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ICICI Lombard's Elevate Mediclaim Policy

Mediclaim

Reliable Protection. Zero Worries. Zero% GST AO

Mediclaim Policy - Elevate Plan Benefits

Mediclaim under Health Insurance

Medical emergencies affect more than just your health. They can also put pressure on your savings. A mediclaim policy helps take care of your hospital bills, so you can focus on recovery instead of worrying about expenses. The terms mediclaim and health insurance are often used interchangeably, but they are not the same. A mediclaim policy mainly covers hospitalisation costs. A comprehensive health insurance plan goes a step further by covering pre- and post-hospitalisation expenses, day-care procedures, and more.

In simple terms, mediclaim covers the basics while Health insurance gives you broader protection for different medical needs.

What is a Mediclaim Policy?

A mediclaim policy is a simple way to stay prepared for medical expenses. It helps cover costs during hospitalisation, including room rent, doctor’s fees, and treatment charges, as per your policy terms. So when you need medical care, you don’t have to pause and worry about arranging money. Whether it is a planned procedure or an unexpected hospital visit, your mediclaim takes care of the financial side while you focus on getting better.

Here is a simple real-life example to explain how a mediclaim policy works:

  • Imagine you have a mediclaim policy with a sum insured of ₹5 lakh. You are hospitalised for a minor surgery that costs ₹1.8 lakh. This includes room charges, doctor’s fees, and other treatment costs.
  • If you choose a network hospital, you can opt for a cashless claim. The insurer settles the bill directly with the hospital as per policy terms. You can focus on recovery instead of arranging funds.
  • If you visit a non-network hospital, you pay the bill first and then apply for a reimbursement claim. Once your documents are verified, the eligible amount is paid back to you.

In both cases, your mediclaim policy helps reduce the financial burden of hospitalisation. The remaining sum insured remains available for future medical needs during the same policy year.

Read more
Mediclaim Insurance - Happy & Secure Family

How Does a Mediclaim Policy Work?

A mediclaim policy is designed to keep things simple when you need it the most. Here’s how it works, step by step:

1

Buy the Policy: Choose a mediclaim plan and a sum insured that fits your needs and budget. Think of it as setting up a financial backup for medical situations.

2

Pay the Premium: Pay a fixed premium to keep your policy active. Once done, your coverage is ready when you need it.

3

Get Coverage: You are now covered for hospitalisation expenses as per your policy terms. So if a medical situation comes up, you are not starting from scratch financially.

4

Hospitalisation: If you need treatment, you can get admitted to a hospital. Choose a network hospital for a smoother, cashless experience or opt for any hospital and claim later.

5

Claim Settlement: The insurer settles the eligible bill directly with the hospital, so you don’t have to arrange funds upfront.

6

Reimbursement Claim: You pay the bill and submit documents. The approved amount is paid back to you.

Types of Mediclaim under Health Insurance

Different needs require different types of coverage. Here are the common types of mediclaim plans available:

Parameters Individual Mediclaim Family Floater Mediclaim Senior Citizen Mediclaim Critical Illness Mediclaim
Coverage Type Covers a single individual under the individual mediclaim policy.. Covers multiple family members. Designed for older individuals with age-specific needs. Covers specified critical illnesses as defined in the critical illness insurance policy.
Sum Insured Dedicated to one person. Shared among all insured family members. Dedicated to the insured senior citizen. Paid as a lump sum on diagnosis.
Ideal for Individuals who want separate coverage Families looking for cost-effective shared coverage People above a certain age seeking focused health coverage Individuals looking for financial support during major illnesses

Benefits of Buying a Mediclaim Policy

One diagnosis can wreck a budget faster than bad investing. Prepared or hopeful, your call.

Cost Shield:

One illness, years of savings gone? That happens fast. A mediclaim policy covers eligible hospital costs, so your emergency fund, investments and credit card limit do not become the backup plan.

Tax Relief:

Paying your premium can also cut your tax bill under Section 80D (old tax regime) by up to ₹1 lakh, depending on the insured members’ age. The benefit extends to self, spouse, children and parents.

Cashless Care:

Need treatment, not a funding round? Visit the network hospital, where the insurer settles the approved bills directly. You don't need to stress about arranging funds.

Expense Cover:

A good mediclaim policy usually covers room rent (as per the limits), ICU charges, doctor fees, medicines and surgery costs, within the policy terms.

No Claim Bonus:

Stayed claim-free all year? Your insurer may reward you with higher cover at no additional cost or lower your premium, subject to its internal policy.

Who Should Buy a Mediclaim Policy?

Think health cover is only for “later”? Hospitals disagree.

  • If you are a young professional, buying early means lower premiums.

  • If you have a family, one illness, surgery, or a child's emergency can quickly become expensive, so family floater mediclaim cover makes sense.

  • If you are self-employed or a freelancer, you do not have employer health cover, which means medical costs come directly from your pocket during both illness and income loss periods.

  • If you are a senior citizen, medical needs often increase with age, and frequent hospital bills can make this plan highly valuable.

  • If you support ageing parents, separate cover for them can reduce financial pressure during emergencies.

Who Should Buy a Mediclaim Policy?

What is Covered in a Mediclaim Policy?

People read policy documents after falling ill. But you do not have to.

  • What’s Covered
  • What’s Not Covered

  • Hospitalisation Expenses

    Nobody plans a hospital stay, but the bills arrive like guests. In the event of hospitalisation, the policy covers inpatient expenses such as doctor visits, nursing fees, medications, surgery charges and diagnostic tests, subject to policy terms.

  • Room Rent

    Yes, even the bed has a price tag. Although the policy covers the room charges are usually covered, the limits depend on the plan you have purchased. Some offer a single private AC room, while others have caps or specific room-category restrictions.

  • Ambulance Charges

    Emergencies rarely wait for convenience. If you need immediate transport to the hospital, road ambulance expenses are generally covered up to the policy limit.

  • Cosmetic Treatments

    Want a sharper nose or a “new you” surgery? But remember that procedures done only to improve looks, such as aesthetic nose jobs, skin enhancement or slimming treatments, are usually not covered.

  • Self-Inflicted Injuries

    If harm is caused deliberately, including attempted suicide or intentional self-injury, insurers generally step away.

  • Non-Medical Expenses

    Hospitals bill for everything. Registration fees, attendant meals, toiletries, visitor masks, gloves and comfort extras are usually your bill, not the insurer’s.

  • Experimental Treatments

    If a treatment is unproven, investigational, or outside accepted medical practice, reimbursement may be denied. New does not always mean covered.

Mediclaim vs Health Insurance: Key Differences

You are standing at the hospital reception, bills in hand, expecting your insurer to handle everything. And then the question comes: "Is this mediclaim or health insurance?" Suddenly, what sounded like the same thing does not look the same anymore. Most people discover the difference between mediclaim and health insurance only at this moment. The good news is, you are reading this now, and not then. Mediclaim covers hospitalisation expenses. You get admitted, the bills get handled up to a fixed limit, and that is where it ends. Health insurance, on the other hand, travels with you through the entire treatment journey. It covers pre-admission, admission, and post-admission expenses.

Here is how mediclaim vs health insurance actually breaks down:

Basis Mediclaim Health Insurance
Scope Limited strictly to hospitalisation expenses Covers hospitalisation + pre/post-treatment, daycare, and more
Coverage amount Usually fixed with lower sum insured options Wider range with higher coverage and scalability
Flexibility Basic plans with limited customisation Highly flexible with add-ons (riders) and upgrade options
Additional benefits Minimal or none beyond hospital bills Includes wellness benefits, check-ups, no-claim bonuses, etc

Why Health Insurance Offers Broader Coverage than Mediclaim

When someone in your family falls sick, the journey begins in the consultation room, not the hospital ward. Tests follow. Then, sometimes, hospitalisation.
Now, picture your insurer stepping in only at the last stop. That is the gap mediclaim leaves behind. Health insurance bridges it by staying with you through the full journey, not just the final step. This is exactly where the health insurance vs mediclaim difference becomes impossible to ignore.
Medical treatments today rarely come in one neat bill. Expenses are spread across weeks, sometimes months. This is why a health insurance policy shows up early rather than arriving late. Here is what makes it broader in real life:

  • Covers doctor consultations
  • Covers tests before hospitalisation
  • Includes post-treatment recovery costs and medicines
  • Handles daycare procedures without 24-hour admission
  • Offers preventive health check-ups and wellness benefits
  • Allows add-ons for personalised coverage
  • Provides access to a large cashless hospital network

Choose a plan that covers the complete journey, not just the hospital bills.

Calculate Premium Now

Factors to Consider Before Buying a Mediclaim Policy

You are comparing mediclaim policies, and two options look almost identical in coverage and price. It feels like a quick call.
But a rushed decision can turn small oversights into big problems at claim time. Before moving ahead, look beyond just the premium. A practical mediclaim buying guide can help here.
Here are the factors that deserve your attention when looking for the best mediclaim policy:

How Much Mediclaim Coverage Should You Choose?

You are selecting coverage, and the question appears: Is INR 5 lakh enough?
Five lakhs feels like a safe mediclaim coverage amount, and most buyers go with it. Until the bills cross that number. Healthcare costs do not stay still. They move fast, and they often move ahead of what you planned. Skip the guesswork and choose your mediclaim policy coverage based on real-life needs:

Profile Profile
Individual (young) INR 5-10 lakh
Family (2-4 members) INR 10-20 lakh (family floater)
Senior citizens INR 15 lakh or higher
Metro city residents Higher coverage due to the cost of treatment

Tax Benefits of Mediclaim Under Section 80D

When tax season arrives, your mediclaim premium can do more than protect your health. Under Section 80D mediclaim benefits, what you pay toward your mediclaim policy coverage also reduces your taxable income. It may not feel significant on a regular day. But mediclaim tax benefits add up when it actually counts.
Here are the likely tax benefits:

Category Deduction Limit
Self, spouse, children Up to INR 25,000
Parents (below 60 years) Additional INR 25,000
Senior citizen parents Up to INR 50,000
Preventive health check-ups Included within limits

Why Choose ICICI Lombard Health Insurance

You arrive at the hospital during an emergency. Treatment begins. Then comes the pause: approval, paperwork, waiting. Nobody plans for this part. But ICICI Lombard focuses exactly here, working to reduce the gap between needing help and actually getting it.
Rather than just settling bills, ICICI Lombard health policies are built around speed, clarity, and ease. Here is how this difference shows up when it matters:

Why Choose ICICI Lombard's Mediclaim Insurance?
1

Wide cashless hospital network.

2

Faster claim approvals

3

Comprehensive coverage that goes beyond hospitalisation

4

Add-on flexibility to match your changing needs

5

Simple digital process to manage everything in one place

Buy health insurance today and stay a step ahead of the unexpected.

Key Features of ICICI Lombard Health Insurance Policies

When buying insurance, the real question is not about features. It is about whether the policy will actually work when you need it. That answer usually comes at the hospital, not while comparing plans.
ICICI Lombard health insurance is built around exactly this situation. They are designed for flexibility, ease, and real access, not just paperwork promises. Here is what these policies offer:

  • High sum insured options, so coverage does not fall short during major treatments

  • A wide cashless hospital network to avoid running around during emergencies

  • Lifelong renewability, so you stay covered as health risks grow with age

  • No-claim bonus that increases your coverage over time

  • Add-on flexibility to personalise your plan

  • Digital-first experience for easy policy access and claim tracking

Features of ICICI Lombard's Mediclaim Insurance

Add-on Covers Available with ICICI Lombard Health Insurance

You buy a base plan, confident that everything is covered. Then a situation comes up that sits just outside your policy. That is exactly what health insurance add-ons are for. They let you build a plan around your actual life, not a standard template.
Here are some common add-ons:

Add-on Cover What It Covers
Maternity cover Pregnancy and childbirth expenses
Critical illness cover Lump sum payout for serious illnesses
Personal accident rider Financial support in case of accidental injury
Hospital cash Daily cash allowance during hospitalisation

These are not extras for the sake of it. They turn a basic plan into something that genuinely fits your needs.

How to Buy Mediclaim or Health Insurance Online

Buying a health insurance policy no longer means agents, thick files, and long waiting periods. Your phone is all you need. You can buy a mediclaim policy online in a few straightforward steps, and your coverage is active before you know it. Just follow these simple steps:

How to Buy Mediclaim or Health Insurance?
1

Visit the ICICI Lombard website.

2

Enter your basic details

3

Choose your coverage amount, select your plan type and opt for relevant add-ons

4

Fill in medical details, if applicable.

5

Make the payment and receive the policy instantly

Documents Required to Buy Mediclaim Insurance

You do not need a thick file to get started. ICICI Lombard keeps the mediclaim documents required minimal and manageable:

  • Identity proof (Aadhaar, PAN, etc.)
  • Address proof
  • Age proof
  • Medical history (if applicable)
Documents Required to Buy Mediclaim Policy

Mediclaim Claim Process Explained

The real test of any policy is not at the time of purchase. It is at the time of the claim. The mediclaim claim process is simple and generally works like this:

  • Inform your insurer about hospitalisation
  • Choose the cashless or reimbursement route
  • Submit the required documents to the hospital or afterward
  • The claim is reviewed
  • Approval and settlement follow

Cashless vs Reimbursement Claim in Mediclaim

You are at the hospital, and treatment has started. Now comes the next question: mediclaim reimbursement claim or cashless mediclaim? Both work well, but in different ways, like:

Basis Cashless Mediclaim Mediclaim Reimbursement Claim
Payment process The insurer directly pays the hospital You pay the hospital first
Out-of-pocket expense Minimal or none (except non-covered items) Full payment upfront
Hospital requirement Must be a network hospital Any hospital (network or non-network)
Claim process Handled at the hospital with insurer approval Submit bills later for reimbursement
Speed and convenience Faster, less paperwork for you Takes time and documentation
Best suited for Planned or emergency treatment in network hospitals Situations where network hospitals are not available

Cashless offers a smoother experience when available. When it is not, reimbursement is your reliable backup.

Tips to Choose the Best Mediclaim Policy

When plans look similar in price and features, choosing feels harder than it should. Here are a few useful tips to help you find the best mediclaim policy:

  • Check if the coverage amount matches real hospital costs in your city

  • Compare premiums across plans without compromising on coverage

  • Review the hospital network for cashless treatment options

  • Read policy terms carefully to understand exclusions and waiting periods

  • Check the claim settlement record

  • Confirm there is room to upgrade the plan as your needs change

    

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FAQs on mediclaim insurance

What happens if the hospital is not part of the insurer's network?

Continue with your treatment and pay the bill upfront. File for reimbursement afterward, and your amount gets settled. It takes a little longer than cashless mediclaim, but it works.

Can I submit a mediclaim claim after being discharged from the hospital?

Yes, within the insurer's specified timeline. Keep all bills and documents ready before filing.

Is a hernia covered in mediclaim?

Yes, usually. Most policies include a waiting period of 1 to 2 years. Once that period is over, hernia treatment costs are covered.

Is miscarriage covered in mediclaim?

Coverage varies across plans. Check the maternity-related terms carefully before buying.

Is surgery covered in mediclaim insurance?

Yes. Surgeries requiring hospitalisation are generally covered, provided they are medically necessary and within policy terms.

Does a mediclaim policy cover pre-existing diseases (PED)?

Yes, after the waiting period of 1 to 3 years. Once it ends, pre-existing disease coverage kicks in.

Does mediclaim cover COVID-19 expenses?

Yes. Most mediclaim policies now cover COVID-19 hospitalisation and related expenses, treating it like any other illness.

Does mediclaim cover maternity expenses?

Not always by default. An add-on can be purchased, but plan ahead as waiting periods apply.

Does mediclaim cover dental treatment?

Only when dental treatment is needed due to an accident or injury. Routine procedures are usually excluded.

Is OPD treatment covered in a mediclaim policy?

Standard policies focus on hospitalisation. An OPD add-on can be purchased separately to cover doctor visits, medicines, and minor treatments.

Are diagnostic tests covered under mediclaim insurance?

Mostly when linked to hospitalisation. Tests done before and after admission are usually covered. Standalone diagnostics are generally not included.

Is mediclaim the same as health insurance?

No. Mediclaim primarily covers hospitalisation, while health insurance offers broader coverage, including pre-and post-hospitalisation expenses.

Which is better: mediclaim or comprehensive health insurance?

It depends on your needs. Comprehensive health insurance offers wider coverage. Mediclaim works for those who need basic hospitalisation protection.

Can I port my mediclaim policy to another provider?

Yes, at the time of renewal. Waiting period benefits are usually carried forward during porting.

Can I get a refund if I cancel my mediclaim policy?

If you cancel within the insurer's specified window and have not made any claims, you can get a refund.

Can I add family members to an existing mediclaim policy?

Yes, usually at renewal. Some insurers also allow mid-term additions.

Can senior citizens buy a mediclaim policy?

Yes. There are plans designed specifically for senior citizens, though premiums are generally higher.

Can I increase the sum insured at renewal?

Yes. Renewal is the right time to increase the sum insured, especially when medical costs or your coverage needs have changed.

Is there a waiting period in mediclaim policies?

Yes, for maternity, pre-existing diseases, and specific treatments. Know these timelines before buying.

How long does a mediclaim policy remain valid?

Generally, one year. Renewal before the expiry date ensures continued coverage.

What factors affect the mediclaim premium?

Age, coverage amount, health condition, and chosen add-ons all influence the mediclaim premium.

Does the premium increase with age?

Yes. Buying early helps lock in lower premium costs.

Can I pay mediclaim premiums monthly?

Some insurers offer monthly payment options, though annual payment is usually more cost-effective.

How do I find my mediclaim policy number?

Check your email confirmation, policy documents, or the insurer's website or app.

What is the minimum and maximum sum insured under a mediclaim policy?

It usually starts from INR 1 to 2 lakh and can go up to INR 50 lakh or more, depending on the insurer or your needs.

Can I buy a mediclaim policy for my parents?

Yes. Several plans are available specifically for parents and senior citizen family members.

How do I check my mediclaim policy status online?

Log in to the insurer's app or website using your mobile number. Policy status is available anytime.

Can I buy mediclaim insurance online in India?

Yes. Buying mediclaim insurance online is the most convenient route. Compare plans, choose coverage, and get the policy without paperwork or waiting.

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