What is Mediclaim?

 

What is Mediclaim?

if this is one of the questions that is keeping you from getting comprehensive financial security for your health, then we are here to help you out! Let’s understand what is Mediclaim policy in detail so you can make the right choices for your family’s well-being. 

What is Mediclaim Policy?

A common area of confusion for most people is the difference between health insurance and Mediclaim, often mistaking one for the other. Even though both offer financial protection during emergencies, Mediclaim is not just another word for health insurance.

A Mediclaim policy is a sort of health insurance policy in which the insurer reimburses the policyholder for medical expenses incurred in treating their medical condition. If you have a medical insurance policy, you can submit your bills to the insurance company for payment. Alternatively, you can opt for the cashless treatment option which makes the insurance company and hospital administrator responsible to settle the medical bills. 

How Does Mediclaim Insurance Work? 

Mediclaim insurance is designed to provide policyholders with financial backup during medical emergencies. To understand what is medicalim policy and how it works, you need to know the following things about it:

  • Provides Coverage - It covers the cost of hospitalization due to accident, surgery, or critical illness throughout the policy period.
  • Premium Payments - Like all other forms of health insurance, you must routinely pay a premium amount to avail the benefits of Mediclaim.  
  • Renewal Terms - However, Mediclaim comes with a pre-specified insurance cover, and you need to renew the policy at the end of every term to keep enjoying the perks.
  • Settlement Options - As per your preference, you can either opt for Mediclaim offering cashless hospitalization or reimbursement settlement. Cashless hospitalization Mediclaim is much more convenient as the bills are settled by the insurance provider directly with the hospital. Whereas the reimbursement method requires you to settle the expenses from your own pocket, and the total amount is then reimbursed by the insurer. 

Mediclaim Insurance Vs Health Insurance 

After addressing some basic questions like what is Mediclaim? And how does Mediclaim work? It is now time to understand the distinction between health insurance and Mediclaim insurance. Even though Mediclaim sounds a lot like health insurance, there are some major differences between the two. Here are some key pointers that will help you understand the dissimilarities between Mediclaim and health insurance: 

Criterion

Health Insurance

Mediclaim

Coverage Level

Health insurance is comprehensive and covers several medical expenses, including hospitalization.

Mediclaim typically only covers hospitalization-related costs.

Inclusions

The coverage offered under health insurance extends to pre & post-hospitalization costs, daycare treatments, ambulance charges, domiciliary care, AYUSH treatments, and more.

 

In contrast, Mediclaim insurance pays/reimburses bills incurred during hospitalization, be it due to an accident, chronic illness, or surgery

Cover Amount

Health insurance cover can go up to crores of rupees if required

In Mediclaim, the coverage amount is limited based on the plan you opt for.

Add-ons

Numerous add-ons can be included with health insurance such as critical illness cover, disability cover, maternity cover etc.

Mediclaim, generally does nothave add-ons.

  • Health insurance comes with a plethora of add-on covers such as maternity benefits, critical illness cover, and COVID care. However, Mediclaim may not offer the same. Instead, there are certain benefits like room rent modification and reduction in waiting period that you can avail. 
  • A health insurance plan can be customized or personalized as per the policyholder’s medical requirements, making them quite flexible. On the other hand, Mediclaim has no flexibility but can still be beneficial.

Now that we have the question ‘What is Mediclaim policy?’ out of the way let’s shift the focus to the specifics of Mediclaim, starting with its types. 

  • Health insurance comes with a plethora of add-on covers such as maternity benefits, critical illness cover, and COVID care. However, Mediclaim may not offer the same. Instead, there are certain benefits like room rent modification and reduction in waiting period that you can avail. 
  • A health insurance plan can be customized or personalized as per the policyholder’s medical requirements, making them quite flexible. On the other hand, Mediclaim has no flexibility but can still be beneficial.

Now that we have the question ‘What is Mediclaim policy?’ out of the way let’s shift the focus to the specifics of Mediclaim, starting with its types. 

 

The Types of Mediclaim Policies 

Many people are often under the impression that there is only one type of Mediclaim policy, but it has several variations. Keep on reading to know more about the most popular Mediclaim policies available to policy buyers.

1. Individual Mediclaim 

An individual Mediclaim plan covers expenses borne by the policyholder during hospitalization. As the name suggests, it only provides coverage to the insured. Individual Mediclaim is best suited for those living alone or without any dependents.  

2.  Family Floater Mediclaim 

Family floater Mediclaim is basically the same as an individual policy. However, besides the policyholder, family plans also offer coverage to the policyholder’s spouse, children, and parents. It is an excellent option for anyone wanting to secure their immediate family under one premium.

3. Senior Citizen Plans 

A senior citizen Mediclaim plan is designed to cater to the medical needs of people above the age of 60 years. It specifically covers expenses for age-related diseases and illnesses, which are not included in basic Mediclaim policies. You can get a senior citizen plan for your parents, in-laws, or anyone who has crossed the age of 60 in your family.

4. Critical Illness Mediclaim 

It is not news that treatments for chronic ailments like cancer, cardiovascular diseases, and kidney failure can take a financial toll on you, which is why investing in critical illness Mediclaim is a smart choice. These policies offer cover for medical expenses, including hospitalization and treatments for serious conditions.  

5. Personal Accident Policy 

Personal accident Mediclaim policies provide medical cover against partial disability, total disability, and accidental death. Although it is not a must-have plan, personal accident Mediclaim further secures you and your loved ones’ future. 

Features of Mediclaim Policies 

If you are new to the concept of Mediclaim, the first few things that must have popped in your head would have been: What is Mediclaim policy? How is it different from health insurance? And what are its types? Although we have answered all these questions, we haven’t yet covered the features of Mediclaim. 

While the features of each Mediclaim policy vary based on the insurance provider, here are some common ones that can be found in most plans:

Cashless Settlement

If you have ever wondered ‘what is cashless Mediclaim’, you are about to find out. By investing in Mediclaim, you can reap the benefits of cashless settlements. Under cashless Mediclaim, the bills and included medical expenses are paid directly to the hospital by the insurance provider. This way, you don’t have to pay anything out of your pocket. 

Tax Returns

Whether you buy health insurance or Mediclaim insurance, you are eligible to enjoy certain tax benefits with Mediclaim 80D section of the Income Tax Act, you can claim deductions up to rupees 25,000 on your income tax amount for premiums paid towards insurance plans. Moreover, seniors citizens can avail up to rupees 50,000 for the same.

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If you have ever wondered ‘what is cashless Mediclaim’, you are about to find out. By investing in Mediclaim, you can reap the benefits of cashless settlements. Under cashless Mediclaim, the bills and included medical expenses are paid directly to the hospital by the insurance provider. This way, you don’t have to pay anything out of your pocket. 

Tax Returns 

Whether you buy health insurance or Mediclaim insurance, you are eligible to enjoy certain tax benefits with Mediclaim 80D section of the Income Tax Act, you can claim deductions up to rupees 25,000 on your income tax amount for premiums paid towards insurance plans. Moreover, seniors citizens can avail up to rupees 50,000 for the same.

Abundant Policy Choices

When it comes to the number of policy choices, Mediclaim falls in line with health insurance plans. You can buy plans for yourself, your spouse, children, or your parents at pocket-friendly premiums. Furthermore, with Mediclaim, you get access to specific policies like those catering to people suffering from critical illnesses and even senior citizens.

Financial Protection

We all know that life is uncertain, but there is no way we can escape what it throws our way. But the least we can do is safeguard our future, especially against medical emergencies, and there is no better way to do so than by purchasing Mediclaim. If nothing more, it can protect you from financial losses and debt.

Inclusions In Mediclaim

The inclusions can slightly differ depending on the type of Mediclaim and the insurance provider. However, here are the general inclusions of a Mediclaim policy:

  • In-Patient Hospitalization – It covers the expenses incurred in case the insured person is hospitalized for 24 hours or more.
  • Day Care Treatment – Treatments that do not require hospitalization will also be covered under the Mediclaim policy.
  • Pre-And Post-Hospitalization Cover - Medical expenses incurred prior to being admitted to the hospital and after being released from the hospital are covered.
  • Domiciliary Hospitalization - Domiciliary treatment is treatment provided at home due to a lack of hospital beds or when the insured is unable to be transferred to a hospital.
  • Annual Health Check-Ups - Almost all health insurance policies cover free preventative health screenings once every one to four claim-free policy years.
  • No Claim Bonus – For every year that goes by without the policy being claimed, the insured person is given a bonus in the following policy year. 

Who Should Buy? 

Anyone who wishes to secure the future for themselves and their family members against health problems should consider buying a Mediclaim policy. Regardless of your marital status or life stage, it is crucial to protect yourself against the rising costs of healthcare. Hence, having a sound financial support system for such expenses can prove immensely helpful.

Why Mediclaim? 

It is not news to anyone that we are surrounded by an increasing number of lifestyle diseases. Moreover, considering the hospitalisation costs and general inflation, it is in your best interest to understand what is Mediclaim an how it can help you

Here are some reasons you should consider it:

  • It provides a financial safety net in the event of a medical emergency.
  • A cashless hospitalisation facility is available which makes it more convenient for you to get healthcare during a medical emergency. Hospitalization costs are managed by the insurance company.
  • It is an affordable method of receiving healthcare services and reduces the budgetary burden
  • Most importantly, it gives you peace of mind that you will be able to meet the costs and receive quality healthcare.
  • Individual and family floater mediclaim insurance are available so you can choose whichever fits your financial and health needs.
  • Premiums paid for a medical insurance coverage are eligible for tax benefits.

How to Choose the Right Mediclaim Policy? 

Now that you know what is Mediclaim policy, let’s talk about how you can find the right policy. Although there is no formula to finding the best Mediclaim policy, the first step should be to assess your needs. Or if you are buying Mediclaim for family, evaluate their medical requirements, post which you can consider the following factors to make an informed decision: 

  • Adequate Cover - Choose an adequate sum insured/coverage amount when you are buying Mediclaim for family. This is crucial because you do not want to end up with insufficient cover in the face of a medical emergency. 
  • Co-Payment Clause - Check the co-payment clause, as you might be required to pay a share of the amount while claiming the Mediclaim policy. Sometimes, policyholders are caught by surprise by this clause which can result in disappointment. Be sure to read the policy document carefully to avoid such a circumstance.
  • Compare Plans – Like any policybuyer, you would want to select plans offering maximum benefits at affordable rates· Comparing different Mediclaim policies will give you in-depth information about the benefits and a clearer idea of your requirements as well. Go for policies with no waiting period, especially if buying Mediclaim to treat a critical illness. 

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  • Co-Payment Clause - Check the co-payment clause, as you might be required to pay a share of the amount while claiming the Mediclaim policy. Sometimes, policyholders are caught by surprise by this clause which can result in disappointment. Be sure to read the policy document carefully to avoid such a circumstance.
  • Compare Plans – Like any policybuyer, you would want to select plans offering maximum benefits at affordable rates· Comparing different Mediclaim policies will give you in-depth information about the benefits and a clearer idea of your requirements as well. Go for policies with no waiting period, especially if buying Mediclaim to treat a critical illness.

  • Check Network Hospitals - It is best to invest in Mediclaim with a wide hospital network and the option of cashless payment.This will help you get the necessary healthcare in any part of the country without worrying about the cost.
  • Even though Mediclaim policies typically do not come with add-on covers, if you can find a plan that does, purchase it.
  • If possible, buy Mediclaim offering long-term or lifetime renewability, as renewing the policy every year can get hectic.
  • Lastly, always check the exclusions, limits, and sub-limits.

Once you have understand what is Mediclaim insurance and its importance, buying Mediclaim can be the best decision that you make for yourself or your family.But it is important to keep everything we’ve discussed above in mind. Also, it is crucial to carefully read the terms & conditions along with the policy wordings before investing.

Frequently Asked Questions (FAQs)

1. What are the Eligibility Criteria for Mediclaim?

Typically, the minimum entry age for a Mediclaim policy is 18 years, and the exit age is 65 years. However, some insurance companies do offer plans to children as young as five years old. Similarly, few Mediclaim policies come with the option of lifetime renewability.

2. What is the Co-Payment Clause in Mediclaim Insurance?  

As per the co-payment clause, you are required to pay a share of the medical expenses you wish to claim during the policy period. This can either be a percentage (ranging between 10 to 30%) or a fixed sum already mentioned in the clause.

3. Which Documents are Required at the Time of Claim?

Most Mediclaim/insurance providers require policyholders to submit three main documents at the time of claim, which is – Identification proof, a health or medical card provided by the insurer, and the bills & receipts you wish to be reimbursed for.

4. Do Mediclaim Policies Offer Countrywide Coverage?

Mediclaim policies can usually be claimed across India unless specified otherwise. However, this is something you must check with your insurance provider before making the purchase to avoid any last-minute confusion.

5. Can You Buy Mediclaim Online?

Yes, policy buyers can buy Mediclaim online by visiting any insurance provider’s website. It is not only easy and convenient but also completely safe. However, make sure you don’t skip out on any important details or terms.

 

Sources:

https://www.policyholder.gov.in/uploads/CEDocuments/Guidelines%20on%20Standardization%20in%20Health%20Insurance%202016.pdf

https://www.incometaxindia.gov.in/Pages/tools/deduction-under-section-80d.aspx

ARN No : Sept22/Bg/14A