What is Mediclaim Health Insurance in India?

If you're unsure about "What is a mediclaim plan?" and it's preventing you from securing a comprehensive health plan to safeguard your family's financial stability, we're here to assist you. 

Let's delve into the details of the Mediclaim policy together, empowering you to make the best decision for your family's health and financial security.

What is Mediclaim?

Mediclaim is a type of health insurance policy designed to cover medical expenses incurred by the policyholder due to illness, surgery, or accident. It offers financial protection by reimbursing the cost of hospitalisation, treatments, and other medical services up to the sum insured. Mediclaim policies typically cover room charges, doctor's fees, diagnostic tests, pre and post-hospitalisation costs, and sometimes even ambulance charges. 

Policyholders can avail of these benefits either cashless, where the insurance company directly settles the bills with the hospital, or through reimbursement, where the policyholder pays the bills upfront and later claims the expenses from the insurer.

Types of Mediclaim Policy

Similar to other health insurance policies, a Mediclaim policy has two main types: individual policies and group/family floater health insurance plans.

1. Individual Mediclaim Policy

   An individual mediclaim policy provides its bearer with extensive medical coverage for a monthly premium subscription payment. Individual mediclaim insurance provides health coverage that insures an individual against any medical bills, including hospitalisation and treatment charges and room and ambulance charges. This insurance coverage is best suited for individuals living alone without a family dependent on them, as they can enjoy the complete coverage and benefits provided by the policy.

    

2. Family Floater mediclaim Policy

   The biggest benefit of a family floater mediclaim policy is that it provides insurance coverage for multiple family members under a single premium payment. As part of this policy, the whole family is provided with a single cover, any amount of which can be availed by any family member. This proves to be an advantage over individual mediclaim policies, as if one person has unused coverage that the other needs. This cover is not transferable. With a family floater mediclaim policy, however, any member can share the common cover.

Mediclaim Policy Coverage

A mediclaim policy provides customers with several benefits that are covered under their policy. If contracting an illness requiring medical treatment, your mediclaim policy will cover all hospitalisation costs (assuming your policy does not have hidden limits and sub-limits, something you should check for before purchasing your mediclaim policy). Additionally, medical health coverage will provide compensation for pre and post-hospitalisation charges.

Suppose you require a longer stay at the hospital due to your illness/ medical problem. In that case, your mediclaim insurance policy also covers any room charges you would incur during your multi-day hospital stay. Your policy will also cover any costs of doctor visitations or consultations you might require during your treatment.

Understanding How Mediclaim Insurance Works?

Mediclaim insurance is designed to provide financial support to policyholders during medical emergencies. Here's what you need to understand about Mediclaim policies and how they work:

1. Coverage: Mediclaim covers the cost of hospitalisation due to accidents, surgeries, or critical illnesses throughout the policy period.
2. Premium Payments: Like other forms of health insurance, policyholders must routinely pay a premium to avail of Mediclaim's benefits.
3. Renewal Terms: Mediclaim policies come with a pre-specified insurance cover, and you need to renew the policy at the end of each term to continue enjoying its benefits.
4. Settlement Options: You can choose between cashless hospitalisation and reimbursement settlement options. Cashless hospitalisation is more convenient, as the insurance provider directly settles the bills with the hospital. You pay the expenses upfront using the reimbursement method, and the insurer reimburses you later.

Essential Features of Mediclaim Policies

While the features of each Mediclaim policy vary by insurance provider, here are some common aspects found in most plans:

1. Cashless Settlement: With cashless Mediclaim, the insurance provider directly pays the bills and covers medical expenses to the hospital, eliminating out-of-pocket payments for the policyholder.
2. Tax Benefits: Mediclaim policies offer tax benefits under Section 80D of the Income Tax Act. You can claim deductions up to ₹25,000 on your income tax for premiums paid towards insurance plans. Senior citizens can avail deductions up to ₹50,000.
3. Abundant Policy Choices: Mediclaim offers a wide range of policy options. You can purchase plans for yourself, your spouse, children, or parents at affordable premiums. There are also specific policies for critical illnesses and senior citizens.
4. Financial Protection: Mediclaim provides a safety net against medical emergencies, protecting you from financial losses and debt. This ensures you are prepared for unexpected healthcare expenses and can focus on recovery rather than financial strain.

Inclusions in Mediclaim Coverage

The inclusions of a Mediclaim policy can vary slightly depending on the type and the insurance provider but generally include the following:

1. In-Patient Hospitalisation: Covers expenses when the insured person is hospitalised for 24 hours or more.
2. Day Care Treatment: Covers treatments that do not require a full day of hospitalisation.
3. Pre and Post-Hospitalisation Cover: Covers medical expenses incurred before admission and after discharge from the hospital.
4. Domiciliary Hospitalisation: Covers treatment at home when hospital beds are unavailable or the insured cannot be moved to a hospital.
5. Annual Health Check-Ups: Includes free preventive health screenings once every one to four claim-free policy years.
6. No Claim Bonus: Provides a bonus for each claim-free year, applicable to the following policy year.

Tips for Choosing the Right Mediclaim Policy

There are several things that you should consider before choosing a mediclaim policy. Below mentioned are a few tips for the same.
 

1. Assess Your Needs: Evaluate your medical history, age, family health background, and potential health risks to determine the coverage you need. Ensure the policy covers critical illnesses, hospitalisation, and treatments relevant to your situation.
2. Compare Coverage and Premiums: Compare different policies based on coverage, premiums, and benefits. Look for policies that offer comprehensive coverage at an affordable premium without compromising on essential benefits.
3. Check Network Hospitals: Ensure the policy has a wide network of hospitals, including reputable hospitals near you. A broad network ensures you can easily access cashless treatment.
4. Understand Policy Terms: Read the policy document carefully to understand inclusions, exclusions, waiting periods, and claim procedures. Clarify any doubts with the insurance provider to avoid surprises during claim settlement.
5. Consider No Claim Bonus and Renewability: Opt for policies that offer a no-claim bonus for claim-free years and ensure lifetime renewability so you can continue enjoying benefits as you age.

Mediclaim Health Policy vs Health Insurance

Mediclaim, or medical insurance, provides the insured with coverage against any medical illnesses, including hospital and hospitalisation bills. Health insurance, on the other hand, provides its bearers with more extensive and holistic coverage for their health. The coverage extends beyond basic medical bills to cover factors such as consultation with various specialists as well as any specialised tests one might require.

However, there are also a number of services that are provided by a mediclaim policy and the mediclaim health policy that is not provided by health insurance policies. Mediclaim insurance provides its customers with features such as cashless procedures, coverage for pre-existing diseases, renewability age, and reimbursement. On the other hand, health insurance does not provide cashless treatments, cash top-ups or medical checkups.

Final Thoughts

As healthcare costs continue to rise globally, having a robust Mediclaim policy becomes indispensable. It offers individuals and families the peace of mind that they won't be burdened with excessive medical bills in times of illness or emergencies. However, it's imperative to carefully scrutinise the terms, coverage limits, and exclusions of a Mediclaim policy before purchasing to ensure it aligns with specific healthcare needs. Additionally, staying updated on policy changes and periodically reassessing coverage adequacy are essential practices.

FAQs

1. What do you mean by mediclaim?

   Mediclaim is a health insurance policy covering medical expenses incurred due to hospitalisation, surgery, or critical illness. It provides financial protection by reimbursing costs or offering cashless treatment at network hospitals.

    

2. How do I get a mediclaim?

   To get a Mediclaim policy, compare different plans from various insurance providers online or through an insurance agent, and select the one that best suits your needs. Then, complete the application process by providing the necessary documents and paying the premium.

    

3. Who can take mediclaim?

   Anyone who meets the eligibility criteria specified by insurance providers, including age and medical history, can take a Mediclaim policy. Reviewing policy terms and consulting with insurance providers to determine suitability is advisable.

    

4. What is the age limit for mediclaim?

   The age limit for Mediclaim policies typically ranges from 18 to 65 years, but this can vary among insurance providers and specific plans. Some policies may offer coverage beyond this range, catering to seniors or specific demographics.