Mediclaim Policy

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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.

What is Mediclaim Policy?

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.

Top Mediclaim Policies in India on Bajaj Markets

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+

Types of Mediclaim Policies Available in India

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
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.
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.
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.
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
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.

Features and Benefits of a Mediclaim Policy

A Mediclaim policy can bring you a host of features that can provide you with financial security against medical emergencies and unforeseen medical crises. These features and benefits, as listed below, can not only help you manage your finances without any event or need taking you by surprise, it can also help you stay secure and stress-free.

1. Helps You Be Future-Ready

With the rise in lifestyle diseases and the ever-increasing medical inflation, it is becoming rather difficult for the common man to be able to afford healthcare treatments. Having a Mediclaim policy by your side will ensure that in case of medical urgency, you do not have to run around arranging finances. The policy would take care of the expenses.

2. Economically Cost-Effective

A Mediclaim insurance policy is almost always more affordable than a general health insurance plan because the scope of its coverage is only limited to medical expenses.

3. Multiple Options

When considering buying a Mediclaim insurance policy, you can choose from a wide variety of options to meet your insurance requirements.

4. Financial Security

Once you have purchased a Mediclaim policy, you can rest assured that you will be financially covered against medical expenses. You won’t have to deplete your savings or shoulder any debts to pay off your hospital bills.

5. Coverage for Family

You have the option to cover your family members and ensure that even if a medical emergency strikes you, you do not have to dig into your savings.

6. Different Types of Policies to Choose From

As discussed above, there are a number of choices when it comes to choosing the right kind of Mediclaim policy. Chalk out your medical insurance needs and accordingly choose the policy that would best suit your needs.

7. Choice to Opt for Renewal

After you have purchased a Mediclaim insurance plan, you can keep renewing it for as long as you want. Although some insurers may have an age limit on insurance renewal, you can thoroughly read the policy documents to confirm such conditions.

8. Tax Benefits

You can enjoy a tax deduction of up to ₹25,000 or ₹50,000 (for senior citizens) on premiums paid towards Mediclaim under Section 80D of the Income Tax Act, 1961.

Inclusions and Exclusions Under Mediclaim Policies

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
Daycare Procedure 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 Pre and post-hospitalisation expenses incurred by the policyholder are included in the Mediclaim policy. Consultation Fees Many Mediclaim plans cover the doctor’s /specialist’s consultation fees so that policyholders can rest assured while seeking treatment. Hospitalisation Charges 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. Additional Expenses Any other healthcare expenses incurred during hospitalisation might also be covered under the Mediclaim policy.	Pre-Existing Conditions A Mediclaim policy will not provide coverage for pre-existing conditions unless their waiting periods have been completed. Cosmetic Procedures Any cosmetic procedures done for any reason other than for medical purposes will not be covered by Mediclaim. Dental Procedures The medical cost of dental treatments is also not covered by the insurance provider. Abortion and Pregnancy 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. Suicide Any self-inflicted injuries or suicide attempts are not covered under the insurance plan. Sexually Transmitted Diseases The coverage for treatment expenses incurred for any sexually transmitted disease is not included in the policy. Vaccination 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.

Difference between Health Insurance and Mediclaim Policy

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.

How to Buy a Mediclaim Insurance Policy?

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.

Why Should You Buy a Mediclaim Insurance Policy?

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.

Factors to Remember When Buying a Mediclaim Insurance Policy

With so many options to choose from, it is necessary to keep certain pointers in mind before making a decision. These aspects help an individual to choose a suitable Mediclaim insurance policy as per their needs and goals within their financial capacity.

1. The Coverage You Require

While there is a plethora of health plans available in the market, you need to choose the one that is in line with your medical needs. Opt for a Mediclaim policy that offers the coverage features that would be suitable for you.

2. The Size of Your Family

Choose a Mediclaim policy that is according to your family's needs. Opt for a policy that covers them all without burdening your pocket too much. For example, opting for an individual policy for every member of the family might turn out to be too expensive if you have more members in your family. In such a case, choosing a family floater with a high sum insured would be more advisable.

3. Your Medical History

If you or a family member has some medical issues, then you should opt for a Mediclaim policy accordingly. In case some genetic illness runs in the family, try opting for a policy that covers such illness or offers a minimum waiting period.

4. Wide Range of Network Hospitals

If you prefer a cashless treatment policy, select an insurance company that has a large and wider network of reputed hospitals to ensure smooth and hassle-free hospitalisation. A larger network would ensure that you can get easier access to more hospitals, and thus get the right treatment at the right time.

5. Claim Settlement Ratio

The CSR or health insurance claim settlement ratio is an aspect that has to be carefully observed before opting for a Mediclaim plan in any company. The settlement ratio means the number of claims settled by the insurance company in comparison to the claims made in a year. It is recommended to always opt for an insurer with a high Claim Settlement Ratio, a score above 90% is considered to be a decent score.

6. Percentage-Based Compensation

There are several categories in the expenses of the medical bills like hospital equipment charges, consultation charges, etc. The insurance companies have terms and conditions like percentage-based compensation. Under this condition, only a specific amount is settled by the insurance company, and the rest has to be paid by the insured. Hence, go through your policy documents to know if your plan has such clauses before purchasing it.

7. Waiting Period

In case you have a pre-existing illness before purchasing any Mediclaim policy plans, you will have to bear with the waiting period applicable. A waiting period in health insurance is a duration ranging between 1-4 years where the insured cannot claim any reimbursement of medical bills for their pre-existing illness. Therefore, look for an insurance company that has a shorter waiting period.

8. Cost of Premiums

It is important to always keep your financial goals and needs into consideration before opting for a Mediclaim policy. There might be a hefty health insurance premium attached to plans with attractive features and benefits which may affect your budget.

9. Ratings and Reviews

In a world of online shopping where nothing is bought without considering the ratings and reviews, why should insurance be any different? A quick online research will give you fair feedback on how well the insurer deals with its customers. Be it the products, customer approach or claim settlement, make sure you do your research.

Why Buy a Mediclaim Insurance Policy Online

You no longer have to visit an insurance company’s office to buy a Mediclaim policy. You can now complete the process within minutes online. Here’s why you should buy your Mediclaim policy online.

Convenience

Did you know that you can purchase Mediclaim on the go? The online Mediclaim plans can be easily bought from the comfort of your home or while you are travelling due to easy online access!

Option to Compare Plans

An important benefit of opting for online Mediclaim insurance is the option to compare various policies. You can choose a suitable plan after taking the Mediclaim coverage and features into account.

Competitive Premium Quotes

Moreover, you can also compare the Health insurance premium quotes offered by insurance providers online and pick a pocket-friendly Mediclaim policy that suits your budget!

How to Make a Claim Under Mediclaim Insurance?

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:

1. Cashless Insurance Claim

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.

2. Reimbursement Insurance Claim

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.

Documents Required While Buying a Mediclaim Policy

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)

Health Insurance Plans Available at Bajaj Markets

Bajaj Allianz Health Insurance	Aditya Birla Health Insurance	Care Health Insurance

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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.