Mediclaim insurance is a type of coverage provided under a health insurance policy. By paying a premium, you can safeguard yourself against medical expenses resulting from illnesses or accidental injuries. The coverage can be in the form of cashless claims, available when accessing treatment from network hospitals, or reimbursement claims when treatment is obtained at non-network hospitals. It's important to note that the specifics of the coverage may differ from one insurance company to another and across various plans.
In today's increasingly costly healthcare landscape, managing medical expenses has become challenging. However, the importance of addressing healthcare needs cannot be understated, whether it's a long-term illness or an unforeseen emergency. This is where Mediclaim policies come into play, offering a lifeline to individuals.
Mediclaim insurance serves as a subset of health insurance, providing financial assistance during medical emergencies through reimbursement and cashless facilities. However, it's crucial to carefully select a Mediclaim policy that suits your specific needs, as the coverage inclusions and sub-limits can vary based on the policy chosen.
Mediclaim insurance is a type of insurance plan that is specifically designed to cover your medical expenses. Under a Mediclaim policy, the health insurance company reimburses your funds when medical bills are submitted to the company. In case you don’t have the resources to cover the medical bills, a Mediclaim insurance plan can offer you a cashless facility at authorised network hospitals.
Due to the cashless treatment option, you don’t have to worry about the healthcare bills as the insurance company will pay off the expenses directly. Let’s take a deeper look into Mediclaim and why it is important for you to buy a Mediclaim policy.
You can find below some of the best Mediclaim policies in India that you can find on Bajaj Markets.
Mediclaim Policy |
Total Sum Insured |
Network Facilities |
Aditya Birla Mediclaim Policy |
₹10 Lakhs to ₹30 Lakhs |
8700+ |
Care Health Insurance Mediclaim Policy |
₹3 Lakhs to ₹60 Lakhs |
16,500+ |
Bajaj Allianz Mediclaim Policy |
₹1.5 Lakhs to ₹50 Lakhs |
6500+ |
You can find a plethora of Mediclaim policies in India, however being aware of the various types of Mediclaim policies that exist is important. Hence, for your perusal, you can find the types of Mediclaim policies you can get in India in the table given below.
Type of Policy |
Features |
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Individual Mediclaim Policy |
Such a Mediclaim insurance plan is for a single person where the Mediclaim benefits and policy perks can be enjoyed only by the insured person. |
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Family Floater Policy |
The family floater insurance plan covers the medical expenses of the policyholder and their family members added under the policy. This includes the spouse, children, dependent parents, etc. |
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Senior Citizen Mediclaim Policy |
Mediclaim insurance offers a separate category of health plans for individuals over the age group of 60 years. Such senior citizen health policies are personalised to meet the policyholder’s insurance needs. |
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Personal Accident Plan |
Such Mediclaim insurance plans also cover medical expenses incurred during an unfortunate accident leading to bodily injuries, partial or total disability, death, etc |
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Critical Illness Policy |
The critical illness Mediclaim policy covers specific ailments that are listed under the plan. A lump-sum benefit for treatment and recovery shall be provided to the insured upon diagnosis. |
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Individuals who are planning to buy any Mediclaim insurance plan must always go through the inclusions and exclusions of the plan. While there are some prominent inclusions in a Mediclaim insurance policy, there are some general medical expenses that a policy plan may not cover. These expenses have to be borne by the patient and their families. Let's take a look at the inclusions and exclusions under Mediclaim policies:
Inclusions |
Exclusions |
Healthcare treatments that don’t require the patient to be hospitalised for 24 hours are termed as daycare procedures and are covered under Mediclaim insurance.
Pre and post-hospitalisation expenses incurred by the policyholder are included in the Mediclaim policy.
Many Mediclaim plans cover the doctor’s /specialist’s consultation fees so that policyholders can rest assured while seeking treatment.
Expenses related to the policyholder’s hospitalisation such as the room charges, ICU room charges, blood, oxygen, medications, etc. are covered by the insurance provider.
Any other healthcare expenses incurred during hospitalisation might also be covered under the Mediclaim policy. |
A Mediclaim policy will not provide coverage for pre-existing conditions unless their waiting periods have been completed.
Any cosmetic procedures done for any reason other than for medical purposes will not be covered by Mediclaim.
The medical cost of dental treatments is also not covered by the insurance provider.
Mediclaim policies do not provide any coverage for abortion-related medical expenses. Pregnancies that exist are considered pre-existing conditions at the time of buying insurance and aren’t covered.
Any self-inflicted injuries or suicide attempts are not covered under the insurance plan.
The coverage for treatment expenses incurred for any sexually transmitted disease is not included in the policy.
The Mediclaim insurance plan will not cover any cost resulting from vaccinations. |
Note: These are general points that might have the addition of such more conditions with time and type of Mediclaim policy. It is advisable to read the documents and understand the conditions carefully.
While often used interchangeably, mediclaim vs health insurance are two different things. A health insurance plan is a very comprehensive term that includes a wide range of coverage. A Mediclaim policy, on the other hand, is more specific to the medical treatment/ procedure. Let us take a closer look at these differences.
Details |
Health Insurance Policy |
Mediclaim Policy |
Coverage |
Apart from the hospitalisation expenses, it covers other services like pre and post-hospitalisation, ambulance charges, check-ups etc. You have the option to include add-ons and riders in your health insurance plan. |
A Mediclaim policy often covers only the cost of treatment and hospitalisation expenses. A Mediclaim policy does not offer any option of enhancing the coverage through add-ons or riders. |
Sum Insured |
The sum insured can be quite high depending on the coverage sought, which can go up to 8 figures. |
Such policies come with a more modest sum insured as compared to a health insurance plan. |
Claim Settlement |
In case of accidental injuries or critical illness, often a lump sum amount is paid out after which the plan may cease. |
Unlimited claims can be made until the sum insured is finished. |
With the advent of online services, you can now buy a Mediclaim policy in just a few minutes by following the straightforward steps given below:
Step 1: Go to the ‘Health Insurance Premium Calculator’ page.
Step 2: You will see the top health insurance plans at Bajaj Markets. Pick the insurance provider of your choice by clicking on “View Plans”.
Step 3: Health insurance options as per the partner you chose will be displayed on your screen. Click on ‘Buy Now’ for the insurance policy you’d like to get.
Step 4: Enter details such as your name, gender, contact information, etc. Click on ‘Get Quote’.
Step 5: Choose your policy by clicking on its subsequent ‘Buy Now’ option.
Step 6: Choose the tenure as per premium amount and select ‘Next’.
Step 7:Enter the details asked of you such as your contact information, address, basic health information, nominee details, medical health details and more.
Step 8: Once you have confirmed that all your details are correct, click on ‘Proceed’.
Step 9: Pay the premium amount through you desired payment method.
Mediclaim insurance provides security against the ever-increasing medical care inflation in India. With the help of a cashless facility available under the insurance plan, you do not have to make any upfront payments. This enables you to seek planned as well as emergency medical treatment without the financial worries of hefty bills. Furthermore, the Mediclaim premiums are quite affordable for individuals who want monetary protection against healthcare emergencies.
Part of buying a Mediclaim policy is also understanding how the claim process works so that you can instantly apply for a claim when a medical emergency arises. There are two ways you can make a claim, as explained below:
For Mediclaim policies that offer cashless services, you need to notify the insurer at the earliest and visit an authorised network hospital. You must fill out the pre-authorisation form from the insurance desk at the hospital. Once the insurance details are swiftly verified, treatment for the patient begins. Post-treatment, the insurance company shall pay off the medical bills.
In case of reimbursement claims, you must inform the insurer about the claim as soon as possible. All the original bills and receipts of the medical treatment must be stored carefully. At the end of the treatment, these bills and receipts need to be presented to the insurer. The insurance company will verify the claim details and then pay out the reimbursement amount.
You may need to keep the following set of documents ready while purchasing a Mediclaim policy.
Accurately filled Mediclaim insurance form
Proof of age (i.e. Aadhaar, PAN, etc.)
Proof of identity (i.e. passport, driving licence, etc.)
Proof of address (i.e. driving licence, Aadhaar card, etc.)
Passport-size photographs
Medical test reports (may or may not be required depending on the insurer)
Yes, you can get your doctor’s consultation fees reimbursed under most mediclaim policies.
Yes, under Section 80D of the Income Tax Act, 1961, one can claim tax benefits on the mediclaim premium paid towards the mediclaim insurance plan.
No, you cannot carry forward any benefits of the mediclaim insurance plan next year, if you have not used them during the policy year.
Yes, the mediclaim policy covers pre and post-hospitalisation costs incurred by the policyholder.
Yes, you can buy two different mediclaim insurance plans from different insurance companies.
Most health insurance companies follow a basic and simple claim settlement procedure. You need to fill up the claim form, and submit the required set of medical documents with the insurance provider. In case of a pre-planned hospitalisation, you need to inform the insurer a few days in advance so that the formalities can be completed., in case of emergency hospitalisation, you can do the paperwork within 24 hours of admission to the hospital.
While the age threshold may differ from company to company and plan to plan, generally people between 18 years to 60 years qualify for mediclaim policies.
Yes, almost all kinds of mediclaim policies cover accidental injuries that require hospitalisation for more than 24 hours. The coverage, however, depends on the sum inserted that you have opted for.
There can be a number of factors when it comes to choosing the best cashless mediclaim policies. Make sure you keep in mind the coverage, the sum insured, the features and the premium in mind before you finalise the plan.
When choosing a mediclaim policy make sure you draw an online comparison of the different available options. Compare and analyse the features of every plan and then pick the one that suits your needs as well as your budget.
An individual mediclaim insurance plan is for a single person. Here the coverage, the mediclaim benefits and the policy perks can be enjoyed only by the person covered. Such policies cover the expenses incurred during hospitalisation due to an illness or injury.
The premium that you pay towards the mediclaim policy depends on a number of factors such as:
a. Age of the applicant
b. His/ her medical condition
c. Lifestyle habits, for example, people who smoke/ drink usually pay a higher premium
d. Sum insured and coverage chosen.
Yes, almost all mediclaim policies will offer a cover for the hospitalisation required due to coronavirus. It is, however, recommended that you confirm the same from your insurance provider.
The best mediclaim policy will cover the following:
a. Costs due to hospitalisation
b. OT charges
c. Cost of medicines, oxygen etc
d. Investigations and tests.