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Why Mediclaim Policy?

A mediclaim is a type of health insurance wherein the insurance companies reimburse the policyholder for medical expenses that he/she might have incurred during the policy term. The policyholder can either submit the medical bills to get reimbursement or avail cashless facilities at the network hospital of the insurance company.

Skyrocketing healthcare expenses have made mediclaim policies a necessity to make quality healthcare affordable for everyone. Mediclaim insurance is a type of health insurance that offers medical cover for illness and hospitalisation up to a specific sum insured. A mediclaim policy is valid for a particular period after which the insured has to renew it to resume the policy benefits.

Difference Between Health Insurance and Mediclaim Policy

The terms mediclaim policy and health insurance are often used interchangeably; however, both of them are somewhat different. Mediclaim insurance works on an indemnity basis which means that the insurance company will reimburse any healthcare expenses incurred by the policyholder. On the other hand, health insurance policy function on the benefit principle where a lump sum benefit is paid out if the insured meets with an eventuality like an accident, critical illness, etc.

Following are some of the significant differences between health insurance and mediclaim policy.

FeatureMediclaim policyHealth insurance
CoverageCovers medical expenses and hospitalisation costsCovers hospitalisation costs along with additional costs such as ambulance charges, daily cash allowances, etc.
ClaimInsured can make multiple claims until the sum insured is exhausted. Insured is given a lump sum benefit if they meet with an accident or if diagnosed with a critical illness. The health insurance policy ceases to exist once the payout is made.
Sum InsuredUsually have a lower sum insuredA comprehensive health insurance policy offers a higher sum insured that may go up to crores at times.

Why mediclaim policy is important?

Here are some reasons why a mediclaim policy is important.

We are surrounded by the increasing number of lifestyle diseases, and hospitalisation expenses, which is why mediclaim policy is inevitable. It offers a financial cushion in case of a medical emergency. At the same time, it offers various benefits such as

  • Cashless hospitalisation facility
  • A cost-effective way of obtaining healthcare services
  • Lowers financial burden
  • Offers peace of mind
  • Eliminates out-of-pocket expenses
  • The insurance company manages hospitalisation expenses
  • Offers individual as well as family floater mediclaim policies
  • Tax benefits are available on premiums paid towards mediclaim policy

Mediclaim policy coverage

Coverage under mediclaim policy varies from one policy to another. Following are some common expenses covered under a mediclaim policy.

  • Hospitalisation expenses: It covers all the expenses incurred during hospitalisation, such as OT charges, blood, oxygen, chemotherapy, diagnostic procedures, x-ray, radiotherapy, pacemakers, radiotherapy, room rent, etc.
  • Daycare expenses: Expenses incurred on technically advanced treatments which do not require hospitalisation for more than 24 hours such as cataract treatment, dialysis, etc.
  • Pre and post hospitalisation expenses: Medical expenses incurred on hospitalisation for a period of 30 to 60 days prior to admission and up to 60 to 90 days after discharge are reimbursed. The number of days may vary from one policy to another.
  • Hospital room charges: Expenses incurred room rent towards regular wards or ICU are fully compensated, or taken care of with cashless hospitalisation facility in the network hospitals.
  • Consultation fees charges by medical professionals: Fees charged by the medical professionals, doctors, surgeons, etc. are compensated by the insurance company.

Benefits of Mediclaim Policy

Mentioned below are a few notable points that explain why mediclaim policy is beneficial.

  • Medical emergencies: A mediclaim policy can prevent any financial stress during medical emergencies.
  • Cost-effective: Mediclaim policy is an affordable way to combat increasing healthcare costs.
  • Cashless facility: Mediclaim policy offers cashless hospitalisation facility where the policyholder doesn’t have to spend any money from his/her pocket during medical emergencies. The insurance company settles the medical bills directly with the network hospital.
  • Income tax benefit: Investing in a mediclaim policy helps the policyholder to save on income tax under Section 80D of the Income Tax Act, 1961.

The claim process for mediclaim policies

Mediclaim policies give policyholders an option to avail cashless hospitalisation facility or reimburse the claim amount. In case of a cashless facility, the policyholder can get treatment in any of the network hospitals of the insurance company without having to pay for the medical expenses. However, if the insured chooses to avail treatment at a hospital which is not in the insurance company's network, he/she has to bear the medical costs which will be reimbursed by the insurance company upon filing a claim.

Mentioned below is the process of filing a claim under mediclaim policy.

  • Reimbursement claim: In the case of a reimbursement claim, it is imperative to inform your insurance company about the medical emergency, or hospitalisation about to take place in the near future or within the stipulated time once it has occurred. It is important to keep all the medical bills and track of expenses incurred during hospitalisation. To get reimbursement for the expenses incurred, you need to submit the payment receipts you have made related to medical expenses. It is important to keep all the original medical bills and payment receipts so that they can be submitted to the insurance company to get the reimbursement amount.
  • Cashless claim: The insured is expected to submit a pre-authorisation form along with the medical card in advance in case of planned hospitalisation. In case of emergency medical treatments, the policyholder can produce the medical card issued by the insurance company in order to avail cashless hospitalisation facility at the network hospital and then submit the pre-authorisation form within the prescribed time limit.

You can easily choose the right mediclaim policy online with the help of online platforms that offers numerous mediclaim plans. It is advisable to compare and buy a mediclaim policy from top health insurance companies in India. These mediclaim policies ensure the best coverage at affordable rates. We hope that now you understand why mediclaim policy is important, and you will be able to choose the best plan that meets your requirements.

Recommended Link:Five Tips to Buy a Mediclaim Policy