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Tips to Choose the Right Mediclaim Policy

A cashless mediclaim policy allows easy and hassle-free hospitalisation by ensuring adequate coverage for treatment costs. Being cashless, the insureds can avail hospitalisation facilities without having to pay any money from their pocket. Showing a health card from the insurance company is all that is required to get admitted. After discharge, the hospital gets the expenses reimbursed from the insurance company. If the bills are more than what the cashless mediclaim insurance policy covers, then the extra amount will have to be borne by the insured.

Cashless Mediclaim Policy Vs Normal Insurance Policy

Despite the similarities, there are many vital differences between a mediclaim policy and a health insurance policy. At the fundamental level, a mediclaim policy covers basic hospitalisation expenses. It covers treatment during medical emergencies such as in case of an accident or critical illness.

On the other hand, a health insurance policy for example a critical illness policy offers coverage beyond hospitalisation. It covers pre and post hospitalisation expenses. Several other expenses are covered too, such as critical illness cover, ambulance charges, daycare treatments, outpatient department expenses, and miscellaneous expenses. Even insurance policies offer cashless hospitalisation. The mode of payment to the hospital is via the insurer, as in the case of mediclaim policies.

A mediclaim policy only reimburses actual medical costs. A health insurance scheme deposits lump sum insured amount irrespective of the amount of medical expenditure. The lump sum amount is deposited on the diagnosis of a specified illness or critical illness, if it is a specific illness cover.

Hospitalisation expenses are reimbursed when hospitalisation is taken for the treatment of most types of medical conditions. But in case of health insurance, there are policies where hospitalisation expenses are reimbursed only for certain specified illnesses. Some policy also come with domiciliary expense benefit where expenses are covered for availing treatment at home.

A mediclaim health policy only covers hospitalisation and is intended to relieve a person from the financial stress due to hospitalisation. A health insurance plan might cover even the income loss aspect incurred due to hospitalization.

Read More: Cashless Claim Vs Reimbursement Claim in Health Insurance

Factors to be Considered While Buying a Mediclaim Policy

The following factors can be considered before purchasing a mediclaim policy.

Individual and Family Floater

In an individual plan, the individual is covered while in the family floater plan, all members of the family are covered. In case of a family floater, when the primary policyholder fails to renew the policy or dies, the other family members cannot take ownership of the policy. A mediclaim policy’s title transfer to another person is dependent on the insurer.  So, one should choose carefully while buying the type of policy.

Coverage Amount

Similar to health insurance policies, even mediclaim policies have high coverage amount. Choosing a policy with the right coverage amount depends on many factors. The number of hospitals in the area, and the average cost of treatment is one consideration. The age of the person and the current health condition is another consideration. Taking into stock such considerations a rough estimate of a probable coverage amount can be arrived at.


This can be applied in senior citizen or specific illness plans. However, not all mediclaim critical illness policy schemes come with co-payment options. Even if they do, the range is similar to general health insurance policies. It will be in the range of 10% to 20%. If a mediclaim policy has high co-payment, check if it has a low premium and high coverage amount. Check the list of network hospitals and claim process. Read on the mediclaim policy’s reviews from trusted sources. If all of them are good, then taking a mediclaim policy even if there is a co-payment option can be a good idea.


All mediclaim policies have general exclusions, and it applies even to the best medical insurance policy. They may not cover treatments availed due to self-harm, rioting, arson, suicide-attempt, drug use and alcoholism. It is rare for a mediclaim policy to exclude necessary procedures such as gall bladder surgeries, hysterectomy, kidney stone removal, and maternity expenses. It is advisable to go through the exclusions section of the mediclaim insurance policy before purchasing a policy.

Network Hospitals

Because mediclaim policies primarily serve the purpose of hospitalisation, a vital consideration to make for choosing a mediclaim critical illness policy is its list of network hospitals. A large hospital network is ideal because medical emergencies may arise anywhere. These hospitals spread across all regions of the country, ensuring that the policyholder is at all times covered for financial distress due to hospitalisation.

Customer Support

Imagine a situation where the policyholder does not have their e-card and does not know how to retrieve it. But suddenly a medical emergency arises. When calling the customer support of the policy company, there is no response. So the person has to be forced to pay-up for hospitalisation. Now the question is – what if the person did not have money to pay-up at the hospital. The customer support could have assisted the person in retrieving the e-health card; then the person could have availed cashless hospitalisation. Therefore, a critical consideration to make when choosing a mediclaim policy is its quality of customer support. Choose the best medical insurance policy with quality customer support.


Most mediclaim and health insurance schemes provide lifelong renewability. Only a few have upper age limits. It is ideal to choose a policy that has no upper age limit. Lifelong renewability ensures that the person can be insured against potential hospitalisation expenses at any stage of their life.

Important Features of mediclaim Policies to Look for!

While buying, also consider these features to exist in a policy:


A health policy seldom comes only with hospitalisation coverage. It generally has comprehensive coverage. This means the premium is high too. So considering the premium amount, a mediclaim policy is inexpensive. Not only that, but it is also more beneficial with regards to the extent of coverage, which could be in lakhs.

Cashless Treatment

A mediclaim policy provider generally has a wide network of hospitals offering cashless hospitalisation facilities. It is beneficial for individuals or families who wish to cover themselves for any urgent medical emergencies arising out of accident, critical illnesses etc. They can immediately seek hospitalisation support and not worry about any out-of-the-pocket expenses.

Pre and post Hospitalisation Coverage

The lines between mediclaim policies which are offered as critical illness policy and other health insurance plans are blurring. Many mediclaim health insurance providers have started to offer pre and post hospitalisation cover starting from 60 days prior and 90 days after hospitalisation on average. Coverage can also include ambulance expenses, in-transit treatment and emergency evacuation.

Daycare Hospitalisation

There are certain illnesses or medical conditions that require only daycare treatments, as overnight hospitalisation stay is not required for such conditions. Daycare treatments are covered by most mediclaim policies. Therefore, the insured does not need to be forced to stay overnight to avail coverage for hospitalisation.

Read More: All You Need to Know About Mediclaim Policy in India

Types of Mediclaim Policies

This type of health insurance can be availed as:

Individual Mediclaim Policy

It covers only the policyholder. Only one person can get medical insurance benefits.

Family Floater

Covers the policyholder, their parents, spouse and children. It is ideal for those who have family members as dependents.

Senior Citizen Mediclaim Policy

Covers senior citizens who have crossed the age of 60 years. May or may not require medical health checkup. Procedure to avail the policy is after furnishing age, residence, income and identity proof. Covers senior citizens on all ailments unconditionally. May not cover ailments related to personal lifestyle habits such alcohol, smoking, drugs.

Critical Illness Policy

It goes without saying that hospitalisation expenses incurred due to critical illnesses are quite huge. Therefore, it is ideal to choose a mediclaim health policy, that also includes pre and post hospitalisation coverage, to cover critical illnesses.

Room Rent and ICU Coverage

All aspects related to hospitalisation are covered, including room rent and ICU costs. There is no upper cap on the room rent or ICU fees. However, if the cost of hospitalisation exceeds the coverage amount, the overhead cost has to be borne by the insured.


  • Q. When to take mediclaim policy or critical illness policy over health insurance policy and vice-versa?

    Ans: It comes to personal needs. A mediclaim policy covers only basic hospitalisation. If the requirement is pre and post hospitalisation support, then taking a health insurance policy is best. A mediclaim insurance policy’s insurance premium may be lower. If someone is looking only for hospitalisation expense reimbursement, then a mediclaim policy can be more suited.

  • Q. Do people who have health insurance policies also have mediclaim policies?

    Ans: As mediclaim policies provide hospitalisation coverage for any type of eventualities, it can be suitable for those who do not like to be constrained by the specified-illnesses list of health insurance policies. Not just health emergencies, but even accidents are covered in a mediclaim health policy. A health insurance policy may or may not have coverage for accidents.

  • Q. What is an overseas policy, and how is it different?

    Ans: An overseas mediclaim policy, as its name suggests, covers the person against any emergency hospitalisation expenses incurred abroad. It is no different from a regular mediclaim policy. It can be taken by those who travel overseas frequently.

  • Q. Can a mediclaim policy be ported?

    Ans: Almost all mediclaim policies have a porting facility. To transfer a critical illness policy or mediclaim policy to another insurance company, a form has to be filled with the current insurance company 45 to 60 days prior to the renewal date of the policy.

Written By: Paisawiki - Updated: 11 February 2021

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