Mediclaim Plans & Policies: Check & Compare Online

Updated: 13-10-2022 06:47:34 AM

Despite rising healthcare costs, there is a huge chunk of our population that still needs to enrol in any kind of medical insurance cover. A mediclaim policy can largely support you during medical emergencies as it involves cost of hospitalization. It is the facilitation of cashless hospitalization for the insured and their family.

What is a Mediclaim Policy?

Many people confuse mediclaim with health insurance policy which is not true. A mediclaim enables the insured to get reimbursement for hospitalization expenses of a treatment that requires admission for 24 hours or more. Whereas, a critical illness plan covers a certain set of illnesses like cardiac arrest and cancer and gives lump sum coverage for the diagnosed health issue, mediclaim caters to hospitalization expenses.

Types of Mediclaim Policy

There are following types of mediclaim available:

• Individual Plan: As the name suggests, this policy covers hospitalization expenses only for an individual and the benefits can’t be extended to any other family member.
• Family Floater Plan: This one covers the medical costs of the policyholder along with their family members. This is an ideal health insurance plan if one is married. Usually it covers policyholder, their spouse and 2-3 children. This number may vary as per the providers.
• Group Mediclaim: This is popular among employers that provide Mediclaim as an employee benefit to their staff. This plan is applicable for not only staff groups but also other groups where a group in-charge can insure the members.
• Low-cost Plans: These plans are chosen mainly by small to medium scale organizations to ensure Mediclaim for their staffs at low rates.
• Overseas Plan: Under this plan, the medical expenses of the insured can also be covered at the time of traveling or stay abroad.
• Senior Citizen Plan: This plan covers the senior citizens in terms of medical expenses, and it is a major progress for the insurance industry.

What all a Mediclaim Policy Covers?

The plan provides coverage on various grounds and at various levels. You can have a look at the list of coverage provision below:

• Hospital Expenses: Medicines, blood transfer, OT charges, medical tests, etc.
• Accommodation Expenses: Charges including that of ICUs
• Pre & Post Hospitalization Expenses: It usually ranges from 30-45 days and 60-90 days for pre and post hospitalization expenses, respectively
• Doctors’ Fees: Apart from hospital charges, the doctor’s fees, if any, is usually covered

Eligibility Criteria

All insurance companies have varied T&Cs for the age of the insured, but the most common age measure is of 5 to 80 years.

Mediclaim Policy Claim Process

For Reimbursement:

• Inform the insurance provider about hospitalization as soon it happens, i.e. within 24 – 48 hours of the same
• Collect all the hospital bills along with medical reports and discharge papers
• Submit the duly filled claim form available with your provider along with all the aforementioned documents
• Your insurance provider shall look into all the details in lengths and once done with verification shall send you a verification mail/SMS
• Post scrutinizing, your claim amount shall be releases, typically within 30 days or so

For Cashless Claim:

• In case of a planned admission, inform the provider a day or two before hospitalization, otherwise do so at the time of admission
• The hospital shall send the intimation request to the insurance company in order to obtain approval for cashless treatment
• This usually takes 1-3 hours
• Meanwhile, get admitted and provide your health card (which has your membership number on it) at hospital reception
• After release, all the bills are sent to the insurance provider who then reimburses the same to the hospital without you having to meddle in

Documents Required for Claim Process

• Claim Form (Duly filled & signed)
• Physician’s Report
• Attested copies of all the medical records
• ID proofs
• Original policy documents
• Death certificate (if the case be)
• Copy of FIR (in case of unnatural death)
• Copy of autopsy report (in case of unnatural death)

Cases Where You Can’t Claim Mediclaim Policy

There are many insurance providers in the country, and all of them vary in terms of inclusions and exclusions. The exclusions in a standard plan are as follows:

• The medical issues that affect the insured within 30 days of the commencement of the policy are not included in the coverage unless they are pre-specified in the agreement.
• Mediclaim does not include expenses for the following:

Contact lenses, hearing aids, spectacles, dental implants, dental surgeries (unless any accidental damage is involved), pregnancy, childbirth, miscarriage, abortions, diseases or wounds due to any nuclear activity, STDs, naturopathy, cosmetic treatment, aesthetic treatment like circumcision or plastic surgery, treatment for drug abuse, alcohol, suicide attempts or any other intentional self-harm.

• Any pre-existing injuries or diseases are excluded
• If the insured faces any injury in war like situations or war itself, he or she will not be provided with required coverage

How Long Does It Take to Pay-out a Claim?

After receiving proper set od required documents and claim forms, usually insurance companies take no longer than 30 days to reimburse the claim amount.

Indian Companies Offering Mediclaim Policy

Following Indian insurance companies offer mediclaim policy:

• Apollo Munich Health Insurance Company Limited
• Star Health and Allied Insurance
• Cigna TTK
• IFFCO-Tokio General Insurance Co. Ltd.
• Cholamandalam MS General Insurance Co. Ltd.
• Bharti AXA General Insurance Co. Ltd. and more.

Note: This is not an exhaustive list.

Important Aspects

• This plan can be availed only for a limited time period. If the policyholder wishes to prolong the benefits, he/she has to renew the policy before it expires.
• Different insurance companies have different norms for premiums. The calculation for premium is based on the policy term, sum assured, geographical factors, lifestyle and age of the insured.
• In case of co-payment the insured and the policyholder both divide the premiums, i.e., the policyholder only has to pay a certain portion of the premium, and the insurer pays the rest – Highly valuable if one falls in the category of senior citizen.
• Check for maternity benefits if you’re planning to extend your family.
• Check for the provider’s Customer Service Ranking (A must for better after-sale services).
• Keep a check on whether or not it is sufficient for your medical needs.
• Other features like network hospitals, limited coverage on some illnesses and waiting period of the policy are also to be closely studied.

Advantages of Buying a Mediclaim Policy

• The premium paid towards a mediclaim policy entails tax benefits under Section 80D of the Income Tax Act, 1961, thus leading to savings
• In times of emergency and/or cash-crunch, one can move ahead with medical attention without having to worry about finances for the same

FAQs

Q1. Should I go for a health insurance policy or a Mediclaim policy?

Health insurance policy covers specific illnesses and disburses a specific amount based on the insurance plan. A Mediclaim policy, on the other hand, reimburses any costs that you might have incurred for your healthcare provided you’re getting hospitalized for the same.

Q2. How much do I need to spend in order to avail a Mediclaim policy?

The amount that you would pay in premium would depend on the coverage amount you want through your Mediclaim policy.