Best Cashless Mediclaim Policies For a Family In India

Having a health insurance plan in this day and age is absolutely necessary. Health insurance covers the various costs associated with medical treatments and hospitalization. Adding further to the policyholder’s convenience is the cashless claim facility offered by many health insurance providers. Here, one does not have to arrange for the bill payment, rather the insurance company will settle it directly with the hospital.

List of Best Cashless Mediclaim Policies For a Family In India

Max Bupa Health Companion

Health Companion by Max Bupa is an affordable and comprehensive family floater plan that covers self, spouse and up to 4 children.

Features & Benefits

The policy provides coverage for:

  • Hospital accommodation
  • Pre & post-hospitalisation expenses
  • All day care treatments covered
  • Refill benefit
  • Alternative treatments
  • Renewal benefit
  • 2-year policy tenure option
  • Emergency ambulances
  • Organ transplant
  • Domiciliary treatment
  • Vaccination in case of animal bite
  • Hospital cash (optional)

Exclusions

Some of the exclusions under the policy include:

  • Ancillary Hospital Charges
  • Hazardous Activities
  • Artificial life maintenance
  • Behavioural, Neurodevelopmental and Neurodegenerative Disorders
  • Circumcision
  • Complementary & Alternative Medicine
  • Conflict & Disaster
  • Experimental/Investigational or Unproven Treatment
  • HIV, AIDS, and related complex
  • External Congenital Anomaly
  • Convalescence & Rehabilitation
  • Cosmetic and Reconstructive Surgery
  • Dental/oral treatment
  • Eyesight & Optical Services
  • Hospitalization not justified
  • Inconsistent, Irrelevant or Incidental Diagnostic procedures
  • Mental and Psychiatric Conditions
  • Non-Medical Expenses
  • OPD treatment
  • Obesity and Weight Control Programs
  • Off- label drug or treatment
  • Puberty and Menopause related Disorders
  • Treatment received outside India
  • Sexually transmitted Infections & diseases
  • Sleep disorders
  • Substance related and Addictive Disorders
  • Unlawful Activity

Claim Process

The policyholder needs to approach the insurance / corporate / TPA helpdesk of the insurer’s network hospital. Individuals can use Passport, Voter Card, PAN Card or Driver's License for identification purpose along with the Max Bupa Health Card or Policy Number. The network hospital will check the identity for validation and submit a pre-authorization form to the insurer.

The insurance company will provide their decision to the hospital within 30 minutes, if no further documents are required. The policyholder then has to get admitted for treatment and sign all forms, documents and invoices on discharge. The insurer will make payments to the hospital for pre-approved treatment and as per policy terms and conditions.

Sum Insured

The plan comes in three variants:

Variant 1: Sum insured - Rs. 3 lakhs and Rs. 4 lakhs

Top Up with Annual Aggregate Deductible Option - Rs. 1 lakh, Rs. 2 lakhs, Rs. 3 lakhs, Rs. 4 lakhs, Rs. 5 lakhs and Rs. 10 lakhs

Variant 2: Sum Insured Options: Rs. 5 lakhs, Rs. 7.5 lakhs, Rs. 10 lakhs and Rs. 12.5 lakhs

Top Up with Annual Aggregate Deductible Option - Rs. 1 lakh, Rs. 2 lakhs, Rs. 3 lakhs, Rs. 4 lakhs, Rs. 5 lakhs and Rs. 10 lakhs.

Variant 3: Sum Insured Options: Rs. 15 lakhs, Rs. 20 lakhs, Rs. 30 lakhs, Rs. 50 lakhs and Rs. 1 crore

Top Up with Annual Aggregate Deductible Option - Rs. 1 lakh, Rs. 2 lakhs, Rs. 3 lakhs, Rs. 4 lakhs, Rs. 5 lakhs and Rs. 10 lakhs

Source: Max Bupa Health Insurance Company

Max Bupa Heartbeat

Heartbeat Family First Plan by Max Bupa offers protection for up to 19 relationships with an individual coverage amount for everyone, and a floating coverage amount that is accessible to any family member.

Features and Benefits

The policy provides coverage for:

  • Pre & post hospitalization medical expenses
  • Maternity benefits
  • New-born baby
  • day care treatment
  • Loyalty additions
  • Hospital cash
  • Health check-up once every 2 years
  • Any age enrolment
  • Organ transplant
  • Domiciliary hospitalization
  • Emergency ambulance
  • No limit on the hospital room category (platinum)
  • International treatment support for specified illnesses (platinum)
  • OPD treatment and diagnostic services (platinum)

Exclusions

Some of the exclusions under the policy include:

  • Ancillary Hospital Charges
  • Hazardous Activities
  • Artificial life maintenance
  • Autoimmune Disorders
  • Behavioural, Neurodevelopmental and Neurodegenerative Disorders
  • Circumcision
  • Complementary & Alternative Medicine
  • Conflict & Disaster
  • Mental and Psychiatric Conditions
  • Non-Medical Expenses
  • Obesity and Weight Control Programs
  • Off- label drug or treatment
  • Congenital Anomaly, Hereditary or Genetic Disorders
  • Convalescence & Rehabilitation
  • Cosmetic and Reconstructive Surgery
  • Dental/oral treatment
  • Eyesight & Optical Services
  • Experimental/Investigational or Unproven Treatment
  • HIV, AIDS, and related complex
  • Hospitalization not justified
  • Inconsistent, Irrelevant or Incidental Diagnostic procedures
  • Puberty and Menopause related Disorders
  • Substance related and Addictive Disorders
  • Traffic Offences & Unlawful Activity
  • Treatment received outside India
  • Unrecognized Physician or Hospital

Claim Process

The policyholder needs to approach the insurance / corporate / TPA helpdesk of the insurer’s network hospital. Individuals can use Passport, Voter Card, PAN Card or Driver's License for identification purpose along with the Max Bupa Health Card or Policy Number. The network hospital will check the identity for validation and submit a pre-authorization form to the insurer.

The insurance company will provide their decision to the hospital within 30 minutes, if no further documents are required. The policyholder then has to get admitted for treatment and sign all forms, documents and invoices on discharge. The insurer will make payments to the hospital for pre-approved treatment and as per policy terms and conditions.

Sum Insured

Silver – Rs. 3 lacs, 4 lacs, 5 lacs, 10 lacs & 15 lacs

Gold – Rs. 3 lacs, 4 lacs, 5 lacs, 10 lacs & 15 lacs, 20 lacs, 30 lacs & 50 lacs

Platinum – Rs. 15 lakhs, Rs. 20 lakhs, Rs. 50 lakhs and Rs 1 cr

Source: Max Bupa Health Insurance Company

Apollo Munich Optima Restore

Optima Restore family floater plan by Apollo Munich is designed to cover self, spouse, dependent children, parents and parents-in-law. The policy comes with a Multiplier benefit, which means the sum assured will see a 100% increase after two claim-free years.

Features and Benefits

The policy provides coverage for:

  • In-patient Treatment
  • Pre-Hospitalisation
  • Post-Hospitalisation
  • Day-Care procedures
  • Domiciliary Treatment
  • Organ Transplantation
  • Ambulance Cover
  • Daily Cash for choosing shared accommodation
  • E-Opinion in respect of a Critical Illness
  • Emergency Air Ambulance Cover
  • Restore Benefit

Exclusions

Some of the exclusions under the policy include:

  • War or any act of war
  • nuclear, chemical and biological weapons
  • radiation of any kind
  • breach of law with criminal intent
  • intentional or attempted suicide
  • participation or involvement in naval, military or air force operation
  • congenital external diseases,
  • defects or anomalies
  • sleep apnoea
  • genetic disorders
  • expenses arising from HIV or AIDs and related diseases,
  • plastic surgery or cosmetic surgery unless required due to an Accident, Cancer or Burns

Claim Process

One needs to intimate the insurance company at least 7 days prior to the event that gives rise to a claim. In case of emergency situations, the insurance company must be notified within 24 hours of the event.

Sum Insured

Basic sum insured per insured person per policy year - Rs. 3 lakhs, Rs. 5 lakhs, Rs. 10 lakhs, Rs. 15 lakhs, Rs. 20 lakhs, Rs. 25 lakhs and Rs. 50 lakhs

Source: Apollo Munich Health Insurance

Reliance Health Gain Plan

Reliance HealthGain Policy is best-suited for those who want a high sum assured, but are unable to pay the premium at one go. The policy gives users the option of paying premiums in four instalments. Under its family floater option, a single cover can be availed for several members of a family by paying a single premium in a year.

Features & Benefits

The policy provides coverage for:

  • Hospitalisation expenses
  • Pre-hospitalisation expenses
  • Post-hospitalisation expenses
  • Domestic Road Ambulance
  • Donor expenses
  • Domiciliary hospitalisation

Exclusions

The below illnesses or surgeries will not be covered for the first two consecutive years from the policy start date:

  • Arthritis (non-infective)
  • Osteoarthritis and Osteoporosis
  • Gout
  • Rheumatism
  • All Vertebrae Disorders
  • Joint Replacement Surgery
  • Benign Ear, Nose and Throat Disorders and Surgeries
  • Nasal Septum Deviation, Sinusitis (and related disorders)
  • Benign Prostatic Hypertrophy
  • Cataract
  • Surgery of Genito-Urinary System
  • Hernia and Hydrocele
  • Internal Tumours, Skin Tumours, Cysts, Nodules, Polyps, Breast lumps (each of any kind), unless malignant
  • Kidney Stone/ Ureteric Stone/ Lithotripsy / Gall Bladder Stone

Claim Process

The steps involved in the claim process are as follows:

1 - Get admitted in any one of the insurer’s network hospitals 2 - Show the Reliance Health Card at TPA helpdesk 3 - Fill "Cashless Request Form" 4 - Submit the authorisation form, with a copy of the health card to the hospital 5 - Wait for authorisation from the hospital 6 - Hospital will forward the pre-authorisation form to the RCare Health /TPA with required medical details 7 - Submit the original discharge summary and other investigation reports with the hospital 8 - Maintain a photocopy of the records

Sum Insured

Plan A - Rs. 3 lakhs, Rs. 6 lakhs and Rs. 9 lakhs

Plan B- Rs. 12 lakhs, Rs. 15 lakhs and Rs. 18 lakhs

Source: Reliance General Insurance

ICICI Lombard Health Care Plus

Health Care Plus by ICICI Lombard takes care of excess payment that may arise, for treating an illness, over and above the existing cover.

Features & Benefits

  • Individual cover for each member of the family
  • Flexible Sum Insured
  • Flexible Deductibles
  • Long term cover of 1 year and 2 years
  • Entry age for members is from 5 years to 65 years
  • No sub-limits on room rent, diagnostic tests/ doctor’s fees, hospitalization expenses etc.
  • No Co-payment
  • Free health check-up for any one insured member in the plan upon policy renewal
  • Policy becomes effective when the claim amount in single incidence / hospitalization is more than the deductible

Exclusions

Some of the exclusions of the policy are as follows:

  • Congenital disease/ defects/ anomalies
  • Suicide or self-inflicted injury
  • Alcohol or drug abuse
  • Treatment relating to birth defects
  • Dental treatment unless caused due to accident
  • Birth control procedures and hormone replacement therapy
  • Cost of cochlear implant(s) unless necessitated by an Accident
  • Cosmetic surgery, Aesthetic treatment and plastic surgery

Claim Process

In case of cashless hospitalization, the insured needs to contact the TPA/Company at least 48 hours before a planned Hospitalization.

The TPA appointed by the insurer will process the claim and make all payments.

Source: ICICI Lombard General Insurance

New India Floater Mediclaim Policy

New India Floater Mediclaim is a health insurance policy designed to cover hospitalization expenses.

Features & Benefits

The policy covers the below hospitalisation expenses:

  • Room Rent / Boarding/ Nursing Expenses and other expenses as specified in policy up to 1% of sum insured per day.
  • ICU up to 2% of coverage amount per day.
  • Medical Practitioner, Consultants, Surgeon, Anaesthetist, Specialists Fees
  • Operation Theatre Charges, Blood, Oxygen, surgical appliances, Medicines & Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, relevant laboratory diagnostic tests, etc.& similar expenses.
  • All hospitalisation costs (with the exclusion of cost of organ, if any) incurred for donor with regards to Organ transplant.

Exclusions

Some of the exclusions under this policy include:

  • Injury or illness caused by or arising from or attributable to war, invasion, act of foreign enemy and war-like operations
  • Change of life or cosmetic or aesthetic treatment of any description
  • Maternity Expenses
  • Naturopathy Treatment.
  • Genetic disorders and stem cell implantation/Surgery.
  • Domiciliary Hospitalisation.
  • Acupressure, acupuncture, magnetic therapies.
  • Experimental or unproven treatments/therapies.

Claim Process

Upon the happening of an event that may give rise to a claim, the insured is required to immediately intimate the TPA or underwriting office or nearest office of “The New India

Assurance Co. Ltd.”, whichever is applicable. He or she will have to provide details like the name of the hospital, treatment, patient name, policy number, etc.

Sum Insured

Amount of sum insured can be Rs. 2 lakhs, Rs. 3 lakhs, Rs. lakhs, Rs. 5 lakhs, Rs. 8 lakhs, Rs. 10 lakhs, Rs. 12 lakhs and Rs.15 lakhs.

Source: The New India Assurance

New India Asha Kiran Policy

New India Asha Kiran Policy is designed to cover hospitalization expenses of the family and personal accident for parents.

Features & Benefits

A. Policy covers the below hospitalisation expenses:

  • Room Rent / Boarding/ Nursing Expenses and other expenses as specified in policy up to 1% of Sum Insured per day.
  • ICU up to 2% of coverage amount per day.
  • Medical Practitioner, Surgeon, Anaesthetist, Consultants, Specialists Fees
  • Operation Theatre Charges, surgical appliances, Blood, Oxygen, Medicines & Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Artificial Limbs, cost of prosthetic devices implanted during surgical procedure
  • All hospitalisation costs incurred for donor with regards to Organ transplant.
  • For cataract claims, the company's liability shall be restricted to 10% of Sum Insured or Rs. 50000 whichever less, for each eye.

B. The policy also covers Personal Accident

  • Accidental Death
  • Permanent Total Disablement
  • Loss of one limb and one eye or loss of both eyes and/or loss of both limbs
  • Loss of one limb / sight in one eye

Exclusions

Some of the exclusions under this policy include:

  • Injury, illness, disability or death caused by or arising from or attributable to War, invasion and Act of Foreign enemy
  • Vaccination and/or inoculation
  • Cost of braces, equipment or external prosthetic devices
  • Sexually Transmitted Diseases
  • Genetic disorders and stem cell implantation/Surgery.
  • Domiciliary Hospitalisation
  • Acupressure, acupuncture, magnetic therapies
  • Unproven / Experimental Treatment

Claim Process

Upon the happening of an event that may give rise to a claim, the insured is required to immediately intimate the TPA or underwriting office or nearest office of “The New India Assurance Co. Ltd.”, whichever is applicable. He or she will have to provide details like the name of the hospital, treatment, patient name, policy number, etc.

Sum Insured

Amount of sum insured can be Rs. 2 lakhs, Rs. 3 lakhs, Rs. 5 lakhs and Rs. 8 lakhs

Source: The New India Assurance

Future Generali Health Suraksha - Family Floater

With rising health care costs, Health Suraksha-Family plan by Future Generali provides you and your family complete health protection,

Features & Benefits

The policy covers:

Pre and post hospitalisation expenses incurred from 60 days prior up to 90 days after hospitalisation

  • Ambulance costs up to Rs. 2000
  • 409 day care procedures
  • Hospital cash benefit for Platinum Plan
  • Pre-existing ailments covered after four years of consecutive renewal
  • Free medical check-up at our empanelled diagnostic centres after every four claim-free years.
  • Patient care expenses up to a maximum of Rs. 500 per day for individuals above 60 years of age
  • Accompanying person expenses, up to Rs. 500 per day
  • Additional accidental hospitalisation limit enhanced by 25% of balance sum insured, subject to a maximum of Rs. 1 lakh

Exclusions

  • Any condition, ailment, injury or related condition(s) that’s been diagnosed, medical treatment undergone or signs and / or symptoms of the same, prior to the first policy’s inception or until 48 months from inception date.

  • Any disease contracted within the first thirty days from the start of the policy.

  • All costs related to AIDS.
  • Joint Replacement Surgery - It will be covered after three years, unless there is an accident.
  • Alcohol consumption or drugs abuse.
  • Non-Allopathic treatment
  • Congenital diseases

Claim Process

The insurance company has an in-house claim settlement team that processes cashless claims within 90 minutes from the time of receiving the cashless request.

Sum Insured

Gold Plan - Rs. 50000, 1 L, 1.5 L, 2 L, 2.5 L, 3 L, 3.5 L, 4 L, 4.5 L, 5 L

Platinum Plan - Rs. 6 L, 7.5 L, 8 L, 9 L, 10 L

Topaz Plan - Rs. 1 L, 2 L, 3 L, 4 L, 5 L

Ruby Plan - Rs. 6 L, 7.5 L, 10 L

Source: Future Generali India Insurance

Documents Required To Buy Cashless Mediclaim Policy

To avail a health insurance policy, an individual will be required to submit certain documents. Some of the documents include: **z

  • Identity Proof - PAN card, Aadhaar card, Passport, etc.
  • Address Proof - Aadhaar card, Passport, Driving license, etc.

Easy Procedure to Renew Cashless Mediclaim Policy

Generally, there are two modes of renewing a health insurance policy - online and offline. Under offline renewal, one would need to contact their health insurance provider at least 30 days before the policy’s expiration and make a renewal request. Any change in the health condition has to be brought to the attention of the insurer during the time of renewal. For online renewal, the insured has to provide certain basic details along with insurance policy number on the insurer’s website. Once this is done, the individual needs to proceed with making the payment online via debit or credit card, or through net banking.

Conclusion

Having a health insurance policy for self and family is important, considering that medical care is expensive. Opting for plans that allow cashless claim is a plus as it saves the insured and his or her family from the trouble of having to arrange the funds at the last minute to pay for hospitalization/treatment. It is advisable to select an insurance provider who has the maximum number of network hospitals, with some situated close to residence.

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