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Mediclaim

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Mediclaim under health insurance

A mediclaim policy is designed to take care of your hospital bills so that a medical emergency doesn’t drain your savings. With a mediclaim plan, your treatment expenses are covered during hospitalisation. It ensures that money is never a barrier to getting the right care. Even though people often use health insurance and mediclaim policy interchangeably, they aren’t the same. While mediclaim covers only hospitalisation expenses, a health insurance policy offers coverage that goes beyond basic hospitalisation.

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 family 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?

Given below are various ways through which a mediclaim insurance policy under health insurance can help you:

Covers hospital bills

Medical treatments can drain your finances quickly. A mediclaim policy helps cover major expenses such as hospital stays, surgeries, doctor consultations and medicines. With a mediclaim insurance policy, you don’t have to dip into your savings each time a medical need arises.

Cashless treatment

Most mediclaim insurance plans allow cashless treatment at network hospitals. This means the insurer directly settles the bills with the hospital. It’s simple and quite helpful during urgent situations.

Peace of mind

Having a reliable mediclaim policy gives you a sense of security. In a medical emergency, you can focus on getting better instead of stressing over how to manage the expenses. Knowing you’re financially protected offers peace of mind.

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

Here are the differences between them on various aspects:

Aspect Mediclaim Health insurance
Coverage A mediclaim insurance policy mainly takes care of hospitalisation expenses Health insurance provides wider protection. It can cover hospitalisation, pre- and post-hospitalisation expenses, day-care procedures, annual health check-ups, and more.
Sum Insured A mediclaim policy typically comes with a lower sum insured. It’s meant for basic medical needs. Health insurance generally offers a higher sum insured. You can also increase it over time based on changing needs.
Add-on covers Generally, mediclaim plans do not offer add-ons or extra covers. Health insurance policies allow you to choose from a range of add-ons by paying an additional premium.
Premium Premiums for mediclaim insurance are usually lower as coverage is limited to hospitalisation. Premiums are higher as health insurance offers broader and more comprehensive protection.
Customisation Since a mediclaim insurance policy focuses only on hospital-related costs, there is limited room for customisation. Health insurance provides greater flexibility. You can tailor the plan as per your lifestyle and medical 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 Mediclaim Insurance online?

Buying a mediclaim policy under health insurance online has several benefits, including:

  • Compare policies with ease: You can compare different mediclaim insurance options side by side and pick the one that truly fits your needs.
  • Quick and hassle-free purchase: The process of buying a mediclaim insurance policy online is straightforward. It has very little paperwork and instant confirmation.
  • Save more: Many insurers offer special discounts when you purchase your mediclaim insurance online. This can help you get good coverage at a lower price.

How to file a claim under mediclaim insurance?

You can easily file a claim under your mediclaim policy by following a few simple steps:

  • First, inform your insurance provider as soon as a medical emergency or hospitalisation occurs

  • Next, submit the claim form along with all required documents such as hospital bills, medical reports and the doctor’s prescriptions, among others

  • Once your mediclaim insurance policy details are verified, the insurer will process and settle the claim as per the terms and conditions of your mediclaim.

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 mediclaim policy under health insurance is generally 18 years. Depending on the insurer, the upper age limit for a mediclaim insurance policy can go beyond 60 years.                                        

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 under a mediclaim policy lets you receive treatment at any network hospital without paying anything upfront. The hospital bills are settled directly by the mediclaim insurance provider. Therefore, you don’t have to rush around arranging money in a medical emergency.

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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