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How Does Mediclaim Work?

Mediclaim, also known as health insurance, is a lifesaver when it comes to managing medical expenses. Learn how mediclaim works in this blog.

  • 31 Mar 2023
  • min read

Mediclaim, also known as health insurance, is a lifesaver when it comes to managing medical expenses. This policy covers an array of expenses such as hospitalisation, surgery, diagnostic tests, and other medical treatments, ensuring policyholders receive the medical attention they need without the burden of paying exorbitant costs. With the increasing cost of healthcare, Mediclaim offers a financial safety net that helps ease the burden of medical bills.

The working of Mediclaim starts with choosing the right policy. With multiple policies available, each with different coverage limits, premiums, and deductibles in health insurance, always review the policy terms and conditions to ensure it meets your requirements. Once you have chosen a policy that suits your needs, pay the premiums to activate your policy. 

Following coverage, if you require medical treatment, visit a network hospital and provide your policy details to the third-party administrator (TPA). The TPA will take care of the remaining steps. For reimbursement claims, keep all receipts and bills related to your medical treatment, as you will need to submit these when filing a claim.

If your claim is approved, the health insurance company will reimburse you for your medical expenses. It is critical to note that the insurance company will only reimburse costs covered by your policy. Hence, carefully read the policy terms and conditions to ensure you understand coverage limits and deductibles.

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What cover does Mediclaim provide?

The coverage provided by a Mediclaim policy can vary depending on the specific policy and the insurance provider. However, here are some of the common coverages provided by most Mediclaim policies:

  • Hospitalisation expenses: Mediclaim policies typically cover the amount incurred due to hospitalisation, including room charges, doctor fees, nursing charges, and other medical costs.
  • Daycare procedures: Many policies cover the expenses incurred due to daycare procedures, which are medical treatments that do not require the patient to stay in the hospital for more than 24 hours.
  • Ambulance charges: Mediclaim policies also cover the expenses incurred due to ambulance services required to transport the patient to and from the hospital.
  • Critical illnesses: A Mediclaim plan allows you to buy critical illness coverage with your standard insurance, after which the policy covers ailments such as cancer, heart attack, kidney failure, and stroke, which require prolonged and expensive treatments.
  • Maternity expenses: Some policies, when supplemented with the rider, cover the expenses incurred during childbirth, including hospitalisation charges, delivery fees, and other medical costs.
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