All About Mediclaim Insurance Policy

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 temporarily fund to cover medical bills, mediclaim also offers a cashless treatment policy. Under a cashless treatment policy, the policyholder does not have to worry about the bill payments. The insurance company directly settles your medical bills with the hospital. However, there are certain terms and conditions involved with mediclaim's cashless treatment policy. 

 Features

With the current lifestyle and eating culture followed by people today, owning any mediclaim policy plans proves beneficial in the need of the hour. There are various features of mediclaim, however, the key features of this insurance plan are -

  • Cashless Treatment Policy

    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.

  • Different Types of Plans

    There are different types of mediclaim policy plans available in the insurance company. One can choose to get an individual or family plan at their convenience.

  • Tax Benefits

    There are tax exemptions and benefits involved in the premium of the mediclaim insurance policy. These benefits are helpful during year-end financial accounting.

Types

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 the insurance plan for the 60+ age group.

  • Mediclaim Accident Policy Plan

    The mediclaim insurance plans also covers 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 of vector-borne ailments like dengue, typhoid, etc.

Inclusions

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

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 -

 

  • Expenses of cosmetic and Plastic surgery

  • Medical Expenses incurred before subscribing mediclaim insurance policy

  • External Medical equipment like hearing aid, wheelchair, etc

 

**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.

Things To Keep in Mind Before Buying the Plan

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.

  • 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.

  • Subscription Premium

    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 is a heavy premium attached to it which might affect your budget.

How to Choose the Right Policy?

Choosing the right policy is tricky, however, if you break down the elements and align them with your needs, you will end up buying the best mediclaim insurance plan. All you have to do is ask three main questions to yourself to understand your needs and align them with the policy you have.

  • What is the purpose of the mediclaim insurance policy plan?

    Align the understanding of types of mediclaim policies and your needs to find the best type of mediclaim policy plan.

  • How much Premium can you afford to pay at regular intervals?

    With such attractive features and benefits, one must also keep their budget and financial capacity into consideration.

  • Which insurance company should I opt for?

    A comparison among the catalogues of different insurance company policy plans will help you to gain a better understanding. Opt for a company that offers maximum benefits at economical rates.

Conclusion

Having a mediclaim insurance policy plan is recommended these days. There is no age bar to own a mediclaim plan. During medical emergencies, a mediclaim plan will take care of the financial aspect of the situation and will reduce stress from 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, it is better to opt for an extensive health insurance plan from platforms like Finserv MARKETS.

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FAQs on Mediclaim Policy

  • ✔️Can I get my doctor’s consultation fees reimbursed from my mediclaim plan?

    Yes, you can get your doctor’s consultation fees reimbursed from most of the mediclaim policy plans.

  • ✔️Will I get any tax exemptions on the premium of my mediclaim plans?

    Yes, under Section 80C of the Income Tax Act, one can generate tax benefits on the premium paid to any of your mediclaim insurance plans.

  • ✔️Can I carry forward my benefits of the mediclaim insurance plan next year if I have not used it this year?

    No, you cannot carry forward all the benefits of the mediclaim insurance plan next year, if you have not used it this year.

  • ✔️What is the claim settlement ratio in mediclaim policies?

    The claim settlement ratio in mediclaim insurance policies varies for different insurance companies.

  • ✔️Can I have two Mediclaim insurance plans from different insurance companies?

    Yes, you can buy two different mediclaim insurance plans from different insurance companies.

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