Mediclaim Policy

Mediclaim will help you stay stress-free and financially secure in difficult times. The individuals who opt for a Mediclaim insurance policy can either raise a cashless or reimbursement claim. These policies also provide tax benefits to policyholders. Best Mediclaim insurance provides the policyholder with financial assistance during medical emergencies and hospitalization. It covers the insured individual against medical expenses that may occur during the policy period and also offers tax benefits under section 80D of the Income Tax Act of India, 1961.

The concept of medical Inflation causes all healthcare services to be expensive with time and under such circumstances, if you end up getting admitted to a hospital due to a medical emergency, the hospital bill will exhaust your savings. Buying the best mediclaim insurance policy is the best way to pay for your costly medical treatment without losing your savings.

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7 Best Mediclaim Policy in India

What is a Mediclaim?

Mediclaim is the safest option to combat large sums of expenses caused due to unforeseen medical emergencies. Mediclaim Insurance protects the insured life against soaring healthcare expenses, caused by hospitalization due to an illness or accident, without needing to incur any expenses from your own pocket.

Mediclaim in simple terms means that insurance companies have collaborated with a bunch of hospitals across the country giving them the term “network hospitals”. In order to provide the insured life with cashless treatment and facilities, the hospital and treatment expenses will later be settled by insurance providers on behalf of the policyholders. Cashless claim service is a blessing in disguise in case of a medical emergency.

What Are The Benefits Of Mediclaim Insurance?

Mediclaim policy is one of the must-have insurance plans as it offers numerous benefits to the insured. Let's find out the advantages of mediclaim policy in general.

Difference Between Health Insurance and Mediclaim

Health Insurance and Mediclaim is often used synonymously however they are different in nature. Mediclaim Insurance Policy works on an indemnity basis meaning, that any medical expense incurred by the policyholder will be reimbursed by the insurer. Health insurance plans function on the principle that a certain lump sum is paid out if the policyholder meets with situations such as critical illness, accident, etc. To further understand the difference between health insurance and mediclaim refer to the table given below:

Best Mediclaim Policies In India

Below is the list of a few of the Best Mediclaim Policies that are available in India. Take a look and choose your ideal mediclaim insurance policy.

What Are The Types Of Mediclaim Policies In India?

To safeguard your financial well-being in the face of medical expenses, different health insurance companies in India have brought various policies. The major ones are as follows.

Individual mediclaim policyFamily-floater mediclaim policySenior citizen mediclaim policyCritical illness mediclaim policy Overseas mediclaim policyLow-cost mediclaim policyGroup Mediclaim Policy

To understand the policies in great detail, we should move forward one by one.

1. Individual Mediclaim Policy

   An Individual Mediclaim policy is a kind of health cover that is designed to provide reimbursement for the various medical expenses to a single person, under a single plan. All the benefits that the policy covers are meant to be enjoyed by that person only. The premium cost of this type of policy is decided after examining the different aspects of that person like age, health and lifestyle conditions, and many more. It is one of the most popular types of health insurance schemes that are enjoyed by many people in India.

2. Family-Floater Mediclaim Policy

   Family-Floater Mediclaim policy is a kind of health insurance cover that offers the entire family compensation for different medical expenditure only on the payment of a single premium, under fixed sum insured. The insured sum can be utilized for multiple hospitalizations of the family members.

   This policy covers you, your children, and your spouse on a floater sum insured basis. Some companies also give coverage to the dependent parents under this policy. This plan can also be customized according to your convenience and requirements.

3. Senior Citizen Mediclaim Policy

   For senior citizens, any kind of health insurance plan plays a pivotal role to save them from a financial crisis due to medical treatment. Senior Citizen Mediclaim policy is a kind of health cover that generally provides benefits to people aged between 60 and 80 years. Often the consumers are needed to undergo medical check-up (as prescribed by the insurer) to detect any pre-existing disease or ailment.

   This policy often offers some unique benefits for the consumers, such as cashless hospitalization cover, daycare expenses, pre-existing disease cover, room and boarding expenses, and many more. The unique benefits might vary from company to company.

4. Critical Illness Mediclaim Policy

   When a person is diagnosed with any critical illness, (s)he has to pay a lump sum amount of money for the treatment. Critical Illness Mediclaim policy is a savior for this kind of situation as it is designed to cover critical illness expenditure and it offers the insured cost as the lump sum to the insured so that (s)he can start the treatment without any issues.

   Unlike other mediclaim policies, this one provides a higher claimable amount and offers unique coverage to different critical diseases. The illnesses that are generally covered by the Critical Illness Mediclaim policy are as follows.

   • Cancer
   • Kidney failure
   • Heart attack
   • Aorta graft surgery
   • Paralysis
   • Stroke
   • Major organ transplant
   • Coronary artery bypass surgery
   • Multiple sclerosis
   • Primary pulmonary arterial hypertension.

   Note: This list may vary from company to company based on their proposed plans.

5. Overseas Mediclaim Policy

   Traveling to a new country always comes with pleasure and anxiety because of the unforeseen odds. Overseas Medical Insurance is there to make your foreign trip worry-free as it is a health cover for the globetrotter (be it a business trip or leisure travel, or education trip), against the risk of hospitalization expenses abroad. The policy covers medical expenditures (inpatient and outpatient as well).

   Most of the companies, under this policy, exclude pre-existing diseases, pregnancy, miscarriage, suicide, or attempt to suicide, among others.

6. Low-Cost Mediclaim Policy

   This policy is for the people who seek low sum insured health insurance plans. This type of policy is very popular among the people because of its nature and as the cost of the premium amount is lower than other mediclaim policies. Another important fact about this type of policy is that it offers health cover to the unprivileged section of society. Generally, small and medium-scale industry employers buy this policy to cover their employees' medical expenses at a low cost.

7. Group Mediclaim Policy

   This is a very common type of mediclaim policy that is offered to the employees of most of the industries in India. Group Mediclaim policy can also be offered to the members of large clubs or associations, but mostly it is seen to be used in the corporate world. The employer buys and pays a single and common premium of this health cover for all the employees. A small percentage is deducted from the salaries of the employees as the premium payment costs of the health cover. This mediclaim policy is very affordable and beneficial for the policyholders.

What Are The Things To Remember While Buying A Mediclaim Policy?

Here are some factors you need to keep in mind while buying a mediclaim policy.

Coverage

Depending on your needs, you should select the coverage amount. There is no point in selecting a mediclaim policy of 2 lakhs SI if you are suffering from critical illnesses (as they demand higher medical expenses).

Co-pay & Deductibles

Under this clause, the insured has to pay a certain amount of the claim and the rest is covered by the insurer. So, look into the amount or percentage of the co-pay & deductibles.

Network Hospitals

If you wish to enjoy a cashless claim, choose the company that has nearby network hospitals under its umbrella.

Type Of The Policy

If you rarely travel abroad, there is no point in availing of an overseas mediclaim policy. Remember your need and then choose the type of policy.

Waiting Period

Each mediclaim insurance company has a certain waiting period before which you cannot claim any medical expenses and there is a different waiting period for pre-existing diseases. So, carefully go through these exceptions.

Terms & Conditions

Insurance companies have some common and unique terms & conditions. Read them carefully and understand before availing of any policy.

Renewability Age

Different companies offer different renewability ages. For most of the companies, the renewability age is life-long, whereas some have restrictions. So, it is advisable to check it before buying.

Mediclaim Policy Vs Health Insurance

The basic differences between a mediclaim policy and health insurance are as follows.

Read More: Mediclaim policy Vs Health Insurance

What's The Claim Procedure Under Mediclaim Insurance?

Follow the below-mentioned steps to smoothly claim under the mediclaim policy.

1. Inform The Insurance Company

   Inform the insurer about the hospitalization before the admission (if the admission to the hospital is pre-planned). In case of emergency hospitalization, you have 24 hours to inform them.

2. Claim Form

   You can ask the insurer for the claim form or else you can also download it from the official website or mobile app (if the company has any). Go through the instructions very carefully.

3. Documents

   Before the discharge from the hospital, collect all the documents like receipts, bills, prescriptions, discharge papers, copies of the report, and so on.

4. Documents Submission

   Fill up the claim form carefully and attach all the required documents as asked by the insurer or written in the instructions of the claim form. No discrepancy will be entertained by the insurer in terms of the documents.

5. Additional Requirement

   The procedure might take up to 45 days to get completed and in the meantime, you can be asked to provide some more documents.

Cashless Claim Vs Reimbursement Claim

Claims can be of two types - Cashless Claim and Reimbursement Claim. Both the procedures are almost the same with some differences. Let's take a look at it.

Health Insurer Network Hospitals

Required Documents For The Claim

In general, the necessary documents for the settlement of the claim are as follows.

• Bills and receipts of the hospital.
• Copies of the medical report, discharge paper, admission form, and prescription.
• Medical certificate or form signed by the doctor.
• Duly filled claim form.
• Copy of the policy form.
• Patient's discharge summary.
• In case of an accident, Medico-Legal Certificate and an FIR or any police report.
• Address proof and age proof.

Note: For safety, keep all the documents in original and photocopy forms. Apart from the above-mentioned documents, you might be asked to provide more documents.

What Are The Exclusions Of A Mediclaim Policy?

The general exclusions are as follows.

Pre-existing illnessDental treatment (unless it requires hospitalisation)Sexually transmitted diseasesBirth control or hormonal treatments Cosmetic surgery and obesity-related treatmentsMaternity expensesNon-medical expenditures like service charges, administrative charges, toiletries, and so on Ailment or diseases contracted within a set period (30 days) from the policy purchase date

Note: There might be more or fewer exclusions varying from company to company.