.png)
On a fine Friday evening, I went out to buy shawarma! Before I could reach the nearest shawarma outlet, I met with an accident. The moment I gained consciousness I figured out that I dislocated my shoulder. I was immediately taken to hospital and the doctor suggested my parents go for arthroscopic surgery. Without any second thought, my father proceeded with the paperwork. It was a day in surgery that lasted around 2 hours. The next morning the doctor told me that I can go back home. The nurse took my dad to reception for payment and there it was a six-digit long unappealing number! Yes, this couple of hours and overnight stay cost my father around 3 lakh rupees. Now with that much amount, I could have had shawarma for the rest of my life. As I was discussing this incident with my friend, he suggested a Mediclaim policy. Now this policy will work as a lifesaver. Had I known about this earlier, maybe I could have saved all that money gone for nothing.
What is this Mediclaim policy?
Well to put it, it is a type of insurance policy where the insurance company covers or reimburses the expenses incurred for the treatment of the medical condition to the policyholder. Some of the highlights of this policy are:
- Covers hospitalization costs up to the insured sum
- Offers cashless treatment at network hospitals
- Available for individuals, families & groups
- Provides tax benefits under Section 80D of the Income Tax Act of India, 1961
Medical inflation in India is rising at 14% annually (PwC India 2023), making Mediclaim policies essential for financial protection.
Due to the increased medical inflation rate, Mediclaim policies are a necessity for people to make healthcare affordable. This policy covers medical treatment for illness and hospitalization charges up to the insured amount. This policy is valid for a certain period and policyholders will have to renew to enjoy the benefits.
Also read: Why should Millennials invest in Health Insurance
What are the different types of Mediclaim policies?
There are different types of Mediclaim policies based on the requirements of the policyholders:
· Individual Mediclaim Policy
This policy is exclusively for the policyholder against any medical expenses.
· Family Floater Policy
In this policy, the individual can cover his/her entire family for the premium.
· Senior Citizen Policy
In this policy, senior citizens are considered (people above 60 years) for medical expenses and provided with special provisions.
· Critical Illness Policy
Chronic illnesses like cancer, heart failure, brain hemorrhage can cost a fortune to get treated. This policy covers the treatment and hospitalization charges of such policyholders.
· Personal Accident Policy
This policy offers protection for any sudden accidental death, disability to the policyholder.
· Overseas Policy
Under this policy, the policyholder is covered by expenses incurred in a foreign country.
· Special Diseases Policy
This type of policy is applicable if the policyholder is infected with vector-borne diseases like malaria, dengue, zika virus, etc. It is also called the mos-bite protector policy.
· Low-Cost Policy
This type of policy is targeted at the underprivileged and poor sectors of society. These types of policies are bought by small and medium businesses employers for their employees.
· Group Health Insurance Policy
Group Health Insurance policy is purchased by the employer for the employees of their company.
Also read: Difference between mediclaim and health insurance - All you need to know
What all is included in a Mediclaim Policy?
1. Hospitalization Costs
These costs include the rent of the room, diagnostic charges, operation theatre charges, blood, x-ray, oxygen, etc.
2. Domiciliary Costs
Some Mediclaim policies cover domiciliary hospitalization charges also, in cases where the patient cannot be taken to the hospital or the hospital does not have facilities to treat the patient.
3. Pre and Post Hospitalization Expenses
Some policies include pre (30 days) before and post (60 days) after hospitalization expenses.
4. Day Care Expenses
This includes all the hospital charges within 24 hours.
5. Medical fees
Consultation fee, the charge of nurses, tablets, and medication expenses are covered.
What is not included in the Mediclaim Policy?
Although Mediclaim Policies cover most of the aspects of healthcare, there are few exemptions in this policy too:
1. Does not cover for pre-existing illness (until waiting period ends).
2. Any sort of dental treatment.
3. Birth control, Hormonal treatments, and STDs.
4. Vaccinations.
5. Plastic surgeries and cosmetic surgeries.
6. Non-medical expenses.
7. Any extra expenses like hearing devices, contact lenses, etc.
Essential things to note while buying Mediclaim Policy
· Total sum coverage of the Mediclaim Policy.
· Is the policy for an individual or for the family?
· What are the network hospitals included in this policy?
· How long is the waiting period and what all is included in the waiting period.
· Is there any add-on available for the specified Mediclaim Policy?
· Are there any sub-limits in the policy?
· Is the policy a co-payment one where the insurer is expected to pay a certain percentage of the claims?
Also read: Health Insurance Claim Process - How Does It Work?
Top 5 best Mediclaim Policies (Health Insurance Plans) in India
Aditya Birla Activ Health Assure
Aditya Birla has plans for both individuals and families. The sum insured is anyway from 2 lakhs to 2 crores. Daycare procedures, In hospitalization charges, home treatment are all included. Starting at Rs 433/month.
Care Health Insurance
Care’s health insurance plans are regarded as the best health insurance plans in India. They have more than 2500 network hospitals and a settlement ratio of 95.47%. Maternity cover, organ donor expenses, and annual health checkups are included in their plans.
Bajaj Allianz Insurance
Bajaj Allianz is the biggest health insurance company in India has 6277 network hospitals and a 92% claim settlement ratio. Insurance plans include anywhere from 1.5 lakhs to 1 crore. Some benefits include pre-and post-hospitalization expenses, road ambulance, maternity expenses, and preventive health checkups.
Kotak Mahindra Healthcare Policy
Starting at Rs 537/month, Kotak provides free health checkups, ambulance cover, daycare treatments, and in-patient hospitalization expenses. The insurance sum is from 3 lakhs to 25 lakhs.
Star Health Insurance
Star’s insurance plan starts at Rs 619/month. It provides Rs 5,000 per day for room rent. Assisted reproduction treatment, new-born baby cover, AYUSH treatment, pre and post-hospitalization expenses are included in the plan. The insurance sum is from 3 lakhs to 25 lakhs.
How to Compare and Choose the Right Mediclaim Policy
A quick checklist for choosing the right plan:
- Premium vs. benefits
- Cashless hospital network
- Claim settlement ratio
- Availability of add-ons (e.g., maternity, critical illness)
What Is a Waiting Period in Mediclaim?
Not all benefits start from day one.
- Initial waiting period: 30 days after policy begins.
- Pre-existing disease waiting period: 2–4 years.
- Specific diseases (hernia, cataract, etc.): 1–2 years.
- Consider plans with reduced or zero waiting through top-ups.
How to File a Mediclaim: Reimbursement vs. Cashless
Understanding the process helps avoid claim rejection.
- Cashless: Inform TPA, submit pre-authorization, and get direct settlement.
- Reimbursement: Pay upfront, collect documents, submit claims with the insurer.
Pro Tip: Always keep copies of discharge summaries, original bills, and prescriptions.
Group Health Insurance by Pazcare
Pazcare offers group health insurance for enterprises of as low as 7 employees, with the best prices in the market. Also, we provide additional benefits like mental wellness, unlimited doctor consultations, super-top, health check-ups, laboratory allowance, and more. Employers will get a sophisticated dashboard to easily manage and track the group health insurance policies and all other employee benefits provided. And employees can manage their benefits with our Pazcare app.
.svg)
.svg)