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How to Choose Mediclaim? How Can I Make a Claim?

With so many options, health insurance products can confuse you while selecting the best mediclaim policy. You may find below pointers relevant while looking for a health insurance policy that meets your requirements.

Mediclaim policy is essential in the present times of ever-increasing healthcare expenses. Today, a fair number of people are aware of the need for and benefits of health insurance. However, a large portion of the population still considers health insurance plan just a tax-saving instrument. With a comprehensive health insurance policy, you can take care of the medical expenses to a large extent. The reasons you need a mediclaim Policy is quite evident, once you consider the following:

  • Bears the expensive medical treatment on your behalf
  • Not only protects you but also prepares you against unplanned medical expenses
  • The premiums are affordable
  • Offers coverage against medical expenses in an extensive manner
  • The simple and hassle-free claim process
  • Fewer chances of a claim being rejected on providing complete information

We have listed below a few tips to consider while choosing a mediclaim policy:

  • Choose the cover smartly: It is recommended to go for the plan that offers maximum coverage and maximum amount for the medical treatment. With medical inflation, healthcare expenses are rising rapidly and therefore; you will need sufficient coverage amount to deal with the rapid inflation. For instance, simple heart surgery costs around 4 to 5 lakhs, and for a middle-class family, this amount is huge and the situation becomes easy to manage if a medical policy covers this amount.
  • Go for family floater plan: Individual medical plans are designed, keeping the needs of an individual in mind. But, if you are a family person, we recommend you to buy a family plan, which covers your entire family. This way, you don't have to obtain a separate plan for each family member and keep them secured against unwanted medical emergencies. The premium amount is also less as compared to individual mediclaim policies and the sum assured is higher which can be utilized all the insured members.

  • Choose the sum insured smartly: It is vital to choose the right sum insured based on your family status and age. At a young age, the odds of getting the illness is less. However, your medical requirements will evolve as you get older. Similarly, once you are married, you should choose the sum insured of your health policy considering the health status of your spouse and other family members as well.

  • Check minimum waiting period for pre-existing conditions: Every mediclaim policy has its own set of terms and conditions regarding pre-existing illnesses. It means if you have any illnesses before taking a health plan, the claim made for seeking medical treatment against those illnesses will be accepted after the policyholder completes a defined waiting period. In most cases, the waiting period varies anywhere between 2 to 4 years; hence it is wise to choose a plan with a lower waiting period.
  • Check maximum age for policy renewal: You may not require a health insurance policy at a young age, but when you grow older, possibilities of encountering health issues increase. Hence, you should opt for a mediclaim policy which you can renew for the entire lifetime.
  • Go for the insurer with a high claim settlement ratio: Claim settlement ratio is the number of insurance claims settled by the insurance company over the total claim it receives. It is advisable to buy a mediclaim policy from an insurer that has the highest claim settlement ratio. This way, you can ensure that your claim will not be rejected unless the company has a valid reason to do so.
  • Consider the network hospitals: Health insurance policy enables you to avail cashless treatments at network hospitals which are a group of hospitals associated with your insurance provider. Always consider an insurer that has a wide network of hospitals in the area where you reside. There is no point buying a mediclaim policy if you are struggling to find a network hospital to avail the cashless benefit.

  • Don’t forget to compare premium: It is important to compare health insurance plans as well as premium. You can compare various health plans online in terms of features, benefits, cost, maximum services, etc. Picking a policy without considering all the options available in the market is like inviting regret. By comparing different plans, you can avail these benefits at comparatively cheaper premium rates.

  • Don’t ignore exclusions: It is important to note that exclusions are part and parcel of mediclaim policies and you can’t avoid it. Some insurance plans exclude Hernia, Gastric, Joint Replacement, etc. in the initial period. While some mediclaim policies exclude expenses for treatment of dental issues, HIV/AIDS, cosmetic surgery, STD, etc. It is recommended to review the exclusions carefully and choose a plan with fewer exclusions.

How to Get a Health Insurance Claim?

A health insurance claim is a formal request that a policyholder submits to the insurance company for obtaining the benefits that are covered in their health plan. The policyholder can get reimbursed or can opt for cashless settlement for the availed treatment. In this way, you can either submit the claim request or can avail cashless treatment at a network hospital.

The authorisation process for mediclaim

As soon as the insurance company receives the intimation from the policyholder, it verifies the validity of the policy and coverage offered to the insured. After that, an executive or third party administrator is assigned to facilitate the request for the pre-authorisation and cross verify the claim. After verification, the medical team of the insurer approves the claim for the policyholder as per the terms and condition of the policy.

Important considerations to avail health insurance claim

  • The authorisation process may be cancelled if you fail to mention the details thoroughly.
  • All claims must be filed within 30 days from the date of discharge.
  • The policyholder has to pay for all non-payable treatments on their own.
  • To claim the post hospitalisation expenses, you must submit all the relevant documents within 30 days from the date of discharge.

List of documents required for health insurance claim submission

  • Health card issued by the insurance company
  • Consultation documents provided by the doctor
  • Duly filled claim form
  • Diagnostic reports such as CT scan, blood reports, x-ray, etc.
  • In case of an accident, submit Medico-Legal Certificate or FIR
  • Invoice of the pharmacy bills
  • Discharge summary
  • All other relevant documents, as requested by the insurer.

We believe you will find this article helpful in making a firm decision at the time of purchasing a health insurance policy. With plenty of health plans available in the market, it is quite a tedious job to find the best health insurance plan. Hence, it is wise to compare different plans and choose the one that meets your health insurance requirements at a reasonable cost.

Recommended Link:Why is Mediclaim the Best and What are its Benefits?

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