Mediclaim policy

Safeguard your health and get coverage for medical expenses with mediclaim policies. Know the features and benefits of a mediclaim policy.
Get Quote
Mediclaim policy
Get Quote
3 min
15-June-2023

Medical expenses can create a financial burden on individuals, especially in times of unexpected illnesses or accidents. Mediclaim policies can alleviate this burden, making it a popular choice among people. It helps individuals and families cope with the rising costs of healthcare services. Thus, you get complete financial security during medical emergencies.

What is a mediclaim policy?

A mediclaim policy is a type of health insurance that covers you against unexpected medical expenses. You can get cashless treatment at network hospitals or reimbursements against your medical bills.

Key features of a mediclaim insurance policy

Here’s a quick look at the key features of a mediclaim insurance policy:

Features

Specifications

Sum insured

Rs. 5 lakh to Rs. 50 lakh

Cashless treatment

6,500+ hospitals

Daycare treatment

Included

Pre-and post-hospitalisation expenses

Covered

Tax benefit

Available


Know in detail about the key features offered by a mediclaim policy.

• Hospitalisation expenses:

The policy covers room rent, nursing expenses, surgeon fees, and doctor consultation fees. It also covers operation theatre charges and other related expenses.

• Cashless treatment:

Get medical treatment at any of the insurer network hospitals without paying any money upfront. The insurance company settles the bills directly with the hospital before you get discharged.

• Sum insured:

Choose the sum insured based on your medical needs and budget. The insurance company will pay for medical expenses up to the sum insured by the policy.

• Tax benefits:

You get tax benefits for the premium paid towards a mediclaim policy. Claim for tax exemption under the relevant sections of the Income Tax Act, 1961.

Key benefits of buying a mediclaim policy

Here are some key benefits of a mediclaim insurance policy:

• Peace of mind:

Having strong financial security provides peace of mind. Mediclaim policy ensures you have an adequate financial backup at the time of need, helping you stay stress-free.

• Financial security:

You get complete financial assistance with a mediclaim policy, as it covers all medical-related expenses. It provides coverage for hospitalisation, surgery, and other medical procedures.

• A cost-effective way to access healthcare services

A mediclaim policy offers a cost-effective means of accessing healthcare services without depleting your savings.

• Lifelong renewability:

The lifelong renewability benefit enables you to renew the policy anytime, without any age limit. Many mediclaim policies come with the option of lifelong renewability.

How does a mediclaim policy work?

A mediclaim policy works in the following ways:

• Medical expenses coverage

Choose a coverage amount on the mediclaim policy basis your medical requirements and budget. The policy will offer coverage up to the sum insured for hospitalisation, treatment, and other medical-related expenses.

• Reimbursement claim process

Reimbursement of the hospital/treatment bills is one of the ways of claiming the benefits on your mediclaim policy. You only need to share the bills, prescriptions, discharge summary, and other required documents to raise the reimbursement claim.

• Cashless claim process

Another way of claiming benefits is opting for cashless treatment. You can take treatment at any of the insurer’s network hospitals. The hospital will contact the insurer with all the details and share the required documents with them. You do not have to bother about the paperwork in this process. Upon verifying the details, the insurer will directly settle the bills with the hospital.

• Policy renewal:

Simply renew the mediclaim policy online by paying the premium. Some mediclaim policies also offer the benefit of lifelong renewability. So, you can renew the policy whenever you want to.

Types of mediclaim policies in India

There are different types of mediclaim policies available in India to suit the varying healthcare needs of individuals. Here are some of the common types of mediclaim policies:

• Individual mediclaim policy:

This policy covers the medical expenses of an individual policyholder.

• Family floater mediclaim policy:

This policy covers the medical expenses of the entire family (self, spouse, and dependent children) under a single sum insured.

• Senior citizen mediclaim policy:

Designed especially for senior citizens, the policy provides coverage for age-related illnesses and other medical expenses.

• Group mediclaim policy:

This policy caters to the medical needs of a group of people. Most employers or organisations offer a group mediclaim policy to their employees or members. It mainly covers the medical expenses of the employees or members and their dependents.

• Critical illness mediclaim policy:

This policy provides coverage for critical illnesses such as cancer, heart attack, and stroke.

Factors to consider while buying a mediclaim policy

Here are some factors that you must consider while buying a mediclaim policy:

• Coverage:

Check the policy coverage including the sum insured, inclusions, and exclusions. Look for a policy that covers your medical needs and fits your budget.

• Premium:

Compare the premium of different policies and choose one that offers the best value for money. However, do not compromise on coverage for the sake of a lower premium.

• Network hospitals:

Check the list of network hospitals associated with the insurance company. This will help you get cashless treatment in case of a medical emergency.

• Claim settlement ratio:

Look for the claim settlement ratio of the insurance company. This ratio represents the number of claims settled against the total number of claims received by the insurance company. A higher ratio indicates a better claim settlement process.

• Waiting period:

Check the waiting period for pre-existing illnesses and other medical conditions. This will help you understand when you can make a claim for such conditions.

Documents required for buying a mediclaim policy

When buying a mediclaim policy, you need to provide the following documents:

  • A completed proposal form
  • Age proof (Aadhaar card, passport, voter ID card, or any other acceptable document)
  • Identity proof (passport, Aadhaar card, driving licence, etc.)
  • Address proof (driving licence, passport, Aadhaar card, or any other acceptable document)
  • A passport-size photograph
  • Pre-policy medical test reports, if required.

Key inclusions of mediclaim insurance policy

Here are some of the common coverages offered under a mediclaim policy.

• Hospitalisation expenses:

The policy covers hospitalisation expenses incurred due to an illness or injury.

• Room rent:

The policy covers room rent expenses incurred during hospitalisation.

• Ambulance charges:

The policy covers ambulance charges incurred for emergency transportation to the hospital.

Key exclusions of ediclaim insurance policy

• Pre-existing diseases:

Many insurers cover pre-existing medical conditions after a certain period, known as the waiting period.

• Cosmetic treatments:

The policy does not cover cosmetic treatments, plastic surgeries, and other related procedures.

• Self-inflicted injuries:

The policy does not cover medical expenses incurred due to self-inflicted injuries or suicide attempts.

• Non-allopathic treatments:

The policy does not cover medical expenses incurred due to non-allopathic treatments such as ayurveda, homoeopathy, or unani.

Choose a mediclaim policy that meets your healthcare needs and budget. Before purchasing a policy, compare different policies and read the policy document carefully for the policy terms and conditions.

Frequently asked questions

What is a cashless mediclaim policy?

A cashless mediclaim policy or cashless health insurance gives you the benefit of availing treatment at a network hospital without paying direct money to the hospital. Insurers tie up with several hospitals across the country to offer this cashless treatment facility. The facility enables policyholders to access quality healthcare services without worrying about immediate funds. The insurer pays for the bills directly to the hospital, also known as cashless claim settlement.

Which is the best insurance company for a mediclaim policy?

To choose the insurance company with the best mediclaim policy, you can consider the following criteria: Choose an insurance company that has a high claim settlement ratio. A high claim settlement ratio indicates the insurance company’s efficiency to resolve the claims. Look for the coverage offered on the mediclaim policy. Also, check the number of network hospitals available, so you can avail of the cashless benefit when needed.

How can I claim the benefits under a mediclaim policy?

You can raise the claim in two ways under the mediclaim policy. You can apply for a cashless or reimbursement claim settlement. In cashless claim settlement, the insurer will directly settle the bills with the network hospital after the completion of treatment. If you choose to take treatment at any of your preferred hospitals, you can apply for a reimbursement claim settlement. In this case, you need to submit the hospital bills, discharge summary, doctor’s report, and prescriptions to the insurer. Upon verifying the documents submitted, the insurer will settle the claim amount. You will receive the amount in your registered bank account.

Do mediclaim policies give coverage for accidents?

Yes, a mediclaim policy covers treatments in case suffered an accident. However, you must check with the insurer on the coverage offered when buying the mediclaim policy.

What is a group mediclaim policy?

A group mediclaim policy covers the medical expenses of a large group. Several companies or organisations provide mediclaim to their employees as a part of employee benefits. The employer pays the premium for the mediclaim policy. In some cases, the premium gets divided between the employer and employees.

What is the difference between a mediclaim policy and health insurance?

A mediclaim policy comes with limited coverage, whereas a health insurance policy offers comprehensive coverage. You mostly get coverage for hospitalisation expenses under a mediclaim policy. Health insurance covers all medical-related expenses including hospitalisation, pre-and post-hospitalisation, doctor’s fees, medicines, room rent and more. Also, you can avail of add-on covers on the health insurance policy but you do not get add-ons on the mediclaim policy.

Show More Show Less

Related videos

Disclaimer

Bajaj Finance Ltd. (BFL) is merely a distributor of third party products from Assistance Services providers such as CPP Assistance Services Pvt Ltd, Bajaj Finserv Health Ltd.(BFHL), AWP Assistance India Pvt. Ltd. (Allianz), Doc Online Health India Pvt Ltd. etc. Issuance of the product is at sole discretion of Assistance Company or Services provider . The product and services or benefits assured under the product shall be governed by respective partner’s product T&C’s and BFL does NOT hold any responsibility for the issuance, quality, serviceability, maintenance and any claims post sale. Your purchase of an assistance product is purely on a voluntary basis after your exercise of an independent due diligence on the suitability, viability of any product. For more details on terms and conditions, inclusions and exclusions please read the product sales brochure carefully before purchase or subscription. All product information such as membership fees, benefits, exclusions, value added services, etc. are authentic and solely based on the information received from the respective value added service provider or Assistance company.

Note – While we have made all efforts and taken utmost care in gathering precise information about the products, features, benefits, etc. However, BFL cannot be held liable for any direct or indirect damage/loss. We request our customers to conduct their research about these products and refer to the respective product’s sales brochures before concluding their sale.