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The ABCs of Mediclaim Policy

Created on 28 Feb 2023

Wraps up in 10 Min

Read by 3.6k people

Updated on 01 Mar 2023

“Health is the state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.”
-World Health Organization

Mediclaim is a type of insurance policy that covers medical expenses and related costs. It is an important form of financial protection that assists you in capturing the costs of healthcare, such as doctor consultations, hospitalisation and emergency treatments.

You can be confident that you are financially prepared for any medical situation that may arise if you have a Mediclaim policy. It is a type of health insurance policy in India that covers medical expenses incurred as a result of illness or injury. Consider the following example to better understand how Mediclaim works:

Assume Mr. Kush, a 45-year-old businessman, has a Mediclaim policy with a  ₹5 lakh sum insured. He has a heart attack one day and is hospitalised; his treatment costs 4 lakh. Mr. Kush's Mediclaim policy will cover the full cost of his hospitalisation and treatment up to the sum insured of ₹5 lakh in this case. This means he will not have to pay for his medical expenses out of pocket. However, if the costs of his hospitalisation and treatment exceed the sum insured of ₹5 lakh, he will be responsible for the difference. It is important to note that mediclaim policies have specific terms and conditions, such as exclusions and deductibles.

Section 80D of the Income Tax Act of India, 1961, provides tax benefits for medical insurance policies. A mediclaim policy provides coverage for the policyholder's medical expenses. Individuals can apply for financial assistance or claim reimbursements for their medical bills through cashless facilities. These policies are only valid for a limited time before the policyholder must renew them.

Only hospitalisation, accident-related treatment, and pre-specified medical conditions are covered by medical insurance policies and only up to a certain limit. For accidents that result in hospitalisation, there is no waiting period. Except for accidental hospitalisation, all claims are subject to a 30-day waiting period. Pre-existing diseases have a two-year waiting period. For policies with sums insured of ₹3 lakh and above, these diseases should be declared at the time of proposal and accepted by the insurer.

Difference between Mediclaim and Health Insurance

Mediclaim and health insurance are both types of insurance policies that provide coverage for medical expenses. So, are they both the same? If not, what's the difference between the two? Let’s take a look.

Mediclaim is the first thing that comes to mind when you think of health insurance. Most people believe they are interchangeable, but they are not. It's critical to understand the distinction between Mediclaim and health insurance so that you can choose the best policy for your needs and those of your family.

Both Mediclaim and health insurance are types of health insurance that offer financial protection against medical expenses. The primary distinction between them is the type of coverage they provide. Mediclaim is an indemnity-based health insurance plan. 

But wait… What is an indemnity-based health insurance plan?

A health insurance policy that reimburses the policyholder for medical expenses is known as an indemnity-based plan. In this instance, medical expenses are those that are incurred as a result of hospitalisation, medical tests, and doctor's fees. Mediclaim eligibility criteria are typically determined by the insurance provider and may differ from one insurer to the next.

In contrast, health insurance is a comprehensive plan that covers a wide range of medical expenses. It provides a variety of benefits, including pre- and post-hospitalization coverage, daycare costs, and cashless treatments. Age, pre-existing conditions, and lifestyle factors are common eligibility criteria for health insurance.

How Mediclaim Policy Helped During Pandemic

COVID-19 was a pandemic that had engulfed the entire world, with India among the worst affected. The pandemic has had a devastating impact on the lives of millions of people in India, as well as on the economy. In such dire circumstances, Mediclaim has stepped in to assist many individuals and families who have been adversely affected by the pandemic.

During the COVID-19 pandemic, Mediclaim was a lifeline for many people. It has enabled them to receive medical care without fear of financial hardship, and it has also provided financial assistance to cover medical expenses. It has enabled many people to gain access to high-quality healthcare services, which has benefited those with pre-existing conditions. During this pandemic, Mediclaim has undoubtedly been of great assistance to the people of India.

Medicine has been a great source of relief for many people in India. It has enabled them to obtain medical services without fear of financial hardship. According to an Insurance Regulatory and Development Authority (IRDA) report, the number of medical insurance policies has increased significantly in the last year. This demonstrates that an increasing number of people are using Mediclaim to protect themselves in the event of a medical emergency.

Mediclaim has also provided people with access to private healthcare services, which are frequently far superior to public healthcare services. This has enabled many people to obtain high-quality medical care that they would not have been able to afford otherwise. Furthermore, Mediclaim policies frequently cover pre-existing conditions, which is advantageous for those who have such conditions.

Process to apply online for Mediclaim

Health insurance is clearly the most underutilised insurance policy in India, with only about 18% of the urban population being covered by any type of health insurance scheme. However, regardless of age, having the appropriate health insurance plan in place is a requirement given the ongoing rise in medical costs and health disorders.

Online insurance policy buying has numerous advantages. Your best bet is to buy health insurance online if you want to reduce your premiums or compare features before you buy. Since it is ultimately your hard-earned money, why not maximise the advantages by making an online purchase?

Here is how you should proceed if you plan to purchase health insurance online. However, everyone, regardless of age, needs to have the right health insurance plan in place due to the ongoing rise in medical costs and health disorders. If you are buying online, here are the steps one may consider to apply online:

1. Determining your needs is the first step in purchasing insurance, whether individual or family health insurance. Find a health plan that will protect you against a wide range of medical needs, such as hospitalisation, critical illnesses that you may be predisposed to due to your family's medical history, and so on. When purchasing family health insurance, make sure that the plan meets the needs of each member of your family. The best part about buying online is that you can compare plans while you're shopping, so do your research, and you'll easily find the best plan that meets your needs.

2. Understanding your needs and budgeting accordingly is another critical factor. You can take a glance into a low-cost health plan, but keep in mind that the benefits will be reduced. If you purchase a low-cost health plan that does not adequately cover your health-care needs, the entire purpose of purchasing health insurance is defeated. As a result, when creating a budget, consider the big picture and keep both premiums and policy coverage in mind.

3. Decide which company you want to use for your mediclaim insurance. Once you've decided on a company, go to their website and look for the Mediclaim application form. Depending on the company, you may be able to access the form online or download it from their website.

4. Once you have the form, fill in your personal information, such as your name, address, and contact information. You will also be asked to provide information about your medical history, the medical history of your family, and any current medical conditions. After completing the form, you may be required to submit it along with supporting documents such as medical reports or bills. Make sure you read through the form carefully to ensure that you fill out all of the necessary information accurately and completely

5. The insurance company will process your mediclaim application after you submit the form and documents. They will examine your application and determine whether you are eligible for Mediclaim. If your application is approved, you will be notified via email or letter, and you will be able to begin using your Mediclaim insurance.

What is Cashless Mediclaim?

Cashless medical insurance is an insurance policy that allows you to receive medical services without paying out of pocket. An arrangement between the insurer and the hospital wherein the hospital agrees to provide medical services to the insured person without any upfront payment from the insured person.

The insured must notify the insurer in advance of the medical services that he or she intends to use. The insurer will then verify the eligibility of the insured person for the medical services, and then, based on the outcome of the verification process, the insurer will make arrangements with the hospital to provide the services to the insured person without any upfront payment.

Mediclaim Policies for Family & Senior Citizen

1. Aditya Birla Activ Health + Multiply Fit Combo
Sum insured- ₹2 lakh to ₹2 crore
Networked Hospitals- 10,000+
A comprehensive four-in-one health insurance plan, the Aditya Birla Activ Health + Multiply Fit Combo focuses on providing the benefits of health insurance coverage as well as fitness, wellness, and rewards. Your insurance needs are met by this modern plan, which also provides wellness points and cashback discounts. The company's digitally enabled wellness ecosystem incentivizes users to adopt good habits.
2. Niva Bupa Health Pulse Policy
Sum insured- ₹3 lakh to ₹25 lakh
Networked hospitals- 8600+
The insured receives coverage from ₹3 lakh to ₹25 lakh at reasonable rates under this low-cost and budget-friendly health insurance plan. There are two distinct versions of the policy: classic and enhanced.
The classic plan provides a cover of upto ₹10 lakh, and refill benefits upto 100% of the base sum. The enhanced plan provides a cover of upto ₹25 lakh, and refill benefits upto 150% of the base sum
3. ICICI Lombard- Complete Health Insurance Policy
Sum insured- ₹1 lakh to ₹50 lakh
Networked hospitals- 6500+
The ICICI Lombard Complete Health Insurance plan is a comprehensive health insurance policy for an individual and a family that gives the insured the freedom to select the sum insured amount from a variety of options based on their medical needs. The policy offers various sub-plans that one can choose from based on their needs.
4. STAR Health’s Senior Citizens Red Carpet Health Policy
Sum insured- ₹1 lakh to ₹25 lakh
Networked hospitals- 12000+
Senior citizens 60 years of age and older are the target demographic for this policy. Most health insurance policies have a maximum age range of 65, but the Star Health Red Carpet plan guarantees coverage past this age bracket. This plan has a policy tenure of one, two, or three years and is offered as a family and individual floater. Before purchasing this policy, there is no prerequisite medical examination required.
5. Reliance Health Gain Policy:
Sum insured- Up to ₹3 crore
Networked hospitals- 8600+
The Reliance Health Gain Policy gives the policyholder the greatest amount of freedom to select their own coverage and benefits from a variety of options in accordance with their needs and requirements. Plus, Power, and Prime are the three additional plans that make up the policy. Additionally, this policy is perfect for senior citizens who occasionally lack a medical policy due to their high age brackets because there is no age restriction for an insured amount up to ₹3 lakh. Additionally, it offers protection for up to 12 family members under a single-family floater policy.

Medical Renewal Process

Mediclaim renewal is the process of continuing your existing Mediclaim policy for another year. It is important to renew your policy every year in order to continue to enjoy the benefits of a Mediclaim policy. The renewal process is simple and straightforward.

  • First, you will need to contact your insurance provider to review the terms and conditions of your policy.
  • You will then need to fill out a renewal form, providing information such as your contact details, policy details, and the payment information.
  • Once you have provided all the necessary information, the insurance provider will assess the renewal request and confirm the policy’s renewal.

For example, if you are renewing a Mediclaim policy with XYZ Insurance, you will need to fill out the renewal form provided by the company, which will require you to provide your name, address, phone number, policy details, and the payment information. Once this is done, the company will assess the renewal request and, if approved, will confirm the policy’s renewal.

Claim and Reimbursement Process

The reimbursement claim process for a Mediclaim policy in India:
1. Inform the insurer: The insured should let the insurer know about any hospitalisations or medical care they've had. In the event of an emergency hospitalisation or a planned hospitalisation, the insurer should be notified within 24 hours or 48 hours respectively.

2. Documents to be submitted: The insured must send the insurer a completed claim form along with all required paperwork, such as the original invoices, prescriptions, and discharge summary. The insurer will examine the supporting documentation and decide whether the claim is admissible.

3. Claim assessment: The insurer will evaluate the claim by confirming the legitimacy of the supporting documentation and medical bills. If necessary, the insurer may also carry out a medical examination.

4. Claim approval: If the insurer grants the claim, the insured will get their money back within a certain time frame.

The Bottom Line

Today, whenever we purchase vehicles or any other equipment, we purchase insurance coverage with it. Then why not insure our primary equipment, which has always been with us from our birth until our death? We always give the least priority to taking out insurance for our health.

So, now that you understand what a mediclaim policy is, you can decide whether to proceed or not. If you have to go ahead, then which would be the best suited policy for you?
There are several mediclaim policies that can be considered. However, this article is not recommending any particular policy; we are trying to give the details of some of the mediclaim policies. Before purchasing a Mediclaim policy, it is also advisable to read the policy document carefully and comprehend the claim procedure.

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Shivam Vallecha

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Shivam is a PGPM student at ICFAI Business School Pune. He participates actively in social activities and believes that people should be the change rather than just seeking it. The majority of his time is spent reading, but he also enjoys binge watching. His belief is that people must dream big and work hard in order to grow each day and achieve their dreams. 

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