Mediclaim Policy

A medical emergency can arise suddenly, out of nowhere, affecting both individuals and families alike. And with rising medical inflation being a common cause of worry in India, it has led to healthcare services becoming very costly, ultimately standing as an obstruction in the way of timely treatment.

Here is where a Mediclaim Policy swiftly steps into the picture, being an essential financial shield to ensure you can receive the best possible medical treatments—without the worry of it eating into your savings. The expenses caused by any illness, injury or accident that results in hospitalisation are covered by a Mediclaim policy in India, thereby helping ease the financial burden brought about during these tough times.

What is a Mediclaim Insurance Policy?

A Mediclaim Insurance Policy is mainly focused on covering hospitalisation expenses incurred due to any sudden illness, injury or accident which requires quick medical attention. This can include coverage for inpatient hospitalisation expenses, such as OT expenses, doctors’ fees, nursing charges, medicine costs, room rent, ICU charges, etc.

Unlike regular health insurance, a Mediclaim Policy is mainly focused on covering hospitalisation expenses, which may lead to more affordable premiums but also a fixed sum insured for each claim. Certain health insurance plans also pay a lump sum amount on the diagnosis of any covered critical disease, irrespective of your medical expenditure.

If you are still on the fence about whether you should buy a Mediclaim Policy or not, check out the many advantages of doing so:

• Cashless Hospitalisation

You are spared from the hassle of upfront payments, as many policies offer network hospitals with cashless hospitalisation benefits to settle your bills directly with the provider, helping streamline the process in medical emergencies.

• Financial Protection During Medical Emergencies

As we already know, a medical emergency can strike at any point in time, which is why a Mediclaim policy plays a crucial part in easing any financial burden on you during this stage and takes care of your medical expenses seamlessly.

• Tax Benefits (Section 80D)

Under Section 80D of the Income Tax Act, it states that the premium paid for your Mediclaim policy is subject to tax benefits to help make healthcare more affordable. Policyholders can claim up to ₹25,000 for premiums paid for themselves, spouses, and children, and an additional deduction of ₹25,000 or ₹50,000 (if parents are senior citizens) is also made available.

• Network Hospitals

Many Mediclaim policies offer a vast network of hospitals that help you avail cashless services. In this way, your insurer is able to directly settle the bills with the hospital and save you from upfront payments while providing access to quality and timely healthcare facilities.

• Day Care Procedures

Many of these plans may include daycare procedures, which include surgery or treatments like cataract surgery, chemotherapy, etc., which require less than 24 hours of treatment and allow you to leave the hospital without the need for an overnight stay.

Types of Mediclaim Policy Available in India

There are not simply one or two but a variety of Mediclaim policies that one can think of availing of, based on your unique needs. Take a look at what these are:

• Individual Mediclaim Policy

Under this policy, only one person is eligible to receive the benefits of health insurance.

• Family Floater Mediclaim Policy

Through this plan, multiple family members, like parents, spouses, children, parents-in-law, and grandparents, are covered under a single insured sum.

• Women Mediclaim Policy

This policy is specifically catered to cover the expenses incurred due to women-related illnesses, including breast cancer, cervical cancer, gynaecological issues or more.

• Senior Citizen Mediclaim Policy

This plan becomes crucial for elderly individuals aged 60 years and above, who are dealing with a rising number of health issues due to age.

• Critical Illness Mediclaim Policy

Upon diagnosis of any critical illness like cancer, kidney failure, heart disease, etc., this type of plan provides a lump sum amount to policyholders to deal with hospitalisation expenses incurred due to it.

• Maternity Mediclaim Policy

These plans come with a waiting period, which is why individuals planning to start a family should avail of them in advance, helping cover pregnancy-related hospitalisation costs like delivery (normal or caesarean), pre- and postnatal care, etc.

• Group Mediclaim Policy

This is a policy that applies to a group of people, such as employees of a particular organisation, giving them the benefit of comprehensive medical coverage at a lower cost than individual policies.

• Top-up and Super Top-up Mediclaim Policies

Top-up plans provide extra cover when a single claim exceeds a set deductible, while super top-up plans cover you after your total medical expenses in a year cross the deductible, no matter how many claims you make.

• Coronavirus Mediclaim Policy

When the policyholder is diagnosed with COVID-19 and required to be hospitalised, this plan helps deal with the expenses that arise along with it.

• Overseas Mediclaim Policy

This plan helps cover any unforeseen medical emergencies occurring during your travels abroad, like accidental injuries, illnesses, etc.

What’s Covered in a Mediclaim Policy?

• Hospitalisation Costs

Covers costs related to the hospital, like the operating theatre, diagnostics, medicines, blood, oxygen, chemotherapy, radiotherapy, donor expenses, pacemakers, etc.

• Hospital Room Rent

Covers charges for staying in a regular ward (single or twin sharing).

• Fees Charged by Professionals

Fees for doctors, surgeons, nurses and anaesthetists during hospitalisation are covered under this policy.

• ICU Charges

In case the policyholder is required to stay in the Intensive Care Unit (ICU), these charges are also covered.

• Ambulance Charges

Expenses for emergency ambulance transportation may also be included in this plan.

• Medicines & Reports

It covers the cost of prescribed medicines and medical reports that may be required during hospitalisation.

What’s Not Covered in Mediclaim Policy (Exclusions)?

• Pre-existing diseases

Any coverage for pre-existing diseases is excluded until the waiting period is completed.

• Cosmetic procedures

Any kind of cosmetic procedures that include plastic surgery, cosmetic treatment, and implants may not be covered under this policy.

• Dental treatments (unless accidental)

Any expenses arising out of dental surgeries, unless they require hospitalisation, will not be covered.

• Injuries due to substance abuse and self-harm

Injuries arising from the usage of alcohol or drugs will not be covered, while also including self-inflicted injuries, like a suicide attempt.

• OPD Expenses

Outpatient Department (OPD) expenses, which include medical expenses that do not require hospitalisation, like diagnostic tests (blood tests, X-rays, MRI scans), physiotherapy sessions, etc., may not be covered.

• Infertility Treatments

Any tests or treatments related to infertility or in vitro fertilisation are not included in this policy.

• Congenital diseases

Any congenital diseases, which are diseases or disabilities arising due to birth defects, are not included.

Disclaimer: Coverage details may vary between policies and insurers. It is strongly advised to carefully read and understand the specific terms, conditions, inclusions, and exclusions stated in your health insurance policy document before purchasing.

Difference Between Mediclaim Insurance and Health Insurance Plans

Curious to know the difference between your regular health insurance and Mediclaim Policies? Then check out the detailed table below to help you understand better:

Factors to Consider While Buying a Mediclaim Policy

While choosing the Mediclaim Policy of your choice, these factors have to be kept in mind:

• Type of Policy

Based on the type of mediclaim policy you choose, whether individual or family floater, it helps impact the cost, as a family floater plan may generally be more affordable than individual plans and cover multiple members under a single sum insured.

• Sum Insured

This stands for the maximum amount your mediclaim policy will pay, and this needs to be selected carefully, taking into account factors like inflation and healthcare costs. It is important to remember that the higher the sum insured, the higher the premiums.

• Entry Age

This stands for the age limit at which you are eligible to buy the mediclaim policy of your choice. Since every policy has one, it is vital to check beforehand to make sure that you or your family members can buy it.

• Scope of Coverage

Make sure to look for mediclaim policies that cover more than just hospital stays, as the broader the coverage, the more benefits you will be able to receive. Look for policies that include ambulance charges and costs before and after hospitalisation, like tests and follow-ups.

• Pre-existing Disease Waiting Period

When it comes to pre-existing illnesses for insurance companies, they may generally have a waiting period of 3 years before you can receive the benefits of the mediclaim policy, so make sure to look for policies with a shorter waiting period.

• Sub-limits

For certain mediclaim policies, there may be limits, like a cap on room rent, and then the insurer won't be willing to pay beyond this limit. So, it is necessary to check and understand if there are any sub-limits included.

• Co-payment

Before buying a mediclaim policy, it is essential to know what co-payment means, as this could involve you paying a part of the claim amount yourself, like 10% or 30%, and the insurer pays the rest.

• Exclusions

It is necessary to know and read clearly what is not covered in your mediclaim policy beforehand, with the common exclusions being treatments for addictions, cosmetic surgeries, outpatient expenses, and infertility treatments.

• Insurer’s Claim Settlement Ratio

Always pick an insurer with a high Claim Settlement Ratio (CSR), preferably 80% and above, because this refers to the percentage of claims settled to the total claims received in a year by the insurer.

Top Mediclaim Policies in India – 2025

If you are looking to get your hands on the ideal Mediclaim Policy, have a look at these top insurance providers and the benefits they can provide you:

Note: The List is arranged in alphabetical order, and the figures are subject to change periodically. The information presented here is for comparison purposes only. Coverfox does not prefer or endorse any particular health insurance company over others. We remain impartial and encourage you to carefully assess all options based on your individual needs before making a decision.

How to File a Claim Under Your Mediclaim Policy in India

There are two means to file a claim under your Mediclaim Policy in India, which include Cashless Claims and Reimbursement Claims.

1. For Cashless Claims

Here’s how the process of cashless claims works:

• You don’t pay the hospital bills upfront, but the insurance company pays directly, and this is available only at network hospitals partnered with your insurer.

• At the hospital, show your health insurance card or policy details at the TPA (Third Party Administrator)/insurance desk.

• The hospital sends a request to the insurer for pre-approval, and the insurer reviews the claim based on your policy coverage.

• If approved, the hospital bills are paid directly by the insurer, excluding non-covered expenses or co-payments.

• For planned treatments, inform your insurer 24-48 hours before admission, and in emergencies, notify your insurer within 24 hours of hospitalisation.

• Delayed or incomplete documents can lead to the denial of the cashless facility.

2. For Reimbursement Claims

In case your cashless claim was denied or you were treated at a non-network hospital, here’s how to file a reimbursement claim:

• You pay the medical bills upfront if you receive treatment at a non-network hospital or if cashless is not approved.

• Collect all original bills, medical reports, discharge summaries, prescriptions, and the claim form.

• Submit these documents to your insurer for reimbursement.

• The insurer checks if the treatment is covered and the documents are complete.

• After approval, the insurer transfers the eligible amount to your bank.

• Submit your claim within the insurer’s specified time frame (usually within 30 days of discharge) to avoid rejection.

• Delayed claims may be considered in special cases, but are not guaranteed.

The Coverfox Benefit

With our team of dedicated professionals at Coverfox, we help provide you with expert guidance, assisting you with claims every step of the way, be it from the documentation related to filing the claim to the follow-ups required.

Why Buy Mediclaim Policy from Coverfox?

Coverfox is an IRDAI-authorised platform that is dedicated to making your journey towards finding the ideal Mediclaim Policy not just instant and seamless, but also transparent. With Coverfox, you can find a policy that is tailored to your needs while enjoying the benefit of expert advice, personalised recommendations and great savings! Along with these, check out the other wide range of benefits that you simply can't miss out on:

• Plan Comparisons

Enjoy the convenience of browsing and comparing across a variety of policies from our list of trusted insurance providers, be it premiums, inclusions or exclusions—and pay securely once you land on the policy of your choice.

• Hassle-free Renewals

Renewals are made easy and instant, with a simple 2-step process to follow, so you can enjoy the continued benefits of your chosen policy.

• Dedicated Claim Support

We help provide 24/7 end-to-end support with a dedicated team to assist with any of your queries or doubts regarding the entire claim process.

• Customer Service & Ratings

We are committed to providing our customers with reliable services and smooth assistance through chat, call and email support, making us a trusted platform for lakhs of individuals to consider, while also being rated highly across platforms like Google and Facebook.

Tax Benefits on Mediclaim Insurance

According to Section 80D of the Income Tax Act, getting a Mediclaim policy can help individuals save on taxes if they pay premiums for themselves, their spouse, children, and elderly parents, with deductions ranging from ₹25,000 to ₹1,00,000 depending on their age and the premium amount.

You can cover yourself, your spouse, and dependent children under a single policy and claim a tax deduction of up to ₹25,000 per year on the premiums paid. If you also pay premiums for your parents who are under 60, you can claim an additional ₹25,000 deduction. For parents aged 60 or above (senior citizens), the deduction limit rises to ₹50,000. This means if you pay premiums for both your immediate family and senior citizen parents, you can claim up to ₹75,000 in tax deductions in a financial year.