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Mediclaim Policy - Saving Your Life and Your Life Savings

What is Mediclaim Policy, What all is included in a Mediclaim Policy?, What is not included in the Mediclaim Policy.

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 to 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 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 about 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 none.


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:

· Policyholders get reimbursements after they submit the bills to the insurance company.

· Policyholders can also go for cashless treatment facilities by getting treated with the insurer’s network hospitals.

· This policy is available for both individuals and families.

· This policy provides tax benefits to the policyholders according to section 80D of the Income Tax Act of India, 1961.

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 (they can be covered after the completion of the waiting period).

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. 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.


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.


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