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Medical emergencies can strike any time, and it is crucial to invest in a good health insurance policy option to be able to afford quality healthcare in such instances. A mediclaim policy is a type of health insurance plan that enables the policyholder to take care of healthcare costs up to the sum insured, in the scenario of any medical emergency. Mediclaim plans are designed to cover those hospitalization expenses caused by an accident or illness.
A Mediclaim policy is designed to provide financial assistance to the insured individual through reimbursements or cashless facilities during instances of hospitalization and medical treatments. These insurance plan options cover policyholders against diverse types of medical expenses that might take place during their policy period. A mediclaim insurance policy will reimburse the cost of the insured upon submission of clinical bills and other such applicable proofs. Such scheme options can alternatively make the insured eligible for wholly cashless hospitalization, where the insurer would directly make payments to the concerned hospital.
By choosing to invest in mediclaim health insurance in India, people can also enjoy tax benefits under section 80D of the Income Tax Act of India, 1961.
Mediclaim policy in India is typically issued for a definite period. Hence, as the renewal date etches closer, the insured individual would have to pay the relevant premium amount to enjoy benefits of such policy options. They need to pay the premium before the due date of the mediclaim scheme option to continue enjoying its advantages.
With the increase in the costs of healthcare, it has become imperative for people to invest in the best medical claim policy. Such a policy scheme is vital for securing the health of both families and individuals. A mediclaim insurance policy would be one of the most economical ways for people to be prepared for medical emergencies, as well as for protecting their savings. People can easily compare online plans for Mediclaim, to find the perfect one that fits their budget and other requirements.
The below reasons are quite convincing to select a mediclaim insurance plan in India:
Read Also: Difference Between Mediclaim and Health Insurance Policy
Find below some of the popular mediclaim insurance policies to choose from:
Insurance Companies | Health Plans | Sum insured (Rs) | Network Hospitals | Incurred claim ratio |
National Health Insurance | National Parivar Mediclaim Policy for Family | 2 to 5 lakh | 3000+ | 103.74 |
New India Assurance | Assurance Senior Citizen Mediclaim Policy | 1 to 1.5 lakh | 3000+ | 103.74 |
New India Global Mediclaim Insurance | USD 0.5 million to million | 3000+ | 103.74 | |
New India Floater Mediclaim | 2, 3, 5, 8, 10, 12 and 15 Lakh | 3000+ | 103.74 | |
Oriental Health Insurance | Individual Mediclaim Health Plan | 1 to 10 lakhs | 4300+ | 108.8 |
*Disclaimer: *Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.
Let’s consider some of the best mediclaim policies in India, their coverage options, features and benefits and things that are strictly excluded.
New India Senior Citizen Mediclaim insurance is especially designed for the senior people in the country, who are between the age of 60-80 years. To avail of this policy, one must undergo a pre-policy health check-up to identify any pre-existing illness. The sum insured to be availed under this policy ranges from 1 lakh to 1.5 lakh. Let’s have a detailed look at the plan here:
The policy features and benefits under this plan include the below:
Minimum Entry Age |
60 years |
Maximum Entry Age |
80 years |
Sum insured |
1 lakh to 1.5 lakh |
Pre-existing Illness |
After 18 months |
Renewability |
Lifelong |
Policy Exclusions:
Some of the important exclusions are:
New India Global Mediclaim policy can be availed by anyone who owns a health policy of sum insured Rs 8 lakh or above. Those who have health insurance with New India can avail 5% discount on this rider cover. Let’s have a glance at the policy features and benefits.
The unique features and plan coverage include the following:
Minimum Entry Age |
18 years |
Maximum Entry Age |
5 years |
Sum insured |
USD 0.5 million to million |
Waiting period |
90 days |
Free-look Period |
15 days |
Pre-existing Illness |
NA |
Policy Exclusions:
Common exclusions under this policy are:
This mediclaim policy from New India Assurance can be availed for your family to secure 2 to 6 members. Some of the unique features of this policy include a 25% cumulative bonus for a claim-free year up to a maximum of 50%, maternity cover, critical illness care up to 10% of the sum insured etc.
Salient features and benefits of this plan are:
Minimum Entry Age |
18 years Child: 3 years |
Maximum Entry Age |
65 years Child- 25 years |
Sum insured |
Rs. 2, 3, 5, 8, 10, 12 and 15 Lakh |
Premium loading |
For the age group 61-65 at 2.5% |
Free-look Period |
15 days |
Pre-existing Illness |
NA |
Policy Exclusions
Oriental Individual Mediclaim health cover reimburses the medical expenses incurred during a hospitalisation caused by an accident or illness. The policy covers in-patient expenses, including pre and post-hospitalisation expense cover for 30 and 60 days respectively.
The policy benefits are to be availed:
Minimum Entry Age |
18 years |
Maximum Entry Age |
65/70 years |
Sum insured |
1 lakh to 10 lakh |
Pre-existing Illness |
After 4 years |
Renewability |
Lifelong |
Policy Term |
1 year |
Exclusions
The insurance coverage is not provided under the below circumstances:
*Note: Kindly refer to the policy document for the complete list of exclusion
Parivar Mediclaim Policy for Family is a floater plan to be availed for the family including self, spouse and two dependent children. It is the best bet for a nuclear family to cover all members. It reimburses hospitalisation expenses including in-patient expenses, pre-existing diabetes, 140-day care treatment, and hypertension cover at additional premium etc.
Parivar Mediclaim Policy for Family comes with the following benefits:
Entry age |
18-65 years |
Sum insured |
Rs 2 lakh to Rs 5 lakh |
Renewability |
Lifelong |
Restricted Illness |
Up to 50% of SI |
Policy Exclusions
The common exclusions of this policy include:
*Note: Kindly refer to the policy document for the complete list of exclusion
Mediclaim Insurance can be availed as
In such Mediclaim insurance policies, only the policyholder is insured against the diverse financial liabilities due to a hospitalization.
Coverage |
For hospitalization expenses, including pre and post hospitalization expense cover |
Age |
|
Sum Insured |
Rs. 1 lakh to 50 lakhs or more |
Premium |
Premiums paid for such scheme options differ from one insurer to another Factors determining the premium sum are sum insured, age, policy benefits, etc. |
Mediclaim policy for family provides financial cover for the whole family of the policyholder against medical expenses, hospitalization costs, as well as other health-related expenditures.
Coverage |
Hospitalisation expenses cover, pre and post hospitalization, add-on benefits etc. |
Age |
|
Sum Insured |
|
Premium |
Premiums paid for such scheme options differ from one insurer to another.
Factors determining the premium sum are age, the sum insured, policy benefits, members involved, etc |
This mediclaim health insurance is designed specifically for senior citizens, i.e., the individuals aged between 60 years and 80 years. This policy scheme option does not involve any pre-medical tests or check-ups and is well suited for individuals who are already retired or are planning to retire shortly.
Coverage |
Individual senior citizens. However, some plans offer the option to cover the life of the insured and their spouse to 90 years of age or lifetime |
Age |
60 years to 80 years |
Sum Insured |
Rs. 1 lakh to Rs. 25 lakh |
Premium |
Premiums paid for this medical claim policy differ from one insurer to another.
Factors that determine premium sum are age, the sum insured, policy benefits, etc. |
In addition to these three major types of scheme options, there are also other types of mediclaim plans available in India. Such as:
In such policies, an employer or a person-in-charge of a particular group invests in the policy for their employees/group members. Group mediclaim health insurance generally is a type of compensation provided by the employer.
Such policies cover costs related to the treatment of major critical illnesses like multiple sclerosis, kidney failure, cancer, and so on.
This mediclaim insurance policy allows the insured to make claims for medical expenses that were incurred out of India.
While the specific documents needed to invest in a mediclaim plan would depend on the relevant insurance company, they generally include:
Age proof – Any of the following documents can be submitted:
Identity proof – Any of the following documents can be submitted:
Address Proof – Any of the following documents can be submitted:
The benefits covered by a mediclaim policy typically vary from one insurer to another. However, here are some of the most common benefits that are covered by major mediclaim health insurance plans:
The exclusions refer to the medical conditions and ailments that are not covered under the mediclaim plan. When buying such a policy scheme, the very first 30 days are additionally treated as the waiting period where claims cannot be made. In case the policyholder gets diagnosed with any disease between this period, the insurer shall not cover it.
Certain exclusions differ from one insurer to another. However, here are some of the common conditions that typically are excluded even from the best mediclaim in India:
The claim process of the mediclaim policy in India is generally quite prompt and streamlined. Cash reimbursement and cashless claims are two of the claim processes available.
The people choosing the cash reimbursement option typically have to go through the following procedure:
Notify the insurer in the event of hospitalization in one of their network hospitals. The names of the network hospitals shall be mentioned in the mediclaim policy document.
The insurance provider would have to follow certain terms and conditions while reimbursing hospital claims. They do not approve of the request for claim settlement until the relevant medical situation is aligned to their particular terms and conditions
The policyholder must keep a tab on and closely monitor their hospital and medical expenses, on which they are eligible for claiming reimbursements. Mediclaim insurance generally covers for the necessary hospital facilities like room rent, but would not provide superior compensation if the insured avails luxury and personal comfort facilities.
The policyholder needs to submit all the relevant medical bills to the insurance company. They would minutely scrutinize these bills before reimbursing the claims.
The insured person must make sure to fill up the claim form would accurate details without misrepresentation or suppressing any facts. The claim will only be reimbursed if the insurance company approves the medical reports and bills provided to support the claim. The mediclaim insurance claim process generally takes around 15 to 25 business days.
In case the insurance claim gets refused by the insurance company, the policyholder must ask for a valid reason and detailed clarification for it. If they are not satisfied by the explanation, they make escalate the issue at a consumer form, or even opt to proceed with legal action
To initiate the cashless claim process, people have to fill up a specific pre-authorization form and submit it to the insurer through the TPA desk at the network hospital.
It is vital to fill up and submit the preauthorization request form at least 72 hours before the hospitalization if it is pre-planned. This provides the insurance company with the time needed to ensure hassle-free and seamless claim settlement.
If the insured person requires an emergency hospitalization due to an accident or critical illness, typically, their mediclaim ID has to be shown at the network hospital, so that they are admitted into the facility. After this, the preauthorization request form of the insured needs to be completed and submitted within 24 hours, so that the claim settlement process can be initiated. People must hence keep their mediclaim ID handy with them at all times.
The Mediclaim insurance scheme renewal process requires hassle-free and straightforward. People can easily go through the process of insurance renewal online by checking out the website of the relevant insurance company. Mediclaim policy can also be renewed by visiting any branch office of the insurance company.