Mediclaim are insurance policies in which the insurer reimburses the policyholder for medical costs incurred during the policy period. A cashless facility is available in the insurer's network hospitals if the insured submits the relevant bills to get reimbursed. The difference between health insurance and Mediclaim is often misunderstood by most people. Despite the fact that both provide financial protection during emergencies, Mediclaim is not just another term for health insurance. Mediclaim is a type of health insurance policy in which the insurer reimburses policyholders for medical expenses incurred in treating their medical conditions. Medical insurance companies can pay your bills if you have a policy. You may also opt for cashless treatment, where insurance companies and hospital administrators are responsible for settling medical bills. Mediclaim policies or health plans have become essential due to the skyrocketing medical inflation rates. Health insurance policies such as Mediclaim cover illnesses and hospitalizations up to a certain amount. The benefits of these policies expire after a specific period of time, after which the policyholder must renew them in order to continue receiving them. Mediclaim plans provide coverage and benefits in the same way as other insurance plans by periodically charging a premium. To continue enjoying the coverage offered under these insurance plans, you must renew them every year during the predetermined policy tenure.
Benefits of a Mediclaim Policy
Mediclaim policies offer the following notable benefits:
- Cost-effective: It is a cost-effective solution to rising healthcare costs.
- Medical emergencies: Make sure you are protected by a mediclaim policy in case of an accident or other medical emergency.
- Cashless claims: During hospitalization, it provides cashless claims, so the policyholder does not have to pay anything from his/her pocket. Direct payment is made to the hospital by the insurer.
- Tax benefits: The Revenue Act of India, 1961 section 80D allows policyholders to claim tax benefits when they purchase Mediclaim policies.
List of Best Mediclaim Policies
Company Name | Plan Name |
Hdfc Ergo Mediclaim Insurance | Optima restore, optima secure, health suraksha, Medisure super top up, health wallet, energy plan, Koti Suraksha, Hdfc ergo I
can. |
Tata Aig Mediclaim Insurance | Tata aig Medicare, Tata aig Medicare premier, Tata
aig Medicare plus, Criticare plan. |
Niva Bupa Mediclaim Insurance | Reassure plan, health companion, health recharge, go
active, health pulse, health premia, senior first plan, heartbeat plan, Criticare,
personal accident plan. |
Care Mediclaim Insurance | Care plan, care advantage plan, care classic plan,
care joy plan, care freedom plan, care senior plan, care heart plan, and care
enhance plan. |
Features of a Mediclaim Policy
- Economical and cost-effective - The scope of mediclaim insurance is usually limited to medical expenses, making it more affordable than general health insurance.
- Options to choose from - If you're thinking of buying Medicare insurance, you have many options to choose from.
- Having financial security - If you purchase mediclaim insurance, you will have financial protection against medical expenses. The hospital will pay for your medical expenses without depleting your savings or causing you to incur debt.
- Renewal Option - Mediclaim plans can be renewed as long as you like after they have been purchased. You can read the policy documents thoroughly to confirm whether your insurer has an age limit for insurance renewals.
Benefits of taxation - Section 80D of the Income Tax Act, 1961 allows you to deduct up to Rs. 25,000 or Rs.50, 000 (for senior citizens) on mediclaim premiums.
Types of Mediclaim Policies Available in India
In India, consumers can choose from the following types of Mediclaim policies:
- Individual Mediclaim: An individual Mediclaim policy covers medical expenses only for the policyholder.
- Family floater: A family floater Mediclaim plan covers all members of the family against medical liabilities by paying a master premium.
- Group Mediclaim: Employers and persons in charge of groups purchase group Mediclaim policies for the employees/members. The employer usually adds it to the employee's compensation.
- Senior Citizen Mediclaim: These policies are specially designed for seniors and may have special provisions or testing requirements.
- Critical Illness Mediclaim: Medical insurance policies that cover critical illness treatments, such as cancer, kidney failure, and multiple sclerosis.
- Overseas Mediclaim: Medical expenses incurred outside India can be claimed under an overseas Mediclaim policy.
- Low-cost Mediclaim Policies: These policies are designed for the underprivileged section of society. Employers usually purchase such policies to insure their employees at low premiums in small and medium-sized businesses.
Inclusions Under Mediclaim Policy
Mediclaim inclusions may vary depending on the type of policy and the insurance provider. The following are the general inclusions of a Mediclaim policy:
- In-Patient Hospitalization - This insurance covers expenses incurred when an insured person is hospitalized for 24 hours or longer.
- In addition to hospitalization, the Mediclaim policy covers treatment in a daycare facility.
- Coverage for medical expenses incurred before and after hospitalization - The insurance covers medical expenses incurred before and after hospitalization.
- Hospitalization conducted at home is referred to as domiciliary treatment when there are not enough hospital beds available in the area or if the insured is unable to be transferred to a hospital.
- One to four claim-free policy years should be enough for most health insurance policies to cover preventative health screenings.
- The insured person receives a bonus in the next policy year for each year without claiming on the policy.
Exclusions Under Mediclaim Policies
A mediclaim policy may not cover some medical expenses that are general in nature. The patient and his or her family are responsible for these expenses. Here are a few examples:
- Conditions that preexist - Pre-existing conditions will not be covered by a mediclaim policy until their waiting periods have expired.
- Procedures for cosmetic improvement - Mediclaim will not cover cosmetic procedures performed for reasons other than medical.
- Procedures performed by dentists - The insurance provider does not cover dental treatments either
- Pregnancy and abortion - Medical expenses related to abortion are not covered by Mediclaim policies. When buying insurance, existing pregnancies are considered preexisting conditions and aren't covered.
- Attempting suicide - Suicide attempts or injuries caused by self-infliction are not covered by the insurance plan.
- Diseases transmitted sexually - In this policy, treatment expenses incurred for sexually transmitted diseases are not covered.
- The vaccination process - There will be no coverage for vaccination costs under Mediclaim insurance.
Claim Process For Mediclaim Policies
In Mediclaim policies, policyholders are given the option of making cashless claims and receiving reimbursements. In cashless facilities, the insured can go to any hospital in the insurance provider's network without having to pay anything out of pocket. Should the policyholder choose a hospital that is not in the insurer's network, the insurer will reimburse the policyholder's expenses upon filing a claim. The following is the process for filing a claim:
1. Reimbursement Claims - The insurer or the TPA must be informed as soon as the policyholder is hospitalized if reimbursement claims are to be submitted. Keeping track of hospital expenses and all bills during hospitalization is important. You must attach the bills and fill in the details correctly when filling in the claim form. The reimbursement process can be delayed even by a minute error.
2. Cashless Claims - For planned cashless hospitalization, the policyholder is expected to sign a 'pre-authorization form' in advance. The insured can show their Medi-Assist ID card at the network hospital in case of emergency treatment, after which the policyholder is given four hours to fill out the pre-authorization form.
Things to Remember When Buying a Mediclaim Policy
Considering healthcare costs are rising constantly, purchasing a Mediclaim policy makes sense. Consumers should, however, invest in a policy suited to their needs. Buying a Mediclaim policy requires consideration of the following factors:
1. Coverage - To ensure good coverage, it is crucial to choose an adequate sum insured. The higher the sum insured, the higher the premium, but assessing one's needs and selecting the right coverage can go a long way in protecting oneself from medical costs.
2. Co-payment - The insured is required to pay a percentage of the claim amount under a co-payment clause. It is usually much cheaper to purchase a policy with a co-pay feature.
3. Sub-limits - When purchasing a policy, it's important to pay close attention to the sub-limits, as some insurers have specific limits on certain illnesses.
4. Waiting limit - There is a waiting period during which claims cannot be made except for those resulting from accidents that have resulted in hospitalization. There is also a waiting period for pre-existing illnesses and other diseases. A consumer can make a better decision by checking the exclusions during the waiting period.
5. Network hospitals - Cashless facilities are only available at the insurance provider's network hospitals. As a result, policyholders have access to a wide range of hospitals across different geographical regions.
6. Add-on - There are generally no add-on riders available with Mediclaim policies. It is possible to significantly enhance the policy by investing in add-ons if the insurer provides them. Buying unnecessary add-ons will, however, only increase the insurance premium amount without benefiting the policyholder.
7. Exclusions - A policy's exclusions should be understood as ignorance could result in confusion when filing a claim.
8. Free look period - If the policyholder is not satisfied with the plan, he/she can return it and receive a refund during the free look period. There is ample time for the insured to review the details of the policy during this period. It is important for consumers to use this time wisely in order to avoid bad deals.
Documents Required While Buying a Mediclaim Policy
When purchasing a medical insurance policy, you may need the following documents:
- The mediclaim insurance form must be filled out accurately
- Identification (such as Aadhaar, PAN, etc.)
- Identity proof (passport, driving license, etc.)
- Address proof (such as a driving license or Aadhaar card).
- Photographs that are passport-size
- Reports of medical tests (depending on the insurer, this may or may not be required)
