What is Mediclaim Policy?

Medical treatments and hospitalisation costs are off the charts. With each passing day, the healthcare facility is getting expensive to avail. In such times, medical contingencies can put a strain on your finances, especially if you do not have adequate mediclaim insurance to cover the expenses.

 

A mediclaim policy is known to cover the expenses incurred in case of planned/unplanned hospitalisation and treatment. It helps combat rising medical costs and allows you to avail high-quality healthcare facilities as and when needed.

 

Let us understand a mediclaim policy in detail.

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024.

 

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

About Mediclaim Policy

A mediclaim policy is a health insurance plan that protects the policyholder against sudden medical contingencies by taking care of the expenses incurred. The insurer will cover the cost of treatment and hospitalisation up to the sum assured chosen by the policyholder. The policy primarily covers the insured against medical emergencies, illnesses, and accidents that may lead to hospitalisation.

 

The mediclaim policies in India are issued for a specific period. For the policyholder to continue availing the benefits under the mediclaim plan, they must renew the policy when the expiry nears. In the event of a claim, the insurer will either pay the compensation directly to the network hospital (known as cashless claim settlement) or reimburse the amount to the policyholder (known as reimbursement claim).

 

Keep reading to know why a mediclaim policy is necessary.

Why Should I Buy Mediclaim Policy?

As mentioned earlier, the medical costs are rising by the day. It has become costly for people to avail healthcare facilities, even for minor treatments in India. However, people should be able to access best-in-class medical facilities despite the rising costs. Having a mediclaim policy makes it affordable to avail high-quality treatments without worrying about the expenses incurred.

Mediclaim Policy Inclusions

The things that are covered under the mediclaim policy vary depending on the insurer. However, the following are a few standard inclusions of mediclaim plans in India.

 

• The policy covers the treatment expenses incurred by the insured. The cost covers diagnostic processes, OT fees, medicines, x-ray, etc.
• The policy provides pre- and post- hospitalisation cover as well. It usually covers pre-hospitalisation medical costs of up to 30 days and post-hospitalisation expenses of up to 60 days. Make it a point to check with your insurer whether these expenses are covered, and for what span, under your chosen mediclaim plan before buying the policy.
• Some mediclaim policies cover the medical expenses incurred for less than 24 hours of hospitalisation.
• Cost for the Intensive Care Unit (ICU) and other rooms is covered.
• At any point, if an additional medical expert opinion/consultation is needed, the policy covers those fees as well.

Mediclaim Policy Exclusions

While the exclusions may vary from one plan to another, it is important to make a note  of these. Much like any other insurance plan, mediclaim plans have a few exclusions. Some of these are as follows -

 

• The policy does not cover any pre-existing illnesses before the waiting period is over
• It does not provide cover for dental treatments.
• It does not cover sexually transmitted diseases such as HIV/AIDS.
• No cosmetic or plastic surgeries are covered under the plan.
• The policy does not cover vaccination costs.
• Maternity expenses are not covered unless the facility has been opted as an add-on benefit before the waiting period is over.

Types of Mediclaim Policies in India

Here’s a list the kinds of mediclaim plans available in the market

 

1. Individual Mediclaim Plan
2. Family Floater Plan
3. Group Mediclaim Plan
4. Senior Citizen Mediclaim Plan
5. Critical Illness Mediclaim Plan
6. Overseas Mediclaim Plan
7. Low-Cost Mediclaim Plan
8. Personal Accident Mediclaim Plan

Depending on your affordability and necessity, you are free to choose a policy that fulfils yours and your family’s medical needs.

Features and Benefits of Mediclaim Plans in India

Following are the standard features and benefits of mediclaim plans -

 

• Insurers offer cashless claim settlements because of which the claiming process is hassle-free and quick. In fact, in cashless claim settlements, the insurer will settle the claims directly with the hospital.
• Having mediclaim cover for self and family will ensure that everyone included in the plan is protected against any sudden medical contingency.
• Mediclaim plans offer tax benefits as well. The premiums paid towards the policy can be claimed for tax deductions under Section 80D of the Income Tax Act, 1961.
• The policy is readily available online and offered by several leading health insurance providers in India.
• With mediclaim coverage, you and your family can avail high-end healthcare services at an affordable price.
• It reduces out-of-pocket expenses in terms of treatment and hospitalisation costs.

Things to Remember When Buying Mediclaim Plans in India

Here are some things that you need to remember when buying mediclaim plans in India.

 

• Choose a sufficient sum assured: To choose the right mediclaim plan, you must select an adequate sum assured amount. You might have to pay higher premiums for extensive coverage, but it will ensure that your medical expenses are fully covered in times of need.
• Check the copay option: Most insurers allow the applicant to choose the copay amount. Copayment feature in a mediclaim plan is the amount you are willing to pay in the event of a claim. Whereas, the insurer will pay the remaining expenses.
• List of network hospitals: Before buying the mediclaim policy, check the list of network hospitals partnered with the insurer. You get to avail cashless treatments at the network hospital, and hence the list needs to be extensive.
• Waiting period: Check the waiting period for health conditions before buying the mediclaim policy. Know that coverage for these health issues will start only after the completion of the waiting period.
• Add-on facilities: Insurers allow you to enhance the scope of your mediclaim policy with add-on benefits. See what add-on features your insurer offers and select the ones that may be beneficial in the future.

Conclusion

The need for adequate health insurance or mediclaim is beyond explanation. Several insurers in India offer different types of health insurance plans, each fulfilling specific purpose. You need to evaluate your medical needs and affordability before buying the mediclaim policy.

 

You can buy health insurance plans at Bajaj Markets and benefits from features such as cashless claim settlements, reinstatement benefits, tax benefits, bespoke health plans that suit your needs, hassle-free renewals, and more. In fact, you can use the health insurance calculator to determine the premiums charged on your chosen coverage and add-on benefits.