17 July, 2024
Mediclaim Policy

What is Mediclaim?

Used interchangeably, mediclaim or health insurance is the insurance policy that you buy to cover your medical expenses. Mediclaim policies have evolved from the coverage of hospitalization costs to cover ancillary costs like diagnostics, consultation charges, OPD expenses, pre- and post-hospitalization expenses, hospital daily cash allowance, etc.

Benefits of Buying Mediclaim Policy

Health insurance or mediclaim policies are beneficial for a variety of reasons that make them an integral part of basic financial planning,

  • Mediclaim insurance minimizes the financial burden in times of medical emergency
  • Medical costs are rising at a fast pace and a sudden medical cost can leave a big hole in your pocket. This makes health insurance a must-have cover
  • The modern lifestyle makes it easier for diseases like diabetes and hypertension to unsettle our lives. Pollution-related ailments are also becoming more common. Therefore, it is beneficial to have a mediclaim cover
  • Most health insurance policies provide cashless hospitalization that enables you to get treated without arranging funds for the hospital bills
  • Apart from the hospitalization costs, you can also claim pre- and post-hospitalization expenses
  • You can cover a host of other medical expenses either with an exhaustive policy or through additional riders or applying for optional benefits. This includes room rent waiver, critical illness cover, hospital cash cover, maternity cover, etc.
  • Premium paid for medical insurance can be claimed as a deduction against your total income under section 80D of the Income Tax Act

Why Buy Mediclaim Policy Online?

A few reasons why you should mediclaim policy online include,

  • When you buy mediclaim policy online, you save considerable time as you don’t need to physically visit offices or meet any insurance agent. Buying mediclaim policy online is convenient as the policy can be selected, compared, and purchased with a few clicks
  • Online mediclaim plan purchase is a paperless process. You don’t need to submit any physical documents. Instead, everything gets done through the internet, phone, chats, and video calling options
  • You can do a comparison online and purchase a medical insurance policy

Things to Consider While Buying Mediclaim Policy

There are several things you should consider while buying a mediclaim plan,

  • Check the health insurance needs of yourself and your family. Decide if you need individual health insurance or a family floater
  • Calculate how much sum assured is sufficient to meet your and your family’s medical needs. A very less sum assured will lead to out-of-pocket expenditures, while an unnecessarily high sum assured will increase the premium
  • To ensure that you can avail cashless treatment, check the coverage of network hospitals for the insurance companies you shortlist
  • The claim process of the insurer should be customer-friendly. Consider the claims settlement ratio and ensure it is a hassle-free and quick claims disbursal process
  • Ensure that medical expenses that are relevant to you are covered in the mediclaim policy. It may include pre and post-hospitalization expenses, maternity benefits, OPD coverage, medicine cost, consultation fees, etc. 
  • The need for health insurance increases with age. Confirm if the policy you shortlist offers lifetime renewal and doesn’t have an age limit
  • Mediclaim policies have a general waiting period and specific ones for pre-existing diseases and listed diseases. Consider the waiting period before buying a policy
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Features of Mediclaim Policy

Some of the features typically offered by mediclaim insurance policies include,

  • Cashless treatment: Treatment in empanelled hospitals can be availed without paying anything out of your pocket. For this, the hospital you are admitted in should be listed in the Network Hospitals of the insurer
  • Pre and Post Hospitalization: Apart from hospitalization expenses, mediclaim also provides coverage of pre and post-hospitalization expenses within a specified number of days
  • No claim bonus: If you don’t raise a claim for a particular policy period, you are eligible for a no-claim bonus. It could mean an increment in the coverage leading to an increase in the sum assured, which will reflect at the time of policy renewal
  • Medical check-up: A few policies offer free medical check-ups as a part of the mediclaim policy benefits

Types of plans in Mediclaim Policy

Mediclaim or health insurance plans  can be generally of two types: ,

  • Individual: The policyholder gets coverage for their medical costs, but can add other members by paying an extra premium. The policy is priced and approved as per the policy applicant’s age, medical history, sum assured selected, etc. 
  • Family floater: A family floater is more suitable to cover an entire family. It provides a single sum assured amount against the payment of a single premium. The premium is higher than an individual policy due to multiple members. But if you have senior family members with complicated health issues, it is advisable to opt for a critical illness cover or specific senior citizen health policies

Few specific kinds of Mediclaim policies are:

  • Critical illness: This type of policy covers severe ailments like cancer, renal problems, paralysis, etc. People opt for this cover because of the high medical costs involved in the treatment of such illnesses. It is also available as a rider in health insurance policies
  • Senior citizen: Tailor-made to meet the special healthcare needs of senior citizens, these policies have a higher premium due to the higher insurance risk. You can claim a separate tax deduction for the premium paid against health insurance for senior citizens
  • Group insurance: It is bought by employers for the health benefit of their employees
See also  Corporate Health Insurance

Mediclaim Policy Claim Procedure

Your mediclaim policy claim procedure may be cashless or reimbursement-based. 

  • Network hospitals: In case of cashless claims, once you have selected a network hospital, you need to intimate the insurer 72 hours before the treatment. In case of sudden admission, it is important to intimate the insurer within 48 hours of admission. Once you provide your health insurance card or policy document and photo ID to the hospital, your pre-authorization form will be forwarded by the hospital to the insurance company. Thereafter, you can continue with the cashless treatment.
  • Non-network hospitals or reimbursement claims: If you get admitted to a non-network hospital and/or choose a reimbursement claim, you can get your claim approved just as easily. Once you get admitted to the hospital, intimate the insurer about your admittance preferably within 48 hours. During your discharge, pay all the bills and retain them, along with medical reports, payment receipts, prescriptions, the discharge certificate, and all other relevant papers. Visit your insurance company’s website and upload soft copies of these documents, along with the claim form. Your claim will be then processed and verified by the insurer and the reimbursement will be disbursed. If you prefer to go offline, you can also visit the insurer’s office, fill out the claim form, and submit the documents physically.

Reasons for Claim Rejection in Mediclaim Policy

A few reasons why an insurer may reject your claim against mediclaim policy are,

  • Incorrect or incomplete claims related to the claim application form or documentation. You can avoid it by understanding the claim process better
  • Not disclosing pre-existing diseases often lead to claim rejection. This happens when you fail to inform your pre-existing disease or raise a claim against the pre-existing disease within the waiting period. You should always disclose any pre-existing condition, and familiarize yourself with the waiting period for the disease covered and not covered by your insurer
  • The waiting period can lead to claim rejection even in various other instances. Insurance companies have waiting periods for specific diseases, pre-existing diseases, maternity benefits, etc. There is a short waiting period even at the time of buying the policy
  • Sometimes the policyholder fails to notice that the policy has expired. If they raise a claim against such a lapsed policy the claim is bound to be rejected
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Documents Required for Buying Mediclaim Policy

The documents required for buying a mediclaim policy in India are similar across different insurers. These are,

  • Proof of age, like birth certificate, passport, Aadhaar, voter ID, PAN, driving license, 10th or 12th mark sheet, etc.
  • Identity proof like Aadhaar, passport, voter ID, PAN, driving license, etc.
  • Address proof such as utility bill, ration card, passport, Aadhaar, driving license, voter ID, etc. 
  • Passport size photos
  • Reports of medical tests that were conducted as a part of the new mediclaim policy process. However, medical tests are not required for all health insurance policies
  • Any other document sought by the insurer

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