Mediclaim Policy

A Mediclaim policy is nearly similar to a health insurance policy. You need a mediclaim policy because it pays for many of your medical expenses during medical emergencies, up to a certain pre-decided amount. This amount is the sum insured or coverage amount that is pre-decided between the mediclaim policy provider and you.

A Mediclaim Policy Covers

Better Premium Rates
Day-care treatment
In-patient treatment
Individual & Family cover
Hospital treatment expenses due to illness or accident
Cashless treatment at the mediclaim policy provider’s network hospitals
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Benefits Of Having A Mediclaim Policy

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Cost-effectiveness

A mediclaim policy gets you hospital treatment without disturbing your savings

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Cashless Treatment Facility

Cashless hospitalization in all your mediclaim policy network hospitals

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No Financial Stress

A mediclaim policy lowers your financial load during any medical emergencies

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Individual & Family Cover

Mediclaim policy covers you & your family during medical emergencies

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Hospitalization Expenses

A Mediclaim policy covers hospital costs related to accidents or illnesses

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Lifelong Renewal

A mediclaim policy offers lifelong renewability options depending on the policy

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Additional Benefits

A mediclaim policy also covers room rent & ICU charges

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Tax Benefit

Tax benefits availed under section 80D on your policy premium you pay every year

3 Major Types Of Mediclaim Policies & How They Work?

Mediclaim Policy For Individuals

This mediclaim policy covers only a single policyholder. This means only one individual can avail benefits of the mediclaim policy. Apart from the single policyholder, no other family member can avail benefits of the mediclaim policy.

Mediclaim Policy For Family

This mediclaim policy covers you & your family; spouse, children & parents. This means the individual along with his or her entire family can avail benefits of the mediclaim policy. You can have a larger cover amount in this type of mediclaim policy.

Mediclaim Policy For Senior Citizens

This mediclaim policy covers the elder members of your family who are above 60. This type of mediclaim policy is designed especially by considering the medical needs of the elderly members. It’s always wise to have a separate mediclaim policy for Senior Citizens.

Things To Look For Before Buying Mediclaim Policy?

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Individual & Family Cover

Choose a mediclaim policy that covers you & your family for large cover amount

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Cover Amount

Pick a high cover amount mediclaim policy considering the increasing treatment costs

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Copay Clause

You have to share expenses with the mediclaim insurer as per a pre-decided percentage in copay

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Exclusions

A mediclaim policy doesn't cover a few medical expenses. Check what's not covered before buying

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Network Hospitals

Before buying a mediclaim policy one must check the list of network hospitals

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Renewability Time

Choose a mediclaim policy with lifetime renewability option

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Pre-existing Disease

Before purchasing a mediclaim policy, check the waiting period for pre-existing diseases as to when they will be covered

What Does Your Mediclaim Policy Cover?

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Hospital Charges
Hospitalization expenses like xray, medical treatment, oxygen, diagnostics & much more.
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Hospital Room Expenses
A mediclaim policy covers for all your regular ward & ICU room charges.
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Medical Professional's Fees
Surgeon, anaesthetist, doctor, nurse etc. are covered in a mediclaim policy.

What Your Mediclaim Policy Does NOT Cover?

Pre-existing diseases
Medical conditions within 30 days
Few treatments until waiting period is over
Dental surgeries not requiring hospitalization
Hormonal treatment
Birth control
Ectopic pregnancies
Childbirth complications
Suicide attempts
Congenital anomalies
Drugs or alcohol addiction
AIDS or HIV treatment
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What Documents Do I Need To Buy Mediclaim Policy?

Filled Proposal Form
Passport
Voter ID
Aadhaar Card
Driving License
Address/Identity Proof
Passport Size Photo
Pre-medical Test Reports
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How to Raise Claim For Mediclaim Policy?

You can raise claims in two ways when you have a mediclaim policy. The first one is a cashless claim & the second one is a reimbursement claim. Here's some quick info on the mediclaim policy claim's procedure.

Cashless Claim Procedure For Mediclaim Policy?

Cashless claims make sure that you receive cashless medical treatment at a network hospital as your mediclaim policy. You don't have to pay a single penny at the network hospital for medical treatment.

Steps for Cashless Claims

  • Visit the network hospital listed in your mediclaim policy to avail treatment.
  • Get the pre-authorization form available at the hospital's health insurance desk.
  • Fill the form mentioning all your details with correct information.
  • Get the hospital stamp on the form.
  • The network hospital will send your stamped form to the respective TPA - Third Party Administrator or the mediclaim policy insurer
  • for further approval.
  • The company will carefully examine the form & then approve the medical treatment.
  • After approval, it will send a fax back to your hospital mentioning the cover amount.
  • You can then complete your treatment & provide your signatures on all documents during your discharge
  • After this, your mediclaim policy company will pay your hospital bill amount.

Reimbursement Claim Procedure For Mediclaim Policy?

  • For reimbursement claims, you need to inform your mediclaim policy company about your hospitalization.
  • You can inform the company via email or by simply making a call to your insurance provider's customer care service number.
  • After your treatment is over, gather all your hospital medical documents.
  • Submit all your hospital bills, medicine bills, payment receipts to your mediclaim policy provider.
  • Attach the claim form & the original discharge card along with the bunch of these bills. After this, the mediclaim policy company will review your claim.
  • After approval, the company will pay your reimbursement amount.

How To Save Tax By Buying Mediclaim Policy?

  • Save Up To Rs. 75,000 On The Overall Mediclaim Policy
    A Mediclaim policy offers tax benefits where you can save nearly up to Rs.75,000. This falls under the Section 80D of IT Act 1961.

  • Save Up To Rs. 25,000 on Mediclaim Policy Premium
    Buying a Mediclaim policy can get you a deduction of up to Rs. 25,000 every budgetary year on your mediclaim policy premium.

  • Save Extra Rs. 25,000 on Mediclaim Policy For Parents
    If you have a mediclaim policy for your parents, you can claim additional deduction of up to nearly Rs. 25,000/- each budgetary year.

  • Save More Rs. 5,000/- Annually On Medical Check-Ups
    You can also get tax benefits through claims on your preventive medical health check-ups once in a year under the Section 80D of IT Act. This can be up to 5000/- annually.

*The above-mentioned list of benefits are according to the present tax laws in our country. You should reconfirm about these benefits from your mediclaim policy provider.

How To Buy A Mediclaim Policy Online With The Help Of Coverfox?

Buying Health Insurance Policy online through the Coverfox website is quite an easy task. Coverfox gives you detailed insights, on-call customer service & an efficient tech-enabled interface. These factors make your online health insurance buying process quite smooth & easy. We get you expert advice along with an informed, unbiased opinion that will clear all your doubts and help you buy the perfect plan.

Follow the steps given below in order to buy a health insurance policy online with the Coverfox website.

Step 1: Enter full name & select gender.

Step 2: Put in your correct mobile phone number, then click on the option 'view plans' & then select your age.

Step 3: Click 'continue' & then enter your resident city name and its pin code.

Step 4: Select Yes or No if you take any medications.

Step 5: Choose the best health insurance plan from the options that are displayed.

Step 6: Now select and compare the different health insurance plans on Coverfox. You can also choose the personalized plans options.

Step 7: Once you select the plan, you can pay the premium or speak to our customer care representative to take you through different options.

Step 8: Do make an informed decision and pay the premium. Once all the steps are done, the policy will be emailed on your registered email-id.

Once you select the plan which meets your needs with the least amount of premium, you can go ahead and pay the health insurance premium or talk to our customer service to avail of the insurance policy. While it is understandable to choose the policy with the least insurance premium, it is essential to know that various factors can affect your health insurance premium. Some factors influencing the premium of a health insurance policy include lifestyle, family health history, personal medical history, proposer’s age, sum insured etc. These factors are considered before the premium amount is determined. It is important to take note of these to make an informed decision.

Why Buy A Mediclaim Policy Online?

  • Allows the convenience to see the top mediclaim policies in a few clicks sitting at home.
  • Secured Modes of payment that are monitored leading to no risk
  • You can pay premiums simply using your debit card, credit card or through your bank’s internet banking facility
  • You can customize your mediclaim policy & calculate your premium instantly
  • All documents are digital which leave you with no paper hassle.
  • Mediclaim Policy vs Health Insurance - What Is The Difference?

    Based On
    Mediclaim
    Health Insurance
    Cover Offered
    Only for hospitalization that includes treatment for accidents & pre-decided diseases with pre-specified limits.
    Comprehensive cover against Pre-hospitalization & post-hospitalization charges. Also includes ambulance charges. Offers compensation in cases where there is a loss of income due to an accident.
    Add-on Cover Option
    No
    Yes
    Flexibility
    No flexibility
    Flexibility in terms of premium & respective coverage
    Plan’s Features
    Vary from company to company
    Mostly remain same across all companies
    Cover for Critical Illness
    No
    Yes
    Sum Assured Amount
    Not more than 5 Lakhs
    Exceeds up to 6 CR per year but not more than that
    Hospitalization Conditions
    More than 24 hrs hospitalization needed
    Not needed

    Most Popular Questions & Doubts

    • Q. How to choose a Best Mediclaim Policy?
      • You need to keep the following parameters in mind while selecting a suitable mediclaim policy:

        • Premiums – The payments made towards Mediclaim policies differ between insurance companies, based on various parameters like age of the applicant, location, policy tenure, sum insured on maturity of the policy tenure, etc.
        • Age – Suitable for individuals right from the age of 91 days to 65 years, though the terms and conditions regarding age vary between insurance companies.
        • Cover for family – The unique option of one master premium enables you to ensure mediclaim for your entire family. Not just that, such a facility often makes you eligible for additional benefits and discounts on premium, based on the insurance company and policy you have opted for.
        • Overseas mediclaim policies – Some mediclaim policies also cover you for emergencies that might occur when you are abroad, based on certain terms and conditions.
        • Claims – While some insurance companies channel their claims through Third Party Administrators (TPAs), some others process claims in-house.
        • Types – There are a wide range of mediclaim policies offered, which we will discuss later in the article.
        • Tax benefits – Mediclaim insurance premiums are eligible for tax deduction under Section 80D of the Income Tax Act, 1961, Premiums up to Rs.25,000 on mediclaim premiums for self, spouse and dependent children. An additional tax exemption of up to Rs.25,000 is applicable on insuring parents and extends to up to Rs.50,000 for parents who are senior citizens.
    • Q. What are the things to look for while choosing a health insurance plan?
      • While choosing a health insurance policy there are a few things which you should be ready with are:

        • Maximum value an insurer will compensate you for complete total loss or theft of your bike
        • Sum insured or coverage amount – Ensure that you consider future expenses too.
        • Room rent – Check for the capping amount or criteria defined if applicable.
        • Sub-limits or co-pay applicable – Check for the sub-limits applicable for some specific list of ailments or package treatments. Also check if the plan has copay feature.
        • Network hospital list – Check for the list of network hospitals and try buying a policy which covers your regular hospital
        • Policy wording – Most important thing to check before buying a policy is the policy wording. In case you are not sure about a certain term or condition you can always contact the insurer for clarification.
    • Q. Which mediclaim policy covers pregnancy in India?
      • Some mediclaim policies that cover pregnancy in India are:

        • Star Wedding Gift
        • Max Bupa Heartbeat Plan
        • Oriental Insurance Universal Health Insurance Scheme
        • Apollo Munich Easy Health Individual Insurance Plan
    • Q. Can I cancel my mediclaim policy and if yes will I get my premium back?
      • Yes you can cancel a policy after you buy it. A free look period of 15 days is provided to you after buying a policy to understand the terms and conditions. In case there is any objectionable clause, you can cancel the policy and get a refund. Stamp duty, expenses on medical check-up and proportionate risk premium (the number of days that the insurance company was at a risk of bearing your health expenses) would be calculated while the premium amount is refunded. Refer to the policy termination or policy cancellation section in your policy wording to know the amount that would be refunded.

    • Q. What is a mediclaim policy for employees?
      • Group mediclaim policies are specifically designed for employers, who can opt for it for their employees on the payment of pre-determined premiums. This policy enables employers to cover their employees on specific hospitalization and other related expenses, as defined in the policy document of the insurance company. Employees can also avail tax benefits under such policies.

    • Q. What are the types of cashless mediclaim?
      • The following are the two types of cashless claims in mediclaim:

        • Cashless claims – Fill up the Preauthorization Request Form with accurate information and submit it to your insurance company to initiate the claim settlement process.
        • Cashless planned hospitalization – In the case of pre-planned hospitalization, you need to submit the completed Preauthorization Request Form at least 72 hours before your hospitalization. This enables the insurer to ensure a streamlined and seamless claim settlement.
        • Cashless emergency hospitalization – For emergency hospitalization as a result of accident or critical illness, you are expected to present your mediclaim ID at the network hospital during admission. Further, the completed Preauthorization Request Form can be submitted within 4 hours of hospitalization to initiate the claim settlement process. Hence, it is essential for you to carry your mediclaim ID with you at all times.
    • Q. How Can Coverfox Help You Choose the Right Mediclaim Policy?
      • Here’s how Coverfox simplifies the process of selecting a suitable mediclaim policy.

        • Our online platform offers a comparative analysis of various mediclaim policies, offered by different insurance companies, which are aligned with your requirements. This ensures a convenient and hassle-free application process.
        • We offer expert and unbiased advice for assisting you with the right decision, as per your needs.
        • Coverfox is equipped with a dedicated customer service unit to assist you with all your pre and post-sales queries, including expert claims handling.
        • The process involves minimal paperwork to ensure a quick and seamless buying experience.
        • Convenient & Hassle-free application process clubbed with online platform for comparison and choosing the right plan.
        • Expert & Unbiased Advice for assisting you with the right decision as per your requirements.
        • Dedicated Customer Service Unit to tackle all your post-sales queries including expert claims handling.
        • Minimal Paperwork to ensure hassle free and pleasurable buying experience.
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