How Does a Mediclaim Policy Work?
Mediclaim insurance is a type of insurance plan 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 the medical bills, a mediclaim insurance plan also offers a cashless facility at authorised network hospitals.
Due to the cashless treatment option, the insured does not have to worry about the healthcare bills as the insurance company will pay off the expenses directly. In this article, we’ll take a deeper look into mediclaim and why it is important to buy mediclaim in India.
Why Should You Buy a Mediclaim 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 urgencies.
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 as per their financial needs from the following options:
1. 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.
2. 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.
3. Senior Citizen Mediclaim Policy
Mediclaim insurance offers a separate category of health plans for individuals over the age group of 60. Such senior citizen health policies are personalised to meet the policyholder’s insurance needs.
4. Personal Accident Plan
The mediclaim insurance plans also cover medical expenses incurred during an unfortunate accident leading to bodily injuries, partial or total disability, death, etc
5. 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 on getting diagnosed.
Features of a Mediclaim Policy
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.
When considering to buy a mediclaim insurance policy, you can choose from a wide variety of options to meet your insurance requirements.
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.
Choice to Opt for Renewal
After you have purchased a mediclaim 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.
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 Under Mediclaim Policies
Individuals who are planning to buy any mediclaim insurance plan must always go through the inclusions that are covered in the plan. Here is a list of some prominent inclusions of the mediclaim insurance policy:
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.
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.
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 may not cover. These expenses have to be borne by the patient and their families. Some of these are:
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 as a pre-existing condition at the time of buying insurance and aren’t covered.
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.
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.
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: Various mediclaim insurance policies shall be visible on the page.
Step 4: Compare the available options for features and benefits and choose a suitable mediclaim policy that suits your budget/requirements.
Step 5: Pay the online mediclaim premiums for your chosen plan and it will soon be activated. The mediclaim insurance policy document shall be issued soon!
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)
Factors to Consider While 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 a suitable mediclaim insurance policy as per their needs and goals within their financial capacity.
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.
The CSR or Claim Settlement Ratio in health insurance 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.
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.
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.
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.
Why Buy a Mediclaim Insurance Policy Online
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!
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 premium quotes offered by insurance providers online and pick a pocket-friendly mediclaim policy that suits your budget!
Conclusion
Due to rapidly rising healthcare costs, financial experts recommend everyone to have a mediclaim policy or a health insurance plan in place. During medical emergencies, mediclaim shall take care of the financial aspect and provide peace of mind. However, it is advisable to read the terms and conditions carefully before opting for mediclaim to avoid any issues in the future. You can also opt for comprehensive coverage for your and your family’s healthcare needs with health insurance plans available on Bajaj Markets.
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