maternity expenses - many Mediclaim insurance plans provide coverage for childbirth related expenses after a specified waiting period.

Other features of Mediclaim Policy

Besides offering a wide scope of coverage benefits, Mediclaim plans also provide the following features:

  • Free health check-ups – Mediclaim plans allow free health check-ups after every 1 to 4 policy years depending upon the plan.
  • Restoration of sum insured A new feature of several mediclaim plans where the sum insured is restored if it is exhausted in any policy year.
  • No Claim Bonus - If a claim is not made in a mediclaim policy year, a no claim bonus is rewarded. Through this bonus either avail a premium discount for the next year or increase the sum insured at the existing rate of premium.

What is not covered under Mediclaim Insurance?

Some expenses and instances of medical emergencies are excluded or not covered by a Mediclaim plan. These include the following:

  • Self-inflicted injuries or an attempted suicide
  • Injuries or illnesses suffered when under the influence of alcohol or drugs, in a criminal act, when participating in hazardous activities, etc.
  • Radioactive injuries or nuclear contamination
  • HIV / AIDS and other sexually transmitted illnesses
  • Cosmetic treatments or treatments related to mental disorders
  • Congenital disabilities or diseases
  • Pre-existing illnesses and their complications are not covered in the first few years
  • War related injuries, etc.

Buying a Mediclaim Policy in India

With the help of Paybima, it is very easy to buy the best mediclaim policy or plan in India. Our website simplifies the process by featuring the best Mediclaim insurance policies on one page. You can go to the page, and compare all the policies with regards to features, medical premium quotes, exclusions, etc. The simplified and in-depth comparison leads to informed decisions, enabling you to buy a mediclaim insurance online, best suited to your individual requirements.

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