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Mediclaim Policy

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.

What is a Mediclaim policy?

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.

How Does a Medical Policy Work?

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.

Reasons to Choose Mediclaim Insurance Policy

The below reasons are quite convincing to select a mediclaim insurance plan in India:

  • Medical Emergencies – A mediclaim insurance would come to their rescue if people get hospitalized suddenly due to any ailment or accident. Such scheme options would typically cover the insured for expenses related to medical treatment, nursing, and lodging, up to the coverage sum chosen at the time of buying the mediclaim plan.  The best mediclaim plans available typically covers the treatment sought before and after hospitalization, related to the ailment or reason the insured individual was hospitalized for. This type of frame depends on the internal policies of each insurer and generally ranges from 60 to 120 days after hospitalization, and between 30 to 60 days before hospitalization.
  • Increase in Medical Costs: The costs of healthcare treatments are rising with every passing day. Ensuring quality health and medical care for severe ailments like cancer and heart diseases can incur more than twenty lakhs of expenses.  Health emergencies are sure to burn a hole in the pockets of people these days, and therefore they must be prepared for it in advance.  By choosing to invest in the mediclaim policy in India, people can enjoy a lump-sum health cover in times of medical emergencies.
  • A Modern Necessity: In the contemporary economy, people cannot wholly rely on traditional avenues like emergency savings and family support when faced with a medical emergency. The exceeding expenses of healthcare treatment have made a mediclaim policy a necessity for both the well-being and financial security of people. The increasing inflation rates and the rising percentage of lifestyle-driven health issues also augment the importance of investing in mediclaim scheme options today. 

Read Also: Difference Between Mediclaim and Health Insurance Policy

Popular Mediclaim Plans in India

Find below some of the popular mediclaim insurance policies to choose from: 

Insurance Companies

 Health Plans

Sum insured (Rs)

Network Hospitals

Incurred claim ratio

New India Assurance

Assurance Senior Citizen Mediclaim Policy

1 to 1.5 lakh

3000+

103.74

New India Assurance

New India Global Mediclaim Insurance

USD 0.5 million to  million

3000+

103.74

New India Assurance

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+

108.80

National Health Insurance

National Parivar Mediclaim Policy for Family

 

2 to 5 lakh

3000+

103.74

*Disclaimer: *Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

Best Mediclaim Insurance Policies-Overview 

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 Assurance Senior Citizen Mediclaim Insurance

    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:

    Policy Features and Benefits

    The policy features and benefits under this plan include the below:

    • Hospitalization expenses incurred for the treatment of illness/injury including expenses of room rent, surgery, ICU cost, medicines, doctor’s fees etc.
    • Pre and post-hospitalization expenses up to 30 and 60 days respectively
    • Ambulance charges
    • Non-allopathy treatment expenses cover for Ayurvedic, Homeopathy and Unani up to a certain limit while treatment is taken from a government or authorised institution 

    Policy at a Glance

    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:

    • Claim arising within 30 days of insurance
    • Dental treatment except it is arising out of an accident
    • Debility and general run-down conditions that don’t require a hospitalisation
    • Treatment expenses for sexually transmitted diseases and HIV (AIDS)
    • Cosmetic surgery
    • Vaccination and Inoculation
    • Pregnancy and new-born expenses
    • Injury due to war, war-like situation, foreign invasion, use of nuclear weapon etc. 
  • New India Global Mediclaim Policy 

    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. 

    Features and Benefits 

    The unique features and plan coverage include the following: 

    • Option to avail medical second opinion
    • The plan covers the treatment only outside India
    • Sum insured is offered through two plan options: 
      • Plan A: Up to USD 0.5 million with a lifetime limit of USD 1 million
      • Plan B: Up to USD 1 million with a lifetime limit of USD 2 million
    • Travel expense cover up to USD 3,000 per person
    • Travel cost of one companion will also be 
    • Airport pick-up expense
    • Accommodation up to USD 330 per day, up to a maximum of 30 days
    • Translation assistance
    • Repatriation of mortal remains up to a limit of USD 15,000
    • Donor expenses, including travel and accommodation expenses 

    Policy at a Glance

    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:

    • No policy benefits will be offered to any condition arising out of a pre-existing illness unless the insurer declares it in the policy document
    • No claim will be entrained up to an initial 90 days of the policy
    • Treatment or services availed or recommended in India are excluded
    • Any injury or expenses arising out of war, war-like situation, act of terrorism, natural calamities etc. are not covered
    • Any medical expense incurred before the issuance of the Medical Second Opinion 
  • New India Floater Mediclaim Policy 

    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. 

    Features and Benefits 

    Salient features and benefits of this plan are:

    • New born baby cover
    • NCB Bonus of 25% SI for a claim-free year up to a maximum of 50% of sum insured
    • 10% of the SI as critical care benefit
    • Newly married spouse can be added midterm
    • Cataract claims, up to 10% of sum insured 
    • Ayurvedic/Homoeopathic/ Unani treatments are covered, up to 25% of the policy sum insured
    • Ambulance charges are covered up to 1% of sum insured
    • Per day hospital cash benefit up to a maximum of 1% of the SI
    • 139-day care procedures are covered 

    Optional Covers:

    • No Proportionate Deduction
    • Maternity expenses cover for availing sum insured Rs 5 lakh or above where 10% of SI is paid
    • Revision in Limit of Cataract, 10% of sum insured in case of coverage Rs 8 lakh or above 

    Policy at a Glance

    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

    • No claim will be entertained within the initial 30 days of the policy, except accidental claim
    • Dental treatment
    • No claim is provided for non-allopathic treatment
    • Any expenses incurred for HIV/AIDS/STD are not covered
    • Claim arising out of drug/alcohol abuse 
  • Oriental Individual Mediclaim Insurance 

    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.

    Features and Benefits

    The policy benefits are to be availed:

    • Sum insured amount rages from Rs 1 lakh to Rs. 10 lakh
    • Pre-existing illnesses are covered by the policy after 4 consecutive policy renewals
    • The policy offers lifelong renewal benefit
    • 10% of family discounts if more than one members are covered
    • On approval, 50% of pre-insurance health check-up cost is covered
    • Daily hospital cash allowance in case of hospitalisation more than 2 days
    • Hospitalisation expenses incurred while donating an organ by the donor
    • Ambulance expense cover
    • PA cover for sum insured from Rs 2 lakh to Rs 10 lakh
    • The policy comes with a free-look period of 15 days to discontinue it in between
    • 30-days grace period is allowed for renewing the policy
    • For not opting for the TPA services, the insurer offers 5.5% discount on premium 

    Policy at a Glance

    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:

    • No policy coverage for pre-existing illnesses before 4 years from the policy initiation date
    • Self-inflicted injury, suicide, attempt to suicide etc. are excluded
    • Alcohol/drug abuse
    • While participating in hazardous activities such as bungee jumping, parachuting, ski-diving, parasailing,
    • paragliding, mountain climbing, hang gliding etc.
    • Infected by venereal diseases
    • Involvement in illegal activities
    • Injury arising out of war, war-like situation, rebellion, civil war, use of nuclear weapon etc. are excluded

    *Note: Kindly refer to the policy document for the complete list of exclusion 

  • National Parivar Mediclaim Policy for Family

    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. 

    Features and Benefits

    Parivar Mediclaim Policy for Family comes with the following benefits: 

    • The policy offers insurance protection with a sum insured ranging from Rs 2,00,000 to 5,00,000
    • The policy only covers allopathy treatment while expenses are reimbursed for in-patient cover, daycare treatment of 140 procedures etc.
    • No pre-policy medical check-up required
    • Tax rebate as per Section 80D of the Income Tax Act 

    Plan at a glance

    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:

    • No claim will be entertained within the initial 30 days of the policy, except accidental claim
    • Dental treatment
    • Pre-existing illnesses are covered after 4 years of waiting period
    • No claim is provided for non-allopathic treatment
    • Any expenses incurred for HIV/AIDS/STD are not covered
    • Claim arising out of drug/alcohol abuse

    *Note: Kindly refer to the policy document for the complete list of exclusion 

Types of Mediclaim Insurance in India

Mediclaim Insurance can be availed as

  • Individual Mediclaim Policy
  • Family Floater Mediclaim Policy
  • Senior Citizen Mediclaim Policy 
  • Individual Mediclaim

    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

    • The typical age at entry age is 18 years to 80 years
    • For children, it can start from 5 years

    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.

  • Family Floater Mediclaim Policy

    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

    • The typical age at entry is 18 years to 80 years
    • Children can be added from 3 months to 25 years
    • Some policies also provide coverage from 91 days for newborn kids

    Sum Insured

    • Minimum = Rs. 2 lakh
    • Maximum = Rs. 50 lakh

    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

  • Senior Citizen Mediclaim Policy

    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:

  • Group Mediclaim

    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.

  • Critical illness Mediclaim

    Such policies cover costs related to the treatment of major critical illnesses like multiple sclerosis, kidney failure, cancer, and so on.

  • Overseas Mediclaim

    This mediclaim insurance policy allows the insured to make claims for medical expenses that were incurred out of India.

Documents Needed to Invest in a Mediclaim Insurance Policy

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:

    • Voter ID Card
    • Pan Card
    • Aadhaar Card
    • Driving License
    • Passport
    • Birth certificate 
  • Identity proof – Any of the following documents can be submitted:

    • Voter ID Card
    • Passport
    • Aadhaar Card
    • Driving License 
  • Address Proof – Any of the following documents can be submitted:

    • Ration card
    • Driving license
    • Passport
    • Rent agreement ( if applicable)
    • PAN Card
    • Aadhaar Card
    • Utility bills like electricity bill, telephone bill, etc. 
      • Passport-size photographs
      • Medical reports (if demanded by the insurer)
      • Proposal form duly filled in and signed 

Inclusions of Mediclaim Policies

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:

  • Hospital expenses: The costs incurred due to hospitalization, like OT charges, blood, medicines, oxygen, radiotherapy, organ transplantation, chemotherapy, medical tests and diagnosis
  • Hospital Accommodation Expenses: The costs related to the ICUs are generally addressed through the cashless hospitalization facility, or are reimbursed by the insurer
  • Daycare hospitalization: Some insurer offer coverage for the expenses incurred for the tech-driven medical treatments that do not require 24-hour hospitalization
  • Pre and Post-hospitalization Expenses: The mediclaim insurance plans typically cover expenses for up to 30-60 days before, as well as till 60-120 days after hospitalization. This may even include ambulance charges and other emergencies medical assistance needed
  • Charges for Medical Experts: The best mediclaim policies ideally cover the fees for medical professionals involved during the hospitalization span, such as doctors, surgeons, and nurses 

Exclusions of Mediclaim Policies

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:

  • Pre-existing diseases
  • Pregnancy and childbirth
  • Dental treatments
  • Vaccination
  • Sexually transmitted diseases (Including HIV/AIDs)
  • Cosmetic surgery and obesity-related treatments
  • Plastic surgery
  • Hearing aid, contact lenses, and so on. 

Claim Process of Mediclaim Insurance Policies

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.

  • Cash Reimbursement

    The people choosing the cash reimbursement option typically have to go through the following procedure:

  • Inform the Insurer

    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.

  • Claim in Line with the Terms & Conditions

    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

  • Keep a Tab on the Expenses

    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.

  • Submission of Documents

    The policyholder needs to submit all the relevant medical bills to the insurance company. They would minutely scrutinize these bills before reimbursing the claims.

  • Submission of Claim Form

    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 of Rejection

    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

  • Cashless Facilities

    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.

  • Planned Cashless hospitalization

    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.

  • Emergency Cashless hospitalization

    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.

Documents Required to Make a Claim

  • Claim Form/Preauthorization Request Form
  • Attending physician's statement
  • Attested copies of all medical records
  • NEFT mandate form 

Renewal Process of the Mediclaim plans

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.

Frequently Asked Questions 

  • Q. What are the elements to look for while selecting a mediclaim policy?

    Ans. While trying to identify the best mediclaim policy available, it is essential to take into consideration the following elements: 
    • Number of members: The number of members and relations to be covered shall be the key basis of buying a mediclaim plan
    • Type of coverage – Individual, Family floater or group
    • Sum insured or coverage sum – Taking the future expenses in consideration
    • Room rent – The capping sum or criteria (if applicable )
    • Network hospital list –  Check if the list of network hospital is extensive, or includes healthcare facilities near your residence
  • Q. How to find the most budget-friendly mediclaim health insurance plan?

    Ans. You can use an online policy calculator to find the plan the best suits your requirements and budget. This policy comparison can significantly help you to buy a budget-friendly mediclaim plan that would be the most affordable for you. 
  • Q. How to calculate a mediclaim premium amount through a policy calculator?

    Ans. These tools calculate the premium amount on their own after you enter certain relevant details. You typically put in a few personal details, the number of insured members, and chosen sum insured so that the calculator can find out the premium amount to be paid.
  • Q. What is a floater mediclaim policy?

    Ans.  In floater mediclaim plans, the sum insured can be shared by any or all members of a family, for any number of claims between the policy term, subject to the relevant insured limit. This mediclaim policy for family covers the policyholder, their spouse, children, and parents under a single plan.
  • Q. How to buy a mediclaim policy?

    Ans.  You can either buy mediclaim online or do so through any branch of an insurance company. To buy an online mediclaim policy, you simply have to visit the website of the relevant insurance company, where all the steps needed to invest in mediclaim online would be mentioned.
  • Q. What is the mediclaim policy for employees?

    Ans. Employers in India generally provide group mediclaim policy to their employees as an incentive to retain talent in their firm. Government employees additionally receive health coverage through various central and state government insurance-based schemes. 
Written By: Paisawiki - Updated: 20 July 2020
Disclaimer: Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.
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