What is a Mediclaim Insurance Policy?

Mediclaim Policy in India

A mediclaim insurance policy is a type of insurance policy that is specifically designed to cover the medical expenses of the policyholder. Under a mediclaim policy, the insurance company reimburses your funds when medical bills are submitted to the company. In case an individual does not have resources to cover medical bills, mediclaim plans also offer a cashless treatment policy. Under a cashless treatment policy, the policyholder does not have to worry about the bill payments as the insurance company will pay off the hospital bills directly. In this article, we’ll take a deeper look into mediclaim and why it is important to buy mediclaim in India.

What is Mediclaim

In simple terms, a mediclaim policy is a form of health insurance that provides coverage only for medical expenses but does not cover any other non-medical expenses. The level of coverage offered depends on the maximum sum insured offered by the policy. Some people confuse mediclaim to be the same as health insurance. However, health insurance plans have a broader scope of coverage compared to mediclaim policies. Let’s take a look at the important aspects of mediclaim you need to consider before finalising a plan:

1. Premiums

Premiums are the payments made by you to your insurer to keep your mediclaim plan active. The cost of premiums depends on variables like sum insured, age, location, etc.

2. Claims

You can make an insurance claim on your medical plan in order to get reimbursed for medical expenses incurred during treatment.

3. Types

There are various types of mediclaim policies available that cater to a wide range of demographics, such as individual mediclaim plan, family mediclaim plan, critical illness medical plan, etc.

4. Cashless Mediclaim

Mediclaim policy offers a cashless treatment policy where the insurance company directly settles your medical bills with the hospitals, however, this feature is applicable only in the selective network hospitals of the insurance company.

5. Tax Benefits

As mentioned in Section 80D of the Income Tax Act, 1961, you can get a tax deduction of up ₹25,000 on the premiums paid. For senior citizens, this limit has been increased to ₹50,000.

Types of Mediclaim Policies Available in India

Mediclaim insurance policy has a wide range of options to choose from. One can get the mediclaim policy plans as per their financial needs -

• Mediclaim Individual Policy Plan

This mediclaim insurance is for a single person. The benefits and policy perks can be availed only by the insured person.

• Mediclaim Family Floater Policy Plan

This insurance plan covers the medical expenses of any immediate family member of the insured.

• Mediclaim Senior Citizen Policy Plan

Mediclaim offers a separate category of insurance plans for the 60+ age group.

• Mediclaim Accident Policy Plan

The mediclaim insurance plans also cover medical expenses caused by the human-error like an accident, partial or total disability, etc

• Mediclaim Illness Policy Plan

Illness related to heart, liver, kidney, etc that require lump-sum funds for diagnosis and treatment are also covered under the mediclaim insurance policy.

• Mediclaim Protector Policy Plan

This mediclaim plan covers medical expenses for vector-borne ailments like dengue, typhoid, etc.

Benefits of Buying a Mediclaim Policy

There are several tangible and non-tangible benefits you can enjoy by buying a mediclaim policy in India. The main ones have been listed below:

1. Economically Effective

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

2. Tax Benefits

As mentioned above, you can enjoy a tax deduction of up to ₹25,000 or ₹50,000 (for senior citizens) on premiums paid for mediclaim policies, as per Section 80D of the Income Tax Act, 1961.

3. Multiple Options

When looking to buy a mediclaim policy, you can choose from a wide variety of options that offer different features and benefits.

4. Relieves Mental Stress

Once you have purchased a mediclaim policy, you can rest assured that you will remain financially covered against medical expenses. You won’t have to deplete your savings or go into debt to pay off hospital bills.

5. Endless Renewability

After you have purchased a mediclaim plan, you can keep renewing it for as long as you want. However, some insurers may put a maximum age limit on renewability, which you can find out by reading the policy documents.

Inclusions Under Mediclaim Policies

Individuals who are planning to buy any mediclaim insurance plan are always concerned about clarity about the types of inclusions that will be covered in the plan. Here is a list of some prominent inclusions that are generally covered in all mediclaim policy plans:

• Consultation Fees

The mediclaim policy covers doctor’s /specialist’s consultation fees.

• Day-Care

In situations where a patient is not hospitalised for a longer period and is admitted for less than 24 hours, mediclaim handles the expenses of the insured.

• Hospitalisation Charges

It includes patients’ room charges, ICU room charges, etc.

• Hospital Equipment Charges

This essentially includes oxygen cylinder, diagnosis charges, etc.

• Additional Expenses

Additional expenses include pre and post-hospitalisation charges.

Note - These are general points that might differ with time and type of mediclaim policy. It is advisable to read the documents and understand the conditions carefully.

Exclusions Under Mediclaim Policies

There are some general medical expenses that any mediclaim policy plan does not cover. These expenses have to be borne by the patient and their families. Some of these are:

• Pre-Existing Conditions

A mediclaim policy will not provide coverage for pre-existing conditions unless their waiting periods have passed.

• Cosmetic Procedures

Any cosmetic procedures done for any reason other than medical will not be covered by mediclaim.

• Dental Procedures

Dental procedures are also not covered under mediclaim policies.

• Abortion and Pregnancy

Mediclaim policies do not provide any coverage for abortion-related medical expenses. Pregnancies that exist as a pre-existing condition at the time of buying insurance are also not covered.

• Suicide

Any medical issues or injuries arising out of suicide attempts are not covered.

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.

How to Buy a Mediclaim 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: Visit the mediclaim policy page of any health insurance provider’s website.

Step 2: Enter your personal details such as gender, age, etc. along with any relevant medical information as required.

Step 3: A set of mediclaim insurance options will appear on the website.

Step 4: Study the available options for features and benefits and choose the best mediclaim policy that suits your budget/requirements.

Step 5: Pay the online premiums for your chosen mediclaim and it will soon be activated.

Documents Required While Buying a Mediclaim Policy

You may need to keep the following set of documents ready when looking to buy a mediclaim policy:

• Accurately filled mediclaim insurance form

• Proof of age (i.e. Aadhaar, PAN)

• Proof of identity (i.e. Passport, Driving Licence)

• Proof of address (i.e. Driving Licence, Aadhaar Card)

• Passport-sized photographs

• Medical test reports (may or may not be required depending on the insurer)

Factors to Remember When Buying a Mediclaim 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 the best mediclaim insurance policy as per their needs and goals within their financial capacity.

• Wide Range of Network Hospitals

If you prefer a direct cashless treatment policy, select an insurance company that has a large and wider network of reputed hospitals under a cashless treatment policy to ensure smooth and hassle-free services during emergencies.

• Claim Settlement Ratio

This aspect has to be carefully observed before opting for a mediclaim plan in any company. The settlement ratio means the number of times the insurance company has settled the medical bills of their clients in comparison to the claims made in a year. Always opt for a company that has a high record of settling bills.

• Per cent-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. Therefore look for insurance companies that have high percentage-based compensation to ease your financial burden.

• Waiting Period

In case, you have an existing illness before purchasing any mediclaim policy plans, as per the protocol, you will have to bear the waiting period. A waiting period is a duration ranging between 1 -4 years where the insured cannot claim any reimbursement of medical bills for their existing illness. After the waiting period is over, the insurance company will settle the bills. Therefore, look for an insurance company that has a shorter waiting period.

• Cost of Premiums

It is important to always keep your financial goals and needs into consideration before opting for a mediclaim policy plan. With attractive features and facilities, there may be a heavy health insurance premium attached to it which might affect your budget.

Mediclaim Policy Claim Procedure

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 Claims

In the case of mediclaim policies that offer cashless services, you need to take the insured patient to a network hospital. There, the policyholder/insured can fill out the pre-authorisation form for cashless treatment. Once the insurance details are swiftly verified, treatment for the patient begins. Post-treatment, the insurance company pays off the medical bills.

2. Reimbursement Claims

In case of reimbursement claims, you must inform your insurer as soon as the insured patient has been hospitalised. All the original bills and receipts of the medical treatment must be stored carefully. At the end of the treatment, these bills and receipts will need to be presented to the insurer. The insurance company will take a few days to verify the claims and then pay out the reimbursement amount.

To Conclude

Due to rapidly rising health costs, financial experts recommend everyone to have a mediclaim or insurance policy in place. During medical emergencies, the best mediclaim plans will take care of the financial aspect of the situation and will reduce stress on the patient’s shoulders. However, it is advisable to read the terms and conditions carefully before opting for any mediclaim plan to avoid chaos in the future. For comprehensive coverage for your and your family’s health, you can also opt for an extensive health insurance plan from platforms like Bajaj MARKETS.

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