Compare and Buy Mediclaim Policy

Safeguard your health and get coverage for medical expenses with mediclaim policies. Know the features and benefits of a mediclaim policy.
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Mediclaim policy
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3 min
26-February-2025

Medical expenses can create a financial burden on individuals, especially in times of unexpected illnesses or accidents. Mediclaim policies can alleviate this burden, making it a popular choice among people. It helps individuals and families cope with the rising costs of healthcare services. Thus, you get complete financial security during medical emergencies.

A mediclaim policy covers medical expenses during hospital stays, such as surgery, nursing, and ICU costs. It provides financial protection up to a chosen sum insured and allows for cashless treatment at participating hospitals. You can purchase it for yourself or your entire family.

What is a mediclaim insurance policy?

A mediclaim policy is a type of health insurance that covers you against unexpected medical expenses. You can get cashless treatment at network hospitals or reimbursement against your medical bills.

A mediclaim policy typically covers inpatient hospital expenses, pre- and post-hospitalisation expenses, ambulance charges, and more. It is important to carefully read the policy terms and conditions and choose a plan that suits your healthcare needs and budget. A mediclaim insurance policy is a vital investment in protecting your health and finances.

Who can apply for a Mediclaim Insurance Plan?

A mediclaim insurance policy is accessible to a wide range of individuals, from young adults to senior citizens. Families can also opt for family floater plans, ensuring coverage for all members under a single policy. Generally, anyone between 18 and 65 years old can apply, though some insurers extend coverage to older individuals. Specific eligibility criteria, including age and pre-existing conditions, will vary depending on the chosen insurer and the particular plan's terms.

Key features of a mediclaim insurance policy

Here’s a quick look at the key features of a mediclaim insurance policy offered at Bajaj Finance Insurance Mall:

Features

Specifications

Sum insured

Rs. 5 lakh to Rs. 50 lakh

Cashless treatment

6,500+ hospitals

Daycare treatment

Included

Pre-and post-hospitalisation expenses

Covered

Tax benefit

Available


Know in detail about the key features offered by a mediclaim policy.

Hospitalisation expenses:

The policy covers room rent, nursing expenses, surgeon fees, and doctor consultation fees. It also covers operation theatre charges and other related expenses.

Cashless treatment:

Get medical treatment at any of the insurer network hospitals without paying any money upfront. The insurance company settles the bills directly with the hospital before you get discharged.

Sum insured:

Choose the sum insured based on your medical needs and budget. The insurance company will pay for medical expenses up to the sum insured by the policy.

Tax benefits:

You get tax benefits for the premium paid towards a mediclaim policy. Claim for tax exemption under the relevant sections of the Income Tax Act, 1961.

Key benefits of buying a mediclaim policy

Here are some key benefits of the best mediclaim policies in India: Cashless hospitalization, comprehensive coverage, and 24/7 customer support, much like the robust protection. Elaborating some below-

Cost-effective:

A mediclaim policy helps manage high medical expenses by covering a significant part of hospitalisation costs. This saves you from spending a lump sum out-of-pocket, making quality healthcare more affordable.

Access to quality healthcare:

Mediclaim policies often include a wide network of hospitals, ensuring you have access to reputable healthcare providers. This access promotes timely treatment without compromising on quality, especially during medical emergencies.

Beat medical inflation:

With the rising costs of medical treatments, a mediclaim policy shields you from inflation. It covers treatments and hospital charges that are continuously increasing, offering financial stability in times of need.

Cashless treatment:

Many mediclaim policies offer cashless treatment facilities, where the insurer settles the bills directly with network hospitals. This reduces financial burden and stress, allowing you to focus solely on recovery.

Tax exemption benefits:

Premiums paid toward mediclaim policies are eligible for tax deductions under Section 80D of the Income Tax Act. This offers dual benefits of financial security and tax savings, making mediclaim a wise investment.

Peace of mind:

Having strong financial security provides peace of mind. Mediclaim policy ensures you have an adequate financial backup at the time of need, helping you stay stress-free.

Financial security:

You get complete financial assistance with a mediclaim policy, as it covers all medical-related expenses. It provides coverage for hospitalisation, surgery, and other medical procedures.

Lifelong renewability:

The lifelong renewability benefit enables you to renew the policy anytime, without any age limit. Many mediclaim policies in India come with the option of lifelong renewability.

What are types of Mediclaim policies in India

There are different types of mediclaim policies available in India to suit the varying healthcare needs of individuals. Here are some of the common types of mediclaim policies:

Individual mediclaim policy:

This policy covers the medical expenses of an individual policyholder. It includes costs like room charges, surgery, and diagnostics, but does not typically cover outpatient or non-hospitalisation expenses.

Maternity health insurance:

Maternity health insurance offers financial protection during pregnancy and childbirth, covering prenatal, delivery, and postnatal expenses, as well as newborn care. This allows families to focus on the joy of welcoming a new baby, rather than the stress of medical bills.

Family floater mediclaim policy:

Secure comprehensive medical coverage for your entire family with a single policy. A family floater health insurance plan covers hospitalization expenses like room rent, surgery, and diagnostics for yourself, your spouse, and dependent children, all under one sum insured. This provides financial protection at a lower cost compared to individual policies. Learn more about the benefits of family floater health insurance.

Senior citizen mediclaim policy:

Designed for individuals aged 60 and above, a senior citizen health insurance policy provides tailored healthcare protection. It covers hospitalization costs, pre- and post-hospitalization expenses, and often includes coverage for pre-existing conditions and age-specific treatments.

Group mediclaim policy:

This policy caters to the medical needs of a group of people. Most employers or any organisations offer the group mediclaim policy to their employees or members. It mainly covers the medical expenses of the employees or members and their dependants.

Critical illness mediclaim policy:

Secure vital financial protection against serious health conditions with critical illness insurance. This policy provides a lump sum payout upon diagnosis of specified critical illnesses like cancer, heart attack, or stroke. This financial support helps manage high treatment costs, income loss, and additional care expenses during recovery.

What are the tax benefits of a mediclaim insurance?

  • Mediclaim insurance offers various tax benefits to policyholders.
  • Section 80D of the Income Tax Act allows for tax deductions on the premium paid towards a mediclaim policy.
  • Up to Rs. 25,000 in premium payment can be deducted for self, spouse, and dependent children.
  • Additional deductions under section 80D of up to Rs. 25,000 are allowed for payment of health insurance premiums for parents.
  • Senior citizens can avail of deductions up to Rs. 50,000 in a financial year for their mediclaim policy.
  • This makes mediclaim insurance not just a means of protecting one's health but also a tax-saving investment.

Hence, choosing the best mediclaim policy suitable for one's needs can help in availing these tax benefits while ensuring financial security in times of medical emergencies.

Comparison between mediclaim policy and health insurance

When it comes to health insurance, the terms mediclaim policy and health insurance can be confusing. The main difference between them is the coverage. Discussed below are the key points of comparison to help you compare mediclaim policy with general health insurance. Discussed below are the key points of comparison between the two:

Aspect

Mediclaim policy

Definition

A policy focused on reimbursing hospitalisation costs

Coverage

Limited to hospitalisation and treatment costs

Hospitalisation requirement

Necessary for claims

Pre and post-hospitalisation expenses

Typically not covered or very limited

Ambulance charges

Generally not covered

Preventive care

Not covered

No-Claim bonus

Limited or none

Customisation

Less flexible, with predefined coverage limits

Premium cost

Generally lower due to limited coverage

Cashless facility

Available in network hospitals but limited

Best Suited For

Basic hospitalization needs

Tax Benefits

Provides tax benefits under Section 80D


Therefore, before choosing a policy, one must evaluate their medical needs and select the plan that best suits them.

Also read: Mediclaim vs health insurance

Pro Tip

A comprehensive health plan not only covers hospitalization but also pre & post-treatment expenses, ensuring complete financial protection against rising medical costs.

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What is covered in mediclaim policy?

Here are some of the common coverages offered under mediclaim policy.

Hospitalisation expenses:

The policy covers hospitalisation expenses incurred due to an illness or injury. Hospitalisation expenses in mediclaim insurance include costs for room accommodation, nursing charges, surgeon fees, anesthesia, blood transfusions, diagnostic tests, medications, and other necessary medical services during hospital stays.

Room rent:

The policy covers room rent expenses incurred during hospitalisation. Room rent coverage in mediclaim insurance refers to the reimbursement or direct payment for the cost of hospital room accommodation during the insured's hospitalisation, subject to the policy's terms and limits.

Ambulance charges:

The policy covers ambulance charges incurred for emergency transportation to the hospital. Policies may include reimbursement or direct payment for these expenses.

What is not covered in mediclaim policy?

Here are some key exclusions of mediclaim insurance policy:

Pre-existing diseases:

Many insurers cover pre-existing medical conditions after a certain period, known as waiting period.

Cosmetic treatments:

The policy does not cover cosmetic treatments, plastic surgeries, and other related procedures.

Self-inflicted injuries:

The policy does not cover medical expenses incurred due to self-inflicted injuries or suicide attempts.

Non-allopathic treatments:

The policy does not cover medical expenses incurred due to non-allopathic treatments such as ayurveda, homoeopathy, or unani.

How does a mediclaim policy work?

A mediclaim policy works in the following ways:

Medical expenses coverage:

Choose a coverage amount on the mediclaim policy basis your medical requirements and budget. The policy will offer coverage up to the sum insured for hospitalisation, treatment, and other medical-related expenses.

Reimbursement claim process:

Reimbursement of the hospital/treatment bills is one of the ways of claiming the benefits on your mediclaim policy. You only need to share the bills, prescriptions, discharge summary, and other required documents to raise the medical reimbursement bill claim.

Cashless claim process:

Another way of claiming benefits is opting for a cashless mediclaim policy. You can take treatment at any of the insurer’s network hospitals. The hospital will contact the insurer with all the details and share the required documents with them. You do not have to bother about the paperwork in this process. Upon verifying the details, the insurer will directly settle the bills with the hospital.

Policy renewal:

Simply renew the mediclaim policy online by paying the premium. Some mediclaim policies also offer the benefit of lifelong renewability. So, you can renew the policy whenever you want to.

Documents required for buying a mediclaim policy

When buying a mediclaim policy, you need to provide the following documents:

  • A completed proposal form
  • Age proof (Aadhaar card, passport, voter ID card, or any other acceptable document)
  • Identity proof (passport, Aadhaar card, driving licence, etc.)
  • Address proof (driving licence, passport, Aadhaar card, or any other acceptable document)
  • A passport-size photograph
  • Pre-policy medical test reports, if required.

Factors to consider while buying a mediclaim policy

Here are some factors that you must consider while buying the best mediclaim policy in India:

Coverage:

Check the policy coverage including the sum insured, inclusions, and exclusions. Look for a policy that covers your medical needs and fits your budget.

Premium:

Compare the premium of different policies and choose one that offers the best value for money. However, do not compromise on coverage for the sake of a lower premium.

Network hospitals:

Check the list of network hospitals associated with the insurance company. This will help you get cashless treatment in case of a medical emergency.

Claim settlement ratio:

Look for the insurance company’s claim settlement ratio in health insurance. This ratio represents the number of claims settled against the total number of claims received by the insurance company. A higher ratio indicates a better claim settlement process.

Waiting period:

Check the waiting period for pre-existing illnesses and other medical conditions. This will help you understand when you can make a claim for such conditions.

Age criteria:

Age is essential as it determines policy eligibility, ensuring that the coverage aligns with your current age and future needs.

Exclusions:

It is crucial to understand what medical conditions or treatments are not covered. Ensure that the policy covers all the required conditions and treatments that may be relevant to you.

Pre- and post-hospitalisation:

It is vital to assess coverage for expenses before and after hospitalisation, ensuring comprehensive support.

No claim bonus:

Significant for enhancing coverage and saving on premiums with each claim-free year.

Co-payment clause:

Co-payment clause: Important to know if you have to share costs with the insurer, impacting your out-of-pocket expenses.

How to file a claim with a Mediclaim Policy

Filing a mediclaim policy claim is simple if you follow these steps:

  • Inform the insurance provider: Notify your insurance provider about the hospitalisation, ideally within 24 hours for emergencies and a few days in advance for planned treatments. This can be done through a call, email, or online portal.
  • Choose cashless or reimbursement: Opt for a cashless claim if admitted to a network hospital, where the insurer pays directly. For non-network hospitals, choose reimbursement.
  • Submit required documents: Provide necessary documents like ID proof, policy details, discharge summary, bills, and prescriptions. Ensure all paperwork is completed to avoid delays.
  • Track claim status: Stay updated on your claim’s progress by checking with the insurer or via their online portal.
  • Receive settlement: Once processed, the insurer will approve the claim, directly settling with the hospital (cashless) or reimbursing you.

Procedure for mediclaim policy claim

Here's a quick guide on the mediclaim policy claim process:

Contact the insurance company:

You must notify your insurance provider about your claim as soon as possible. Contact the customer care number or visit their website for details.

Submit required documents:

Submit all the relevant documents such as the claim form, original medical bills, reports, and prescriptions. Make sure to include all the necessary information.

Await processing:

The insurance company usually takes a few days to process your claim. However, you can check the claim status regularly.

Get approval:

Once the claim gets approved, the insurer will send a notification with the approval details. Your insurer will also contact the hospital for the bill settlement, and you only need to share your claim number or policy number.

Receive payment:

In case of cashless claim settlement, the insurer will directly pay the hospital. For a medical reimbursement claim, you need to clear all the bills with the hospital and submit the bill for reimbursement. After verifying the details, the insurance company will transfer the claim amount to your bank account. You may need to share the bank account number and proof of identity documents.

By following these simple steps, you can get your mediclaim policy claim settled without any hassle.

Choose a mediclaim policy that meets your healthcare needs and budget. Before purchasing a policy, compare different policies and read the policy document carefully for the policy terms and conditions.

Frequently asked questions

What is a cashless mediclaim policy?

A cashless mediclaim policy or cashless health insurance gives you the benefit of availing treatment at a network hospital without paying direct money to the hospital. Insurers tie up with several hospitals across the country to offer this cashless treatment facility. The facility enables policyholders to access quality healthcare services without worrying about immediate funds. The insurer pays for the bills directly to the hospital, also known as cashless claim settlement.

Which is the best insurance company for a mediclaim policy?

To choose the insurance company with the best mediclaim policy, you can consider the following criteria: Choose an insurance company that has a high claim settlement ratio. A high claim settlement ratio indicates the insurance company’s efficiency to resolve the claims. Look for the coverage offered on the mediclaim policy. Also, check the number of network hospitals available, so you can avail of the cashless benefit when needed.

How can I claim the benefits under a mediclaim policy?

You can raise the claim in two ways under the mediclaim policy. You can apply for a cashless or reimbursement claim settlement. In cashless claim settlement, the insurer will directly settle the bills with the network hospital after the completion of treatment. If you choose to take treatment at any of your preferred hospitals, you can apply for a reimbursement claim settlement. In this case, you need to submit the hospital bills, discharge summary, doctor’s report, and prescriptions to the insurer. Upon verifying the documents submitted, the insurer will settle the claim amount. You will receive the amount in your registered bank account.

Do mediclaim policies give coverage for accidents?

Yes, a mediclaim policy covers treatments in case suffered an accident. However, you must check with the insurer on the coverage offered when buying the mediclaim policy.

What is a group mediclaim policy?

A group mediclaim policy covers the medical expenses of a large group. Several companies or organisations provide mediclaim to their employees as a part of employee benefits. The employer pays the premium for the mediclaim policy. In some cases, the premium gets divided between the employer and employees.

What is the difference between a mediclaim policy and health insurance?

A mediclaim policy comes with limited coverage, whereas a health insurance policy offers comprehensive coverage. You mostly get the coverage for hospitalisation expenses under a mediclaim policy. A health insurance covers all the medical-related expenses including hospitalisation, pre-and post-hospitalisation, doctor’s fees, medicines, room rent and more. Also, you can avail of add-on covers on the health insurance policy, but you do not get add-ons on mediclaim policy.

How do I select the right mediclaim policy?

To select the right mediclaim policy, understand your medical needs and evaluate the coverage that each policy offers. Check the waiting period, sub-limits, network hospitals, and other such key features. Compare policies across multiple insurers and pick the one that offers comprehensive coverage at a reasonable cost.

What is the age criterion to buy a mediclaim policy?

Most insurers have a minimum entry age of 18 years and a maximum entry age ranging from 60 to 70 years. However, some insurers now offer policies for senior citizens up to the age of 80 years.

Does mediclaim cover accidents?

Yes, mediclaim policies cover accidental hospitalisation expenses, subject to the terms and conditions mentioned in the policy document. However, it is important to check the policy's specific coverage for accidental injuries and if there is any additional premium. Some insurers may offer riders to enhance the accident cover with a higher sum assured.

Which mediclaim policy covers dental treatment?

Certain health insurance policies may offer coverage for dental treatments as part of their comprehensive plans or as optional add-ons. It's recommended to review policy details to confirm dental coverage eligibility and limitations.

Does a mediclaim policy cover coronavirus?

Yes, many health insurance policies typically cover treatment for coronavirus, including hospitalisation, diagnostic tests, and related medical expenses. However, coverage may vary depending on the specific policy terms, so it's crucial to review your policy documents or contact your insurance provider for clarification on coronavirus coverage.

Which is the top 5 mediclaim policy in claim settlement?

Top mediclaim policies in claim settlement include HDFC ERGO Health Insurance, Star Health & Allied Insurance, ICICI Lombard, New India Assurance, and Max Bupa. These insurers are known for high claim settlement ratios and prompt processing.

Which government mediclaim is best?

Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is among the best government mediclaim schemes, offering extensive healthcare coverage to economically vulnerable families and providing financial support for various treatments at empaneled hospitals across India.

What is the age limit for mediclaim policy?

The age limit for mediclaim policies varies by provider, typically ranging from 18 to 65 years. However, some insurers offer senior citizen plans, extending coverage to individuals over 65 with specific terms and conditions.

Who will be eligible for mediclaim policy?

Individuals aged 18 and above, including families, are eligible for mediclaim policies. Minors can be covered under family floater plans, while eligibility may also depend on pre-existing health conditions as per insurer guidelines.

Which one is the best mediclaim policy?

It's important to understand that "the best" mediclaim policy is subjective and depends heavily on individual needs and circumstances. There's no single policy that's universally the best. However, I can provide information on factors to consider and general guidance.

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