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What is Mediclaim Insurance/ Mediclaim Policy?

Written by - Akshatha Sajumon

August 8, 2019 3 minutes

Media claims are the part of health insurance that acts as “a shield” against your medical expenses and also provides protection against unseen happenings in the future. You can avail the benefits of the policy by paying the cost called “Premium.” This plan comes with a defined tenure, after which you have to renew it.
Do not let hospital expenses to drain your pocket. Compare with different policies that are available in the market and make informed decisions.
Mediclaim policy is a general hospitalization benefit offered by both private and public sector insurance companies in India. This policy will cover all the below-given situations:

  1. Covers accident cases
  2. Covers sudden illness cases
  3. Covers surgery cases during the policy tenure

Why opt mediclaim policy?

With the increasing instances of disease, buying an insurance policy is very necessary. When it comes to health, it would be your responsibility to opt for the best health care services. But mediclaim as an option is the best health care policy, and you do not need to worry about arranging a large sum of money.

Types of mediclaim policies in India

  • Individual health insurance:

It is the simplest of all the other types of health insurance policies and one of the best available options. This plan ensures that it will cover individual medical expenses within the cover limit. Like other insurance plans, you need to pay a regular premium amount to buy the cover. If you need a large cover, then the premium you pay will be high.

  • Family Floaters Plan:

You buy health insurance for your whole family and a single cover for a family. So, anybody in your family can claim the hospital expenses. When compared to other plans, the family floater plan is cheaper.

Benefits you can get:

  1. Cashless hospitalization facility
  2. A cost-effective way of availing the best health services
  3. Eliminates the need for dipping into savings
  4. Reduces the financial burden of meeting high-end hospital expenses
  5. Tax benefits on the premium you pay
  6. Covers both you and your family

What is the difference between medical and health insurance?

Mediclaim Health Insurance 
It reimburses your actual medical expenses.It grants the total cost of the cover irrespective of your medical expenses.
Along with critical illness, mediclaim also provide towards accidents It covers only certain diseases like organ failure, heart attack, paralysis, etc.
It covers hospitalization expenses and does not provide for any financial lossAlong with hospital expenses, it provides compensation for financial loss

How does mediclaim work?

For better understanding, let’s take an example. If the cost of treatment is Rs 5 lakh, the policyholder can get an approval for Rs 3 lakhs from an insurance company. Now, the insurance company will inform the hospital that they will reimburse Rs 3 lakhs under cashless.
At the time of discharge, if the bill amounts to Rs 4.60 lakhs, then the policyholder will have two options:

  1. He can himself pay Rs 40,000 and later he can get it reimbursed or
  2. He can forward the discharge bill to the insurance company and can wait for the revert.

What does a mediclaim not cover?

  1. A claim will not cover pre-existing diseases
  2. Expenses incurred on dental surgeries
  3. Complications during childbirth are not covered
  4. Hormonal treatment is not covered
  5. Special ailments are not covered

It is always advisable to carefully read and understand the terms and conditions before you buy any policy. You can clarify your doubts with the company personals, or you can take help with your financial planner.

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