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In India, the mediclaim policy has been designed in such a manner, so that it efficiently meets the medical treatment costs up to the sum insured amount. This becomes effective if you get hospitalised due to any medical emergency, accident, or ailment. You simply need to pay the premium dues punctually at regular intervals to enjoy uninterrupted coverage.
Depending on the terms of the chosen mediclaim policy, the hospitalisation expenses incurred can be either settled using the cashless facility at any network hospital or reimbursed after discharge. In India, mediclaim can be issued for a specific tenure. To enjoy uninterrupted coverage, you must ensure you clear the premium dues before the due date.
| PLAN NAME | SUM INSURED (INR) | ENTRY AGE | NETWORK HOSPITALS | CLAIM SETTLEMENT RATIO |
|---|---|---|---|---|
| Bajaj Allianz Health Guard | 1.5 lakhs – 50 lakhs | 18-65 years | 6500+ | 93.68% |
| Tata AIG Medicare | 3 lakhs – 20 lakhs | 91 days – 65 years | 4000+ | 96.43% |
| Aditya Birla Active Assure Diamond Plan | 2 lakhs – 2 crores | 5 years and above | 7100+ | 70.81% |
| Care Health Plan | 4 lakhs – 6 crores | 91 days and above | 7800+ | 92.23% |
| Future Generali CritiCare Plan | 1 lakh – 50 lakhs | 18- 65 years | 4800+ | 92% |
Several variants of mediclaim policies are currently available in India including the following:
Individual mediclaim plans: Under the scope of this plan, only the single beneficiary will enjoy policy coverage for the medical expenses incurred during hospitalisation.
Group mediclaim plans: These sorts of plans are purchased by the employer for the employees offering effective financial coverage during medical emergencies.
Family floater plans: Under this scheme, self, spouse, dependent children, and parents are usually covered. However, it may vary depending on the terms of the plan chosen.
Critical illness mediclaim plans: The expenses incurred for the treatment of critical ailments are comparatively very high. This sort of mediclaim will offer effective coverage against such circumstances and ensure efficient financial management during such critical circumstances without compromising on the quality of treatment. Some of the critical ailments include cancer, kidney failure, heart attack, etc.
Senior citizen mediclaim plans: As the name suggests, this sort of mediclaim has been designed to fulfil the unique health coverage requirements of people of and above 60 years of age.
Overseas medical insurance plans: With this plan, you can enjoy financial coverage for treatments undergone beyond the geographical boundaries of India.
Low-cost mediclaim insurance plan: In case you are seeking a low-sum insured, then this sort of mediclaim is the best option for you. Small-scale employers generally purchase these sorts of plans for their employees.
| POINTS OF DIFFERENCE | HEALTH INSURANCE | Mediclaim Exclusively Covers |
|---|---|---|
| Coverage Limit | This is a comprehensive plan and allows multiple medical expenses including in-patient hospitalisation. | Mediclaim exclusively covers all sorts of costs related to hospitalisation. |
| Inclusions | health insurance coverage includes pre- and post-hospitalisation, ambulance costs, daycare charges, AYUSH treatments, domiciliary care, etc. | Mediclaims either pay or reimburse bills incurred during hospitalisation due to any accident, surgery or treatment of any chronic ailment. |
| Coverage Amount | This coverage limit may even range up to crores. | Here, the coverage limit is limited to the plan chosen. |
| Add-ons | Depending on necessity, numerous varieties of add-ons can be chosen including maternity cover, critical illness cover, personal accident cover, etc. | Mediclaims usually do not offer any additional rider/add-on facility. |
A competent mediclaim plan will ensure coverage for a wide range of medical facilities. Some of the most significant coverage areas include:
Hospitalisation coverage: Mediclaim plans allow hospitalisation coverage for self and family members too under the family floater plan. Such expenses include diagnostic investigation costs, medicines, OT charges, surgery costs, etc.
Pre- and post-hospitalisation cover: Mediclaim allows pre- and post-hospitalisation expenses up to a pre-defined specific period depending on the terms of the plan chosen.
Daycare coverage: Indian mediclaim plans also allow daycare coverage i.e., coverage for those treatments that require less than 24 hours of hospitalisation like cataract surgery, dialysis, angiogram, etc.
Additional benefits: Mediclaim plans also allow additional benefits for treatments concerning AYUSH procedures, ICU, annual health check-ups, etc.
Consultation charges: Mediclaims also cover consultation charges of specialist health professionals.
Room rent: Mediclaim allows room rent coverage during the in-patient hospitalisation of the beneficiary.
Ambulance charges: A standard mediclaim will offer emergency road ambulance coverage for the beneficiary if necessary during hospitalisation or post-discharge.
Domiciliary treatment: If you do not require hospitalisation and are treated at home as per your doctor’s prescription, all the associated costs of such domiciliary treatment will also be covered under mediclaim.
Even the best mediclaim policy will also not offer 100% coverage. Although the list of exclusions may vary from one plan to another, certain standard exclusions always remain constant. This list of exclusions includes:
Mediclaim plans have been designed to offer several tax benefits for the beneficiaries:
Premiums paid towards mediclaim qualify for tax deductions under Section 80D of the IT Act.
Premium payment for self, spouse, and dependent children qualifies for a tax deduction limit of up to INR 25000
An additional deduction of INR 25000 is allowed for premiums paid towards the mediclaim of dependent parents
Senior citizens are eligible for tax deductions up to INR 50000 in one financial year for their mediclaim plan.
You can well understand from this analysis that mediclaim saves and manages your finances effectively in more ways than one. It handles and covers multiple types of hospitalisation costs. Moreover, it even allows tax benefits, ensuring effective financial coverage during medical contingencies.
Buying a mediclaim policy online offers several advantages:
Convenience: Online purchase allows you to explore various policies, compare features, and buy the policy from the comfort of your home, at any time that suits you.
Wide Range of Options: Online platforms provide access to a diverse range of mediclaim policies from multiple insurers, offering a comprehensive choice to compare and select the most suitable one.
Transparency: Online platforms offer transparent information about policies, including coverage, exclusions, premiums, and reviews, enabling informed decision-making.
Easy Comparison: Online portals facilitate easy comparison between different insurance policies, allowing assessment of coverage, premiums, benefits, and exclusions side by side.
Instant Quotes: Obtain instant premium quotes for various plans, helping you budget and select a policy that aligns with your financial capabilities.
Paperless Process: Online purchase means a paperless transaction, reducing the hassle of physical documentation and streamlining the application process.
Customer Reviews and Ratings: Access to customer reviews and ratings on these platforms can offer insights into the quality of service and claim settlement processes of different insurers.
Online Support: Many online insurance platforms provide customer support via chat, email, or phone to assist in understanding policies, resolving queries, or guiding through the purchase process.
Secure Transactions: Reputable online insurance portals ensure secure transactions and protect personal and financial information.
Some of the most essential documents that are required to purchase any mediclaim policy include the following:
Under the mediclaim scheme, claim settlements can be classified into two categories: cashless claims and reimbursement claims.
In this scheme, you need to get admitted at any of the network hospitals.
Inform your insurer and contact the TPA desk present at the hospital and present them your cashless mediclaim card as issued by - Coverfox.
They will hand you the pre-authorisation form which you need to submit after the doctor signs it and the hospital authorities stamp it to enjoy the cashless facility.
This form is then forwarded to the TPA of Coverfox which evaluates and sanctions a particular amount depending on the necessity.
This arrangement is informed to the network hospital authorities and your treatment is continued.
You need to pay for the factors that are not covered by your mediclaim plan. The rest are all settled by Coverfox.
In the case of an emergency, you need to fill and submit the pre-authorisation form 4 hours post-hospitalisation, depending on the circumstances.
Once the form is submitted, the procedure will take its due course as per the company norms and the terms of the plan chosen.
This will only take place if you are treated at any non-network hospital.
It is best to inform Coverfox regarding this development at the earliest.
You must keep an organised track of all the expenses incurred during the treatment course and maintain all the receipts, bills, reports, prescriptions and other documents issued during hospitalisation.
Settle all the hospital dues by yourself during discharge.
Contact Coverfox at the earliest after discharge and apply for reimbursement by submitting all the documents.
These papers are subject to verification. The company may ask for additional documents if necessary.
Once all the documents and your claim are verified to be genuine, you will receive the approved claim amount directly credited to your registered bank account.
You must note not to make any false claims during the process as it may eventually lead to claim rejection.
Whether you buy mediclaim policy online or offline, it doesn’t matter, you must compare mediclaim policy with other competent plans before making your final selection. This will help you to understand the scenario better to make the right choice in selecting the correct and the most suitable plan at the most affordable rate.
Some principal factors that you need to consider before purchasing any mediclaim plan include coverage span, premium payable amount, list of network hospitals, claim settlement procedure, claim settlement ratio, waiting period, age criteria, inclusions & exclusions, No Claim Bonus, co-payment clause, etc.
After critically analysing all these factors you can make your final selection and proceed accordingly. Mediclaim policy comes in very handy, especially during medical contingencies. It saves a lot of time, tension, and money.
You need to keep the following parameters in mind while selecting a suitable mediclaim policy:
While choosing a health insurance policy there are a few things which you should be ready with are:
Some mediclaim policies that cover pregnancy in India are:
Yes you can cancel a policy after you buy it. A free look period of 15 days is provided to you after buying a policy to understand the terms and conditions. In case there is any objectionable clause, you can cancel the policy and get a refund. Stamp duty, expenses on medical check-up and proportionate risk premium (the number of days that the insurance company was at a risk of bearing your health expenses) would be calculated while the premium amount is refunded. Refer to the policy termination or policy cancellation section in your policy wording to know the amount that would be refunded.
Group mediclaim policies are specifically designed for employers, who can opt for it for their employees on the payment of pre-determined premiums. This policy enables employers to cover their employees on specific hospitalization and other related expenses, as defined in the policy document of the insurance company. Employees can also avail tax benefits under such policies.
The following are the two types of cashless claims in mediclaim:
Here’s how Coverfox simplifies the process of selecting a suitable mediclaim policy.
