Assured Wealth Insurance Marketing Pvt Ltd

Mediclaim Insurance

Introduction

Medical emergencies can strike anyone anytime, anywhere. No matter how hard you try, you can neither prevent nor predict them. The only thing you can do is stay prepared for them. This is where health insurance plans or medical insurance plans come to the rescue.

What is health insurance or mediclaim?

Health insurance protects you from expenses that may arise out of sickness or surgery. Health insurance policies can be taken in an individual’s name or for the family as a whole.

Health insurance plans in India offer two options: cashless and reimbursement. In cashless, the insurance company has a list of network hospitals. If a patient goes to any hospital that is on this list, he can avail of hospitalisation without having to pay cash. Under a reimbursement plan, the patient informs the company of a planned or emergency hospitalization. On submission of all relevant documents, the patient is reimbursed the actual expenses.

For all kinds of Medical insurance plans, you get tax exemption for the premium amount as defined under section 80D of Income Tax Act.

Why are health insurance plans necessary for everyone?

The growing number of lifestyle diseases and the rising cost of healthcare has made it necessary to have health insurance plans. A majority of the salaried class in India does have a health cover provided by the company that they work for. However, more often than not, this turns out to be insufficient. Therefore, it is important to buy a personal health insurance policy based on your requirements.

 

Benefits of buying a mediclaim policy

You must know by now that buying a mediclaim policy provides tremendous financial assistance to a family in case of medical emergencies. In simple words, Mediclaim policies cover all the hospitalization charges of individuals to provide relief to a family at unfortunate events. Considering the current situation of pandemic and rising prices, investing in an insurance policy seems quite fair. 

Below is a list of benefits that you can get on buying a mediclaim policy. Take a look: 

  • Brilliant Cashless Facilities: This is available in each of the networked hospitals of the insurance company. It cuts down all the unpredictable expenses in terms of unfortunate events. 
  • Dual Cover: Herein, both policies including family floater and individual cover are available. 
  • Highly Affordable: Investing in a mediclaim policy is a cost-effective approach to avail of extensive healthcare services without shattering your savings. 
  • Lifelong Renewal Facility: Insured individuals obtain a comprehensive and lifelong renewability option on buying a mediclaim policy as per the chosen policy. 
  • Cover Hospitalization Expenses: Individuals that opt for mediclaim policy receive hospital expense (in-patient) coverage like doctor’s fee, OT charges, medicine cost, nursing charge, etc. 
  • Eliminates Financial Contingencies: Purchasing a mediclaim policy reduces the financial burden of a family during unforeseen medical emergencies. 
  • Tax Exemption Benefits: Under Section 80D, policyholders receive tax benefits on the policy premium each year. 
  • Other Benefits: Mediclaim policy tags a pool of additional benefits with it like room rent, ICU charges, etc. 

Mediclaim vs. Health Insurance

Although often spoken about in the same breath, there are major differences between health insurance plans and Mediclaim insurance plans.

Mediclaim

Health Insurance

An indemnity product that compensates the policy holder for the actual costs incurred for treatment limited by the sum assured

A benefit product which provides a lump sum amount to the insured as laid down in the policy

It covers only the costs of hospitalisation

Along with hospitalisation costs, it also covers pre and post hospitalisation expenses, ambulance charges, reimbursement for lost income, etc.

Hospitalisation is mandatory

Hospitalisation is not required, especially in critical illness cases

The upper limit of the cover usually does not exceed Rs 5 lakh

The upper limit can be close to Rs 60 lakh

More than one claim can be made till the sum assured amount is reached

Limited to a single claim. A lump sum is paid only once.

Compare and buy the best mediclaim and save upto 60,000/-

Why buy health insurance?

Reasons you should buy Health Insurance

  • Offers protection in times of need.
  • Provides tax benefits, daily cash allowance, etc.
  • Gives the policyholder the benefit of cashless hospitalisation.
  • Enables one to avail of the best possible treatment.

Points to consider before buying Mediclaim or Health Insurance.

  • Opt for health insurance at an early age – The premiums are lower if you start off early.
  • Check the premium amount that needs to be paid. However, remember that higher premium does not necessarily mean that the policy is better.
  • Read the fine print carefully. This will help you understand what is covered in the policy and what is not. It will also explain the process of claims and reimbursements, waiting period, tax deductions, etc.
  • Assess your lifestyle and requirements before buying a policy.
  • Last but not the least, clarify every single doubt, no matter how silly and insignificant it might seem.

What is covered in a mediclaim policy?

Mediclaim policy offers comprehensive coverage for a list of hospital expenses. Below is a list of services that the mediclaim policy offers. 

  1. Hospitalization Costs: This covers a range of expenses and charges that occurred during patient hospitalization. To name a few, mediclaim policy covers expenses incurred on:
    • OT charges 
    • Blood 
    • Diagnostic processes 
    • Oxygen 
    • Chemotherapy 
    • X-ray 
    • Medicine 
    • Donor expenses 
    • Radiotherapy 
    • Pacemakers 
    • Sickness 
    • Accidental hospitalization
  2. Medical Room Costs: All charges incurred in intensive care units (ICU) and regular wards are compensated under the policy. However, note that this cashless hospitalization takes place at network hospitals only. 
  3. Medical Professional’s Fee: This involves fees charged by all medical professionals. The insurance policy provides compensation for doctors, anesthetists, surgeons, nurses, etc. 

What is not covered in a mediclaim policy?

Like every policy, the mediclaim policy has a set of exclusions too. Below is a list of limitations or circumstances wherein you can expect your claim to be considered null. 

  • Addiction to drugs and alcohol 
  • Pre-existing ailment until the completion of the waiting period 
  • Critical illness or medical conditions that are treated within 30 days of the commencing date of the policy 
  • Certain ailments like joint replacement surgeries are excluded for 2-4 years under the terms of the policy 
  • Suicide cases 
  • HIV AIDS 
  • Hormonal treatment
  • Birth control 
  • Congenital anomaly 
  • Expenses occurring on dental surgeries (unless the surgery calls for hospitalization) 
  • Complications during ectopic pregnancy 
  • Childbirth 

Note: To get complete knowledge on the list of exclusions, ensure reading the policy documents carefully.

Factors to consider while buying a mediclaim policy

Before buying a mediclaim policy, there are certain factors that need utmost attention. Don’t skip on considering these factors to purchase the best policy available in the market. Have a look! 

  1. Plan Availability: There are two types of plans: Individual and Family Floater. Under individual plans, each individual gets insured for a certain amount. On the other hand, in a family floater plan, the entire family gets insured under a fixed sum. Furthermore in the case of a family floater plan, note that when the insured individual reaches an exit age or dies, the policy gets closed. Hereafter, other members of the family cannot renew the plan. However, in the case of an individual plan, the individual stays insured under the sum assured even if the policyholder reaches the exit age or dies during the policy term. 
  2. Exclusions: Under a mediclaim policy, there are certain expenses that are covered by the insurance provider and that are not covered by the insurance provider. For example, drugs, HIV, alcohol addiction, etc. are excluded from the policy. However, certain surgeries including gall bladder and kidney stones are covered under the plan. Ensure checking the exclusions of policies before buying. 
  3. Pre-existing Illness: Typically, every insurance company covers pre-existing diseases after a certain waiting period. Hence, while making a policy purchase, make sure to check on the pre-existing waiting period of the plan. 
  4. Coverage Amount: This factor needs utmost attention. While selecting a coverage amount, we recommend you to consider a range of factors including surging healthcare cost, rate of inflation, etc. In addition, if you reside in an urban city, know that the hospitalization costs will be 3x times more than rural areas. Hence, if you wish to cover your precious people in the policy, consider going for a higher sum assured. 
  5. Flexibility In Policy Renewal: Some plans are available with a lifetime renewability option. In other terms, such policies denote that you can renew your insurance policy at any age. As many policies have an age limit, these facilities help older people to renew insurance at any age. 
  6. Co-payment Facility: Several mediclaim policies tag a co-payment clause with it. Ideally, co-payment is a percentage of the sum insured that the insured individual needs to bear while raising a claim. However, this takes place before the insurance company settles the surplus amount. Note that this co payment can range anywhere from 10-30% as per the insurance provider. Make sure to check the co-payment option under the chosen policy.
  7. Network Hospitals: The ideal objective of mediclaim policy is to ease unforeseen financial expenses incurred at unusual events and hospitalizations. Bear in mind that every insurance company has a list of network hospitals wherein policyholders can avail cashless hospitalization expenses. Hence, check the list of network hospitals that the insurance company is associated with. 

Documents required while buying a mediclaim policy

While purchasing a mediclaim policy, you will need to submit the following documents:

  • Address proof: This can be anything like an Aadhar card, Driving license, passport, etc. 
  • Age proof: This includes passport/voter ID card, Aadhar card, etc. 
  • Duly filled application/ proposal form 
  • Identity proof: Driving license, Aadhar card, passport 
  • Pre-policy medical test reports 
  • 2 Passport-size photographs