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All You Need to Know About Mediclaim Policy in India 

Mediclaim policies are a type of health insurance plan, which provide coverage against medical expenses that an individual incurs. A medical policy or health insurance plan provides the insured with much needed financial assistance through facilities for cashless treatments, or they even reimburse the medical treatments and hospitalisation expenses. Mediclaim Policies or Health Insurance Plans not only to cover all the medical expenses incurred during the policy. But also offer tax exemptions under section 80D of the Income Tax Act of India 1961. 

What Do the Mediclaim Policies Mean?

A form of insurance where an insurance company provides reimbursement to the policyholder for any medical expenses that he or she has incurred during the term of the policy is known as a Mediclaim Policy or health insurance plans. 

Extreme inflation in the medical expenses rate has made the Mediclaim policies or the Health Insurance Plans necessary for the people to avail of the healthcare facilities at affordable rates. One must know that a Mediclaim policy is a type of health insurance plan that offers health coverage for certain illnesses and hospitalisation up to a particular specific sum insured. Mediclaim policies remain valid for a particular period, after which the insured has to renew it to enjoy its benefits.

Mediclaim Policies Vs Health Insurance Plans

Though the terms mediclaim policies and health insurance seem to be synonymous, they are very different from each other. Health insurance policies work based on indemnity, which means that the medical expenses which a policyholder incurs, the insurance company reimburses them. Whereas the mediclaim insurance functions for the benefit of the people where a lump sum amount is payable to the policyholder towards the payment of medical expenses for specific unforeseen events like accident, critical illness, etc.

The following table will clarify some of the significant distinctions between Mediclaim Policies and Health Insurance Plans.


Mediclaim Policies

Health Insurance Plans


They cover hospitalisation charges and medical expenses

They cover charges for hospitalisation along with additional expenses like daily cash allowance, ambulance charges, etc.


Policyholders are provided with a lump-sum amount in case of a sudden accident or diagnosis with a critical illness. The cover does not exist after the pay-out

Unlimited claims by the policyholders up to the limit of the sum insured


Sum Insured

They usually have a lower sum insured

Comprehensive Health Insurance Plans offer a substantially higher sum insured that can sometimes go up to a crore.

Key Features of the Mediclaim Insurance Policy

Some critical aspects or key features of mediclaim policies or the best health insurance in India are as follows:

  • Age- Mediclaim policies are available if the prospective buyer falls in the specific age group. Usually, the medical policies or the best Health Insurance in India have an entry age of 18 years while the exit age is 65. In some cases, the entry age starts from 5 years and reaches up to 80 years.
  • Payable Premiums- The premiums payable for mediclaim policies may vary from one insurer to another depending upon the factors that influence the amount of premium such as age, the sum insured policy period, etc. 
  • Overseas Mediclaim Policies- Many insurance companies offer mediclaim policies for overseas where the policyholder can avail treatment both in India and any other foreign country. Such policies come with certain pre-conditions.
  • Coverage for the Family The insured can pay a master premium for availing the coverage for his or her entire family instead of purchasing separate individual policies 
  • Reimbursement Claims- The processing of claims takes place usually through a third-party administrator or TPA. While some insurance companies deal with in house claims
  • Types of Mediclaim Policies- People have different needs and priorities, so there are many types of mediclaim policies available in the market according to these needs and priorities. One can choose from senior citizens' policy, group policies, individual policies, critical illness policies, and maternity policies. 
  • Tax Benefits- Mediclaim policies or the best Health Insurance in India provide a tax exemption under section 80 D of the income tax act of 1961 up to Rs 25,000, while in the case of senior citizens' policies, this benefit goes up to Rs 30,000. Additionally, the policyholder can get an exemption of Rs 25,000 if they are paying policy premiums for their parents. 

*tax benefits are subject to change as per the prevailing Income Tax Act laws     

Benefits of a Mediclaim Policy

While choosing a mediclaim policy or a health insurance plan, one must consider the following benefits:

  • Cost-effective- Mediclaim policies are the best way to fight against the increasing healthcare costs 
  • Medical Emergencies- While investing in a medical policy one gets an assurance that all the medical emergencies like accidents shall be taken care of without any financial stress 
  • Cashless Claims- Mediclaim policies or health insurance plans provide cashless facilities wherein the policyholder does not have to pay from his or her pocket for any hospitalisation as the insurance company directly pays the hospital 
  • Benefits of Tax- Investment in Mediclaim Policy or a health insurance plan will enable the policyholder for tax exemptions under section 80 D of the Income Tax Act 1961 

Types of Mediclaim Policies in India

The following are some of the Mediclaim Policies in India for consumers' choice:

  1. Mediclaim for Individuals-here only the policyholder will get the coverage against any medical expenses.
  2. Family Floater Mediclaim Here the policyholder pays a master premium for giving financial support to the family members in case of any medical liabilities. 
  3. Mediclaim for the Group-An employer or person in charge of the group, can purchase the policy for the employees or members. This policy acts as an additional compensation provided by the employer  
  4. Mediclaim for Senior Citizens- These are tailor-made policies for senior citizens with special provisions and a medical test requirement. 
  5. Mediclaim for Critical Illness- These policies cover the medical expenses towards the treatment of critical illnesses like kidney disease, cancer, multiple sclerosis, etc.
  6. Mediclaim for Overseas- These overseas medical policies allows the policyholder to claim for any medical expenses, which may incur both in India as well as abroad.
  7. Low-cost Mediclaim- Low-cost medical policies are useful to the underprivileged weaker sections of the society. These policies are usually purchased by the small and medium level employers to insure their employees at a lower-income premium. 

Inclusions in Mediclaim Policies

While choosing a good mediclaim policy or the best health insurance plan in India, one has to make sure about which expenses are getting the coverage under these plans. Let's look at some of the expenses which are mention below:

  • Hospital Charges- These charges include expenses by the policyholder during his or her hospital stay such as Oxygen, blood, medicines, organ Donar charges, operation theatre charges, X Rays, etc.
  • Daycare Treatment:  Treatmentconsists of such expenses as required for advanced medical treatment. It does not require the patient to have a hospital stay for more than 24 hours.
  • Hospital Stay- Hospital room rent is included in the medical policies due to a substantial increase in it. Rent towards private rooms or ICU or general wards are fully reimbursable to the insurers and made available through a cashless facility.
  • Medical Professional's Fee- Some mediclaim policies cover the cost of consultation as well as medical professional's fees or charges, doctor's fees nurse's charge, etc. 

Exclusions of a Mediclaim Policy

Usually, while buying a mediclaim policy, the initial 30 days are treated as the waiting period wherein the policyholder cannot make any claim. During such a time, if the diagnosis of a policyholder reveals any disease, it doesn't get insurance coverage. The disease and the medical conditions for the exclusions are listed for the reference. However, these exclusions may vary from one insurer to another.  

  • Diseases which are pre-existing 
  • Sexually transmitted diseases including HIV or AIDs 
  • Pregnancy and childbirth 
  • Any dental treatment 
  • Vaccinations 
  • Any cosmetic surgery or obesity-related treatment 
  • Plastic surgery 
  • Expenses made towards hearing aids, contact lenses, spectacles, etc.

Wrapping it Up!
Mediclaim policies are important as they offer the much-needed financial assistance in the time of need. The policy is as similar as a health insurance plan, except a few differences. Hence, it is recommended to be careful while choosing a cover under mediclaim insurance.


  • Q. How can a policyholder port a Mediclaim Policy?

    Ans. Mediclaim policies or health insurance plans allow portability from one existing insurance company to another at the time of the policy renewal without the policyholder losing any benefits such as a period of waiting and a no-claim bonus. The portability is advisable if there are no claims made during the term of the policy in cases where the premium payable is very high, or the insurance claim process is challenging with the existing insurance company. Again, only similar policies are allowed with portability options. One can port a Mediclaim policy or the best health insurance in India with the same insurance company with a request for portability submitted 45 days before the policy's expiry date.

  • Q. What are the factors that one should consider while choosing a Mediclaim Policy or Health Insurance Plans?

    Ans. While choosing a Mediclaim Policy, one needs to determine the plan to be chosen: an individual or family floater plan, the entry, and exit age, the renewability age criteria, coverage of pre-existing diseases, and co-payment, network hospitals, inclusions, and exclusions. Look for the sub-limits, add-ons, free-look period, etc. along with a comparison of features and benefits among various other mediclaim policies available in the insurance segment.

  • Q. What do you mean by the Mediclaim Policy for employees?

    Ans. In India, the employers' lookout for the best health insurance in India or good mediclaim policies for their employees to offer them as an incentive for retaining them in the company. At the same time, the government employees receive incentives for health from the state and central government schemes. These policies for the employees are specially tailor-made to include their family members and also give them tax exemptions on the premium under section 80 D of the Income Tax Act 1961.

Written By: Paisawiki - Updated: 22 February 2021

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