Mediclaim Policy: Features and Benefits

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Unannounced medical emergencies can happen, and if you don't have health insurance, expect a large hospital bill. Many people ignore the increasing costs of healthcare and don't have a Mediclaim policy to protect their family and themselves.


What is a Mediclaim Policy and how does it work?

Mediclaim policy provides insurance coverage that protects you from certain risks. This policy provides financial protection for hospitalizations due to illness and accidents. Mediclaim policy benefits are similar to other types of insurance. You can purchase a premium each year. The policy has a set policy period that must be renewed in order to continue to enjoy the benefits.

Mediclaim is a type of insurance that covers hospitalization expenses. You can either get reimbursements or choose to pay cash. It is a great investment because the premium you pay is exempt from tax under Section 80D, Income Tax Act 1961.

Features and benefits of Mediclaim Policy

How does Mediclaim benefit you? Let's take a look at the benefits and features of this policy.
• It allows for cashless hospitalisation.
• You can choose to purchase the whole family or just for yourself.
• It protects you against financial hardship.
• You can eliminate expenses that you have paid out of your pocket.
• Hospitalisation expenses can be covered by insurance companies.
• It's easy to buy online insurance.
• It provides tax exemptions.
• Get cost-effective healthcare services.

Types of Mediclaim Policy:

Different types of Mediclaim policies are available to meet different needs. Let's take a closer look at each one:

Individual Mediclaim Policy: This policy covers only the policyholder against major medical expenses that arise from hospitalization.

Family Floater policy: This plan covers the policyholder as well as other family members, such as spouses, parents, and children.

Group Mediclaim Policy: An employer buys Group health insurance policy for employees and members of the organisation under this plan.

Senior Citizen Mediclaim Policy: Under this type of plan, Senior citizens Special provisions are available to cover medical expenses.

Policy for Critical Illness Mediclaim: Critical illnesses can result in high medical expenses. Policy for Critical Illness Mediclaim Offers coverage for illnesses such as heart disease, cancer, and kidney failure.

Policy for Overseas Mediclaim: This type allows you to make claims for hospitalization expenses incurred abroad.

Low-Cost Mediclaim Policies: This policy is for those who need a lower amount of insurance. These policies are also available to those who are less fortunate. These policies are often purchased by employers in small and medium-sized industries to provide coverage for their employees at affordable premiums.

What does a Mediclaim policy cover?

A great Mediclaim policy protects you against a variety of medical expenses. It can differ between policies. These are the most popular inclusions in a Mediclaim policy.

Hospitalization Costs: It covers all medical expenses that are incurred while the policyholder is hospitalized or those who are beneficiaries. It includes expenses for diagnostic procedures, OT costs, medicines, blood, x-ray’s, oxygen, and other related expenses.

Pre- and post-Hospitalisation expenses: Mediclaim covers medical expenses that arise before 30 days hospitalisation or up to 60 days after discharge. You should check with your insurer to confirm if this type hospitalization is covered by the policy.

Day-Care Costs: All medical expenses that arise from advanced medical treatment and do not require the patient be admitted for longer than 24 hours are covered.

Hospital Room Expenses: The cashless facility reimburses all costs for regular wards and the Intensive Care Unit (ICU).

Physician's and Medical Professionals' Fees: Consultation fee for doctors or charges for medical professionals such as nurses' fees, etc. All costs are covered.

What is not covered by Mediclaim Policy?


Each Mediclaim policy contains some exclusions. These exclusions can vary from one insurance company or another. These are the most common exclusions found in Mediclaim policies.

• Pre-existing conditions.

• Dental treatments.

• Sexually transmitted diseases

• Hormonal and birth control.

• Vaccinations

• Plastic surgery.

• Cosmetic surgery and other obesity-related treatments.

• If not selected as an Add-On feature, maternity expenses will be charged.

• Service charges, administrative costs, and toiletries are all non-medical expenses.

• You can contract certain diseases and ailments within a specified time period after the date of purchase.


How is Mediclaim Premium calculated?

The premium for Mediclaim policies is calculated by insurance companies based on factors like age, geographic location, insured sum, pre-existing conditions (if any), coverage and number of insured. The final premium will be determined by the insurer according to your financial and unique needs.

Here are some things to remember when buying a Mediclaim policy

Sum Insured (Coverage): When choosing the best Mediclaim policy for you, make sure that you select the right amount of coverage or sum insured. While you might be able to pay more for a higher amount assured, it is important that you select a policy that meets your needs.

Individual or family floater: Before you finalize your Mediclaim insurance policy, it is important to determine if the policy is for you or your entire family. The entire amount insured under a Mediclaim policy that is family floater-type will be held jointly by all members of your family who are the beneficiaries.

Co-Payment: This clause requires that you, as policyholder, pay a certain percentage of the claims, and that the insurer pays the remainder of the medical expenses.

Network Hospitals: As the cashless facility can only be provided by these hospitals, it is important to choose an insurance company that has a broad network. This will allow you to choose from many options.

Waiting Period: Insurance companies offer a variety of services to help you register a claim. Waiting period, You cannot claim any medical expenses before that time. Insurance companies also have a waiting period to cover pre-existing conditions or illnesses. These exclusions will help you make an informed decision about whether or not to purchase a Mediclaim policy.

Add-ons: Insurance companies rarely offer Add-ons to Mediclaim policies. However, they may offer these additional features if they do. You should be aware that adding add-ons can increase your insurance premium.

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