Mediclaim Health Insurance

The increase in medical and healthcare costs is a good enough reason to emphasize the importance of Mediclaim policy. Another reason is the increasing rate of illnesses and health issues. Health emergencies can arise at any point – think hospitalization due to accidents, due to seasonal, vector-borne diseases or lifestyle ailments. One of the most effective solutions to safeguard one’s self from health problems is – Mediclaim insurance.

Research reveals that more than 70% of Indians do not have any kind of health insurance. The reasons for this are many – a lack of awareness and understanding of carelessness to poor financial planning and lack of time – people have many reasons for not buying insurance. Mediclaim insurance is the most cost-effective and the easiest way to financially prepare for one’s healthcare expenditure.

What is mediclaim policy?

Mediclaim insurance is designed to cover medical expenses arising out of medical emergencies up to the sum insured. Mediclaim policies do not cover critical illnesses. Mediclaim insurance plans offer coverage for hospitalization – in-patient, pre and post hospitalization, and day-care treatments. It offers a lump sum cover towards hospitalization expenses. Mediclaim plans are available for a specific tenure.

Key features and benefits of Mediclaim insurance policy

The features and benefits of different insurers’ Mediclaim plans might differ based on each insurance company’s guidelines. Typically, Mediclaim policies provide these features:

• Cost-effective:

  Mediclaim insurance policies are cost-effective, as typically, the sum insured is less, and the tenure is limited. Due to these two factors, the premium of mediclaim plans is low.

• Cashless treatment:

  Mediclaim insurance offers cashless treatment at network hospitals, making it easy for policyholders to avail of quality treatments without worrying about the payments.

• Eases financial stress:

  Mediclaim insurance reduces financial stress during medical emergencies that require hospitalization due to accidents or other ailments. Most insurers cover pre and post hospitalization expenses, as well.

• Individual and family floater:

  Mediclaim policy seekers can choose to buy individual plans or family floater plans. Both have specific benefits depending on the requirements of the policyholder. Both types of Mediclaim plans can be purchased online.

• Day-care hospitalization:

  Mediclaim insurance plans also cover day-care treatment expenses. These are treatments that do not require hospitalization and are done within 24 hours.

• Tax deductions:

  Mediclaim policies offer tax deductions benefits to the policyholders under Section 80D of the Income Tax Act. This feature makes Mediclaim a critical factor in personal and family financial planning.

• Easy to buy Mediclaim online:

  Most insurance companies offer Mediclaim policies online with quick and easy processes.

• Hospitalization costs:

  Mediclaim insurance policies cover hospitalization costs such as room rent, ICU, medical tests and diagnosis, medicines, among other expenses.

Types of Mediclaim insurance policies

• Individual Mediclaim policy:

  An individual mediclaim insurance plan provides coverage to only a single person. It is also called a personal mediclaim plan.

• Family floater Mediclaim policy:

  Family floater mediclaim plans offer coverage to different family members under a single umbrella policy. Spouses, children, parents, and extended family members such as siblings, grandparents, and more can be a part of the same mediclaim policy.

• Senior citizen Mediclaim policy:

  Senior citizens’ Mediclaim insurance plans are specially designed for citizens above the age of 60 and up to 80.

• Critical illness Mediclaim policy:

  Critical illness Mediclaim plans are specially designed to provide financial coverage against critical illnesses. Diseases such as cancer, diabetes, cardiovascular diseases, hypertension, kidney failure, and paralysis are critical illness plans. Usually, the sum insured is paid in a lump sum by the insurer.

Medical insurance claim procedures

Mediclaim insurance claim is the request from the policyholder to the insurance company to compensate/make payment for the policyholder’s medical treatment costs. There are two types of claims:

1. Cashless

2. Reimbursement

For both types of claims, insurers have to follow specific guidelines and processes that have to be completed within a few days to a few weeks of hospitalization. Typically, the process involves informing the insurance company about the medical procedure/emergency within a specified time frame, submitting a claims form and the required documents. The insurance company then investigates the documents to release the payment.

Reimbursement claim

In the reimbursement claim method, the policyholder has to make the payment to the hospital, which is then reimbursed by the insurer upon following the reimbursement process, as follows:

Documents required by for Mediclaim

Insurance seekers require the following documents to buy online Mediclaim policies.

• Proof of age:

  passport, Aadhaar card, birth certificate

• ID proof and address:

  passport, Aadhaar card

• Proposal form:

  filled with correct information

• Pre-existing medical reports:

  in case of pre-existing diseases and pre-policy health check

What does a Mediclaim policy cover?

The features and benefits of different insurers’ Mediclaim plans might differ based on each insurance company’s guidelines. Typically, Mediclaim policies provide these features:

• Cashless hospitalization:

  Mediclaim insurance plans offer cashless hospitalization facilities. In cashless hospitalization, the policyholder does not have to pay any amount towards the medical bills; the insurer directly pays to the hospital. Cashless hospitalization facilities can be availed at network hospitals.

• In-patient hospitalization:

  In-patient hospitalization means the patient/policyholder has to be hospitalized for more than 24 hours. Mediclaim policies cover in-patient hospitalization expenses, including room rent, ICU charges, doctor’s fees, nursing charges, tests, and medicines.

• Day-care treatments:

  Certain treatments might not require the patient to get admitted in the hospital, but can be completed within 24 hours. Such treatments are called day-care treatments and are covered under Mediclaim insurance plans. These include ICU charges, doctor’s fees, nursing charges, tests, and medicines.

• Pre & post hospitalization:

  Often, diseases, and injuries might require pre and post-hospitalization care, such as doctor’s visits, tests, diagnosis, medicines, ambulance charges, etc. Mediclaim plans cover these expenses.

• ICU charges:

  Mediclaim insurance policies cover ICU charges for in-patient and out-patient treatments.

• Ambulance cover:

  Mediclaim insurance plans cover ambulance rent expenses pre and post-hospitalization.

• Domiciliary hospitalization:

  There are certain types of treatments that can be given to patients at home. They might not require hospitalization. These treatments are called domiciliary treatments and are covered in Mediclaim policies.

• Free annual health check-ups:

  Most insurers offer free annual-health check-ups to policyholders as part of the Mediclaim policies.

• Sum insured:

  Mediclaim policies cover medical expenses up to the sum insured in Mediclaim policies. A policyholder can claim an amount up to the sum insured.

• Tax exemption:

  Mediclaim policies offer tax deductions benefits to the policyholders under Section 80D of the Income Tax Act. This feature makes Mediclaim a critical factor in personal and family financial planning.

What is not covered in a mediclaim policy?

Medical treatments related to AIDS, self-inflicted injuries such as suicide attempts, childbirth, and cosmetic surgeries are excluded from Mediclaim policies. The following medical conditions are excluded:

• AIDS/HIV
• Congenital treatment
• IVF
• Alcohol or drug abuse medical expenses
• Pre-existing ailments
• Birth control
• Complications during birth

Factors to consider when buying Mediclaim insurance plans

• Individual and family floater:

  Individual plans offer coverage to individuals. Family floater plans provide coverage to the entire family under one umbrella family. In an individual Mediclaim plan, the individual is covered for the specified sum insured. In a family floater, Mediclaim plan, the sum insured can be utilized by one or all family members in parts or full.

• Sum insured:

  Mediclaim policyholders must consider the sum insured when buying a policy. The sum insured should be adequate to cover medical treatment expenses. A higher sum insured would mean a higher premium; hence the budget should be considered when determining the sum insured. Moreover, one must factor in the rising medical inflation and think long-term.

• Co-payment option:

  Co-payment refers to the percentage or amount of the claim that has to be contributed by the Mediclaim policyholder. Having the co-payment feature can help policyholders reduce the cost of the premium.

• Sub-limit on room rent:

  Many Mediclaim policies have sub-limits on room rent. Sub-limits are limitations or caps on the amount that can be claimed towards room rent. Usually, insurers have a pre-specified percentage or amount mentioned as sub-limit in Mediclaim policies.

• Claim settlement ratio:

  Claim settlement ratio is the ratio of the number of claims settled by an insurer against the number of claims made to the company during a particular year. A higher claim settlement ratio of 95% or more would indicate that the insurer can settle claims and is reliable.

• Inclusions and exclusions:

  All Mediclaim policies have inclusions – expenses that the policy would cover and exclusions – expenses that the policy would not cover. It is essential to consider and clearly understand what is included and excluded from the Mediclaim plan to avoid last-minute surprises at the time of claims.

• Network hospitals:

  Mediclaim plans offer cashless hospitalization at hospitals that are a part of their network. It is essential to check hospitals’ names in a Mediclaim plan, the number, and quality of hospitals in specific locations to ensure treatments at good hospitals during emergencies.

• Renewability age:

  Many insurers might have a limit to the renewability age of Mediclaim policies. It is better to choose a mediclaim plan that has a higher renewability age or offers lifetime renewability to avail the benefits of long-term relationships with insurers.

• Pre-existing disease:

  Typically, insurance companies apply a waiting period for pre-existing conditions. It is essential to note whether or not the Mediclaim policy includes pre-existing diseases and the waiting period.