Mediclaim Insurance Policy – What You Should Know

By Staff

Life is very uncertain. Anything can happen at any point of time in life. Thus, with the increasing medical costs, it has become a necessity for individuals to have an effective health insurance policy. This policy will help them to deal with financial emergencies that arise due to accidents or medical illnesses. Although, it's quite surprising to know that in a fast-developing country like India, people are still unaware of the need of having an insurance plan. In fact, as per the studies, many Indians are yet to opt for any kind of medical cover that protects them against the sky-rocketing hospitalization expenses.

Mediclaim insurance policy is basically a health insurance that is especially designed to take care of your healthcare expenses in case you face any sort of medical emergency, whether it's an illness or accident which leads to hospitalization. In simple terms, this insurance policy reimburses your actual medical expenses. This policy is taken to cover the medical expenses incurred at the time of hospitalization.

what is mediclaim insurance policy

Types of mediclaim policies in India 

• Individual mediclaim policy: In an individual mediclaim policy, a single person is insured for a specific amount. The insured person can claim the entire sum insured, when required.

• Family-floater mediclaim policy: In case of a family-floater mediclaim policy, the whole family is insured for a fixed sum insured. This offers coverage to self, spouse, dependent children, and in most of the cases, it provides coverage to dependent parents also. The sum insured can be used by the entire family or even by a single member.

Features and benefits of a Mediclaim Policy:

1. This policy not just provides a complete health cover, but it also protects your savings.
2. It reduces the financial burden on any person who suffers from a sudden illness or accident that leads to hospitalization.
3. You can easily buy it online without any hassles.
4. Cashless hospitalization facility ensures that you don't have any out-of-budget medical expenses.
5. It allows you to get a higher cover at affordable premiums.
6. You can get tax deductions on the premiums paid under Section 80D of the Income Tax Act.
7. You can opt for the sum insured of up to Rs. 1.5 crores maximum.

What are the things not covered under a mediclaim policy?

Here're the list of things that are not covered under a mediclaim policy.

• HIV and sexually transmitted diseases
• Vaccinations
• Non-medical expenses, such as service charges, administrative charges, syringes, diapers, toiletries, etc.
• Cosmetic or plastic surgery
• Medical conditions that arise due to addiction of alcohol, drug abuse, smoking, etc.

What to consider while buying a mediclaim policy?

Below mentioned are a few things you need to keep in mind before buying a mediclaim policy.

• Sum insured and coverage required: This is one of the most important factors to consider while buying a mediclaim policy. While choosing the sum insured, it is important for you to consider factors like inflation rate, increasing healthcare costs, etc.

• Credibility of the insurance company: It is advisable to check the reputation of the company from where you are going to buy your mediclaim form. In addition to this, a little knowledge about their claim settlement ratio will also prove to be very useful in order to make the right decision.

• Hospital network: One of the biggest advantages of buying a mediclaim policy is the easiness of cashless settlement of hospitalization expenses. Remember, each and every insurance company has a network of hospitals and thus, you can seek hospitalization in any of these hospitals. This comes out to be a great financial help in your tough times. Also, check out the hospitals in your area that are in tie up with the insurance company from where you are going to buy your insurance plan.

• Individual or family floater policy: It is solely your decision, whether to opt for it or not. If you are unmarried and want to cover just yourself, then opt for individual mediclaim policy. However, if you want to cover your whole family, including parents, then it's good to go for a family floater policy. Family floater plans are affordable as compared to individual plans bought for each family member. Thus, think twice before coming to a decision.

How to file a mediclaim?

It is actually quite simple to file a mediclaim in India, if you follow the below mentioned steps properly.

1. Firstly, you need to put all your medical bills, receipts, and medical reports in order. Check all your documents that contain the required information such as the patient's name, cost price, etc.

2. Secondly, you can ask your insurance company about the claim form. Also, you can download it from the company's website. Read all the instructions that are mentioned in the claim form carefully. Next, get it signed by the policyholder and stamped with the official hospital seal. Now, attach all the relevant medical and policy documents along with the form.

3. You need to submit the original as well as the photocopies of the documents along with the claim form. Review the documents carefully and ensure none of the documents is missing.

4. After submitting the documents, you must inform the health insurance company that the claim has been submitted by sending them a set of copied documents.

Who should opt for a mediclaim policy?

The answer of this question is very simple. Those who cannot afford the sky-high hospitalization prices and health care costs must invest in a mediclaim policy. Considering the premiums that you pay every month, the benefits you get in a mediclaim policy are much higher as compared to other insurance policies.

Compare and purchase mediclaim policies online

There are several online platforms, such as Royal Sundaram that will help you to make comparisons and choose the right policy as per your requirements. In addition to this, it would be beneficial for you to take a mediclaim policy that covers all your family members, including children and parents. Also, you must look for certain factors like benefits offered, ease of claim settlement, cost of premium, etc., so as to get the right mediclaim policy.

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