Mediclaim Policy is one of the most popular forms of health insurance that provides financial coverage against medical expenses. With the rising cost of healthcare, having a Mediclaim policy has become essential to protect yourself and your family from unexpected medical emergencies. This article provides an in-depth understanding of Mediclaim Policy, its benefits, types, eligibility, and frequently asked questions.
What is a Mediclaim Policy?
A Mediclaim Policy is a type of health insurance that reimburses the policyholder for medical expenses incurred due to hospitalization, surgeries, or other medical treatments. It can also offer cashless treatment at network hospitals, depending on the insurer’s terms.
How Does a Mediclaim Policy Work?
- The insured person needs to be hospitalized for a minimum period (usually 24 hours) to claim the policy.
- The expenses are either reimbursed by the insurance company or paid directly to the hospital under the cashless hospitalization option.
- The policy typically covers hospitalization expenses, doctor fees, diagnostic tests, medicines, and surgical procedures.
Benefits of Mediclaim Policy
1. Financial Security
A Mediclaim policy provides financial protection against high medical expenses, ensuring you don’t have to drain your savings during medical emergencies.
2. Cashless Hospitalization
Most insurance providers offer cashless hospitalization facilities where the insurer directly settles bills with the network hospital.
3. Tax Benefits
Under Section 80D of the Income Tax Act, you can claim tax deductions on the premium paid towards Mediclaim policies.
4. Family Coverage
Family floater Mediclaim policies cover multiple family members under a single plan, making it more affordable than individual policies.
5. Pre and Post-Hospitalization Coverage
It covers medical expenses incurred before and after hospitalization for a specified period.
6. Daycare Procedures
Certain policies cover daycare treatments that don’t require 24-hour hospitalization, such as cataract surgeries and chemotherapy.
Types of Mediclaim Policies
1. Individual Mediclaim Policy
This policy provides coverage for a single individual for medical expenses up to a specified limit.
2. Family Floater Mediclaim Policy
A single policy that covers the entire family, including spouse, children, and dependent parents under one sum insured.
3. Senior Citizen Mediclaim Policy
Specially designed for individuals above 60 years of age, providing higher coverage for age-related medical expenses.
4. Group Mediclaim Policy
Offered by employers to cover their employees under a common policy.
5. Critical Illness Mediclaim Policy
Provides a lump sum amount if the insured is diagnosed with specified critical illnesses like cancer, heart attack, or stroke.
Eligibility Criteria for Mediclaim Policy
Age Limit
- Minimum entry age: 18 years (for adults)
- Maximum entry age: 65 years (varies from insurer to insurer)
- Children above 90 days can be covered under family floater policies.
Medical Checkups
Certain policies may require a medical checkup for individuals above a specific age limit.
Pre-existing Diseases
Pre-existing illnesses are generally covered after a waiting period of 2-4 years, depending on the insurer.
How to Apply for a Mediclaim Policy?
- Research different insurers and compare policies.
- Choose the policy based on your needs and budget.
- Fill out the application form with personal and medical details.
- Submit the required documents (ID proof, medical reports, etc.).
- Pay the premium amount.
- Receive the policy document after successful verification.
Claim Process in Mediclaim Policy
1. Cashless Claim
- Inform the insurer about hospitalization.
- Get treatment at a network hospital.
- Submit the pre-authorization form to the insurer.
- The insurer will directly settle the bill with the hospital.
2. Reimbursement Claim
- Inform the insurer about hospitalization.
- Pay the hospital bills from your pocket.
- Submit bills and documents to the insurer.
- The insurer will reimburse the amount based on policy terms.
Documents Required for Mediclaim Claim
- Policy document
- Hospital bills and receipts
- Doctor’s prescription
- Medical reports
- Discharge summary
- ID proof
Exclusions in Mediclaim Policy
Mediclaim policies do not cover:
- Pre-existing diseases (until the waiting period is over)
- Cosmetic surgeries
- Dental treatments (unless required due to an accident)
- Self-inflicted injuries
- Maternity expenses (in some policies)
How to Choose the Best Mediclaim Policy?
- Check the coverage amount and premium.
- Look for network hospitals.
- Understand the waiting period for pre-existing diseases.
- Compare claim settlement ratios of different insurers.
- Check if daycare procedures and ambulance charges are covered.
- Read the policy terms and conditions carefully.
Also Read: Understanding Endowment Policy: Benefits, Features & Types
Conclusion
A Mediclaim Policy is a crucial financial tool that helps protect you and your family from unexpected medical expenses. It not only provides financial assistance during emergencies but also ensures peace of mind. Understanding the various benefits, types, and eligibility criteria can help you make an informed decision while choosing the best Mediclaim policy that suits your needs.
FAQs
1. What is the waiting period in a Mediclaim Policy?
The waiting period is the time you need to wait before certain illnesses or pre-existing diseases are covered under the policy. It usually ranges between 2 to 4 years.
2. Can I buy a Mediclaim Policy for my parents?
Yes, you can purchase a Family Floater Policy or Senior Citizen Mediclaim Policy to cover your parents.
3. Is maternity covered under Mediclaim Policy?
Maternity expenses are not typically covered, but some policies offer maternity add-ons or cover it after a waiting period.
4. What happens if I don’t renew my Mediclaim Policy on time?
If you don’t renew your policy within the grace period (usually 15-30 days), your policy will lapse, and you will lose all benefits including waiting period credits.
5. How can I check the claim settlement ratio of an insurer?
You can visit the IRDAI website or the insurer’s official website to check the claim settlement ratio.