Features and Benefits of a Mediclaim Policy

Health expenses are often unpredictable and can strain your finances. A mediclaim policy helps ease that burden by covering hospitalisation costs. But what exactly is a mediclaim policy, how does it work and how is it different from regular health insurance? This blog breaks down its features, types and benefits to help you make an informed choice.

What is a mediclaim?

Mediclaim is a type of health insurance that pays for hospital expenses if you fall ill or get injured. In simple words, if you have a mediclaim policy, the insurance company will help pay your hospital bills, either directly to the hospital or by reimbursing you after treatment. This gives you peace of mind and protects your savings during medical emergencies.

Features of a mediclaim policy

Mediclaim policies come with some important features:

• Financial protection:

The primary benefit of a Mediclaim policy is financial protection. It can help you pay for expensive medical treatments and hospitalisation costs, which can put a strain on your wallet.

• Cashless hospitalisation:

With a Mediclaim policy, you can get cashless hospitalisation at network hospitals. That means you can get treatment without having to pay cash upfront. The insurance company will settle the bills directly with the hospital.

• Tax benefits:

You can claim a tax deduction for the premium paid towards your Mediclaim policy under Section 80D of the Income Tax Act.

• Pre- and post-hospitalisation expenses:

Mediclaim policies also cover pre- and post-hospitalisation expenses, including doctor's consultation fees, medicines and diagnostic tests.

• No-claim bonus:

Mediclaim policies offer a no-claim bonus if you do not make any claims in a policy year. This can be in the form of a higher sum insured or a reduction in premium.

• Critical illness coverage:

Many Mediclaim policies offer coverage for critical illnesses, such as cancer, heart attack and stroke.

How mediclaim insurance works?

When you buy a mediclaim policy, you select the sum insured, which is the highest amount an insurer will pay for hospital expenses. If you fall ill and need treatment, you can either choose a network hospital for cashless treatment or go to any hospital and claim reimbursement later.

Types of mediclaim policy

There are different types of mediclaim policies to suit various needs:

• Individual mediclaim policy: Covers one person for a fixed sum insured.
• Family floater mediclaim: Covers the entire family under a single sum insured. Anyone in the family can use it as needed.
• Senior citizen mediclaim: Specially designed for older people, usually with higher premiums and different benefits.
• Group mediclaim policy: Usually offered by employers to their staff.
• Critical illness mediclaim: Offers coverage if diagnosed with major illnesses like cancer, heart attack, or stroke.

Each type of mediclaim policy has different features, limits and costs. It is a good idea to compare them before deciding which suits you best. For those looking for personalised coverage beyond hospital expenses, individual health insurance can be a better option as it offers wider protection compared to a basic mediclaim plan.

Inclusions and exclusions of mediclaim coverage

Mediclaim policies usually include:

• Hospital room rent
• Doctor’s consultation fees
• Nursing charges
• Surgery expenses
• ICU charges
• Anaesthesia and operating theatre costs
• Pre- and post-hospitalisation expenses for a certain period
• Day-care treatments that do not need long hospital stays

However, there are also exclusions you should know about. Mediclaim policies typically do not cover:

• Cosmetic surgery (unless needed due to an accident)
• Dental treatments (unless caused by injury)
• Pregnancy and childbirth-related expenses (some policies may offer maternity cover as an add-on)
• Pre-existing diseases until the waiting period is over
• Alternative treatments like Ayurveda, unless stated otherwise
• Injuries from war, self-harm, or substance abuse
• Costs above the sum insured

Tips for choosing the right mediclaim policy

Selecting the right mediclaim can feel confusing, but here are some simple tips to help:

• Look at the sum insured: Choose enough coverage to handle expensive treatments. Medical costs are rising, so do not pick a very low sum insured.
• Check network hospitals: Make sure your preferred hospitals are part of the insurer’s network to benefit from cashless treatment.
• Understand the waiting periods: Know the waiting periods for pre-existing diseases and other conditions before buying.
• Look at co-payment clauses: Some policies ask you to pay a small part of the bill yourself. Understand these terms to avoid surprises later.
• Review sub-limits: Policies sometimes have caps on certain expenses, like room rent. Check these limits.
• See renewal conditions: Prefer a policy that offers lifelong renewability.
• Compare policies: Do not buy the first policy you see. Compare benefits, exclusions, premiums and customer reviews before choosing.
• Check claim settlement ratio: This tells you how reliable the insurer is in paying claims.

Mediclaim health policy vs health insurance

Let’s look at the differences between mediclaim policy vs health insurance:

Conclusion

Mediclaim policies are a vital part of financial planning. They protect you and your family from the high costs of hospital treatment and medical emergencies. By paying a yearly premium, you get peace of mind knowing that you can access good healthcare without draining your savings.

Not sure which mediclaim or health insurance cover is right for you? We can help. Just fill out the form on this page to get simple, clear advice based on your needs. Let us guide you in finding the right health insurance plan for yourself or your family.

FAQs

• Can I buy mediclaim for my family?

Yes, family floater mediclaim plans cover your spouse, children and sometimes parents under one sum insured.

• Does mediclaim cover pre-existing diseases?

Mediclaim policies cover pre-existing diseases after a waiting period of usually 2–4 years.

• Is mediclaim the same as health insurance?

Mediclaim is a type of health insurance that mainly pays for hospitalisation expenses. Broader health insurance can cover more than hospital bills.

• What happens if I cross my sum insured limit?

If your medical bills are higher than your sum insured, you must pay the extra amount from your own pocket.

Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.