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Mediclaim under health insurance

Mediclaim under health insurance helps you pay medical bills when hospitalised. It protects your savings from taking a dip during a medical contingency and ensures funds are not a roadblock in receiving the best treatment.

Types of mediclaim under health insurance

The different types of mediclaim available under health insurance policies are:

1
Individual

It covers you, only a single individual, for hospitalisation and other costs.

2
Family floater

the health insurance cover floats among family members. It offers coverage to all family members under a single plan.

3
Senior citizen

It caters to the health needs of senior citizens and help them cover their hospitalisation expenses.

4
Critical illness

It covers critical ailments such as cancer, renal failure, stroke, etc. as mentioned in the policy.

How can mediclaim under health insurance help?

Covers hospital bills

Medical treatments are expensive. Mediclaim under Health insurance policy helps you to cover costs incurred for hospital stays, surgeries, doctor’s fees and medicines. Hence, you don’t have to worry about paying from your savings.

Cashless treatment

Mediclaim under health insurance policy lets you get treated at network hospitals without paying upfront. The insurance company settles the bill directly to the hospital.

Peace of mind

Knowing you are financially covered in a medical emergency gives you peace of mind. You can focus on recovery instead of worrying about bills.

Mediclaim under health insurance: What it covers?

  • Inclusions
  • Exclusions
  • Hospitalisation expenses
  • Room rent
  • Ambulance charges
  • Self-inflicting injuries
  • Pre-existing diseases during the waiting period
  • Cosmetic treatments

Difference between mediclaim and health insurance

Though health insurance and mediclaim policy are used interchangeably, there are certain differences between them in various aspects (see table):

Aspect Mediclaim Health insurance
Coverage Covers only hospitalisation expenses. Coverage scope is broader. It covers hospitalisation, pre-and-post-hospitalisation, preventive check-ups and more.
Sum Insured Sum insured is comparatively less than health insurance. Has a higher sum insured. You also have the flexibility to enhance it, if needed.
Add-on covers Not available under a mediclaim policy. Offers a range of add-on covers to enhance coverage. The addition of add-ons is subject to additional premium.
Premium Less compared to health insurance. Higher as coverage and scope are high.
Customisation Less than health insurance as it covers only hospitalisation-related costs. Offers higher flexibility and allows you to customise your policy as per your needs.

Tax benefits of mediclaim under health insurance

The premiums paid for health insurance qualify for tax benefits under section 80D of the Income Tax Act (see table) under the old tax regime.

Premiums paid for Available deduction (in ₹)
Self, spouse and children (all below 60) 25,000
Self, spouse and children + parents below 60 50,000
Self, spouse and children + parents above 60 75,000
Self, spouse and children (eldest member above 60) + parents (above 60) 1,00,000

Note: Tax deductions under Section 80D is as per applicable provision of the Act (including any amendments thereto) and are subject to changes in the tax laws.
Source: incometaxindia.gov.in

How does mediclaim under health insurance work?

Here’s how a mediclaim generally works:

1

You buy a mediclaim

You choose a health insurance policy from an insurance company and pay a yearly premium. This policy will cover mediclaims like hospital bills and medical costs up to a fixed limit.

2

You get hospitalised

During a medical contingency, you get hospitalised and get treated accordingly by the team of doctors and caregivers.

3

Mediclaim pays for your treatment

For cashless treatment, the health insurance policy settles the bill directly to the hospital. For reimbursement, you need to produce bills, doctor’s reports, etc., to the insurance company. Upon proper analysis, the insurer reimburses the amount directly into your account.

Factors to consider while buying a health insurance policy

Some factors you need to consider while buying a health insurance policy are:

Why should you buy health insurance online?

Buying health insurance online offers the following benefits:

  • Compare policies: You can easily compare different policies and purchase the one that meets your needs
  • Simplified buying process: You can instantly buy a health insurance policy online with minimal paperwork
  • Enjoy discounts: Some insurers offer discounts for buying insurance online

How to file a health insurance claim?

You can easily file a health insurance claim with your insurer by following these steps:

  • Inform your insurance company about your claim

  • Submit your claim form and necessary documents like hospital bills, medical reports, doctor’s prescriptions, etc.

  • Your insurer will verify the details and documents shared by you and settle the claim based on your policy’s terms and conditions

What are different types of health insurance claim procedure?

There are two types of claim process – Cashless claim and reimbursement claim. In cashless process, the insurance company pays the hospital directly. Whereas, in reimbursement process, you need to pay the hospital first, then get the money back from the insurance company.

Here’s how each process works:

Cashless claim process

If you are treated at a network hospital (a hospital that is affiliated with your insurance company), you can opt for a cashless claim.

  • Inform the hospital’s insurance desk about your health insurance policy

  • Fill out the cashless request form and submit it to the hospital

  • The hospital will send the form to the insurance company for approval

  • Once approved, the insurance company will settle the bill directly with the hospital

  • You only need to pay for things not covered under your policy

Reimbursement claim process

If you get treated at a non-network hospital, you will need to pay the bill first and then claim the amount back from your insurer.

  • Inform your insurance company as soon as possible

  • Pay the hospital bills and collect all documents (bills, prescriptions, reports, discharge summary, etc.)

  • Fill out the reimbursement claim form from your insurance company

  • Submit the form along with the required documents to the insurer

  • The insurance company will review the documents and transfer the approved amount to your bank account

    

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FAQs on mediclaim insurance

How do I claim the benefits from mediclaim?

To claim your mediclaim benefits, inform your insurance company as soon as you need medical treatment. If you choose a cashless claim, visit a network hospital, show your health card and the insurer will settle the bill directly. For a reimbursement claim, pay the hospital bills first, then submit the bills and required documents to the insurance company to get your money back.

How to select the right health insurance policy?

Check the coverage amount, hospital network and claim process. Choose a policy that covers major illnesses, pre- and post-hospital expenses and offers cashless treatment. Compare different plans, read the fine print and pick one that suits your needs and budget.

What is the age criterion to buy a health insurance policy?

The minimum age to buy a health insurance policy is usually 18 years. The maximum age can exceed 60 years or more, depending on the insurer.

Can I claim mediclaim for accidents?

Yes, you can claim mediclaim for accidents. It pays for hospital bills and treatment needed due to an accident.

What is a cashless facility in health insurance?

A cashless facility allows you to get treated at a network hospital without paying any money upfront. The insurance company directly settles the hospital bill. Therefore, you don’t have to worry about arranging funds for treatment.

When can you file for a mediclaim after buying a health insurance policy?

You can file a claim after a month of buying the policy, except in accidents. However, there are waiting periods for certain ailments. If you file a claim for an ailment during the waiting period, your claim will be rejected.

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