What Is Mediclaim Policy?

Mediclaim policy is a type of health insurance policy in which an insurance company reimburses the expenses incurred by the policyholder for the treatment due to his medical condition.

If you have purchased a Mediclaim policy from an insurance company, then you can claim for reimbursement by submitting the bill of your hospital expenses to the insurance company. If you have opted for cashless mode of treatment, your bills are paid directly to the hospital by the insurance company. However, to avail the cashless facility, you will have to get treated in one of the network hospitals of the insurance company.

One of the main features of Mediclaim Policy is that it is valid for a limited period. If you want to continue to get the benefits of the Mediclaim policy, you are required to renew your Mediclaim policy after the expiry of its term.

Features Of Mediclaim Policy

• Benefit of cashless facility in network hospitals
• Mediclaim is available for both individual and family.
• Tax benefit on annual premium .

How Many Types Of Mediclaim Policies Are There ?

There are different types of Mediclaim policies available in the insurance market today. You can choose any of these Mediclaim policies as per your requirement. Now we will know in detail about the types of Medical Mediclaim Policy.

1. Personal Policy –

An individual mediclaim policy is for an individual only. In this only the named person can avail the benefits listed under the policy.

2. Family Floater Policy –

A family floater policy provides insurance coverage to an individual who can extend it to his entire family as per his convenience and requirement.

3. Senior Citizen Policy –

Senior citizen policy is generally designed for people who are above 60 years of age. This policy covers the hospitalization expenses of senior citizens.

4. Critical Illness Mediclaim –

A critical illness policy protects you against hospital expenses in case of a life-threatening illness like cancer, kidney failure, heart disease, etc. In this policy, a lump sum amount is paid by the insurance company on the diagnosis of the disease.

5. Mos-Bite Protector Policy –

In this type of policy, if the policyholder is suffering from any vector-borne disease such as malaria, dengue fever, chikungunya, and Zika virus, then the treatment expenses for the same are covered.

6. Personal Accident Policy –

A personal accident policy serves to provide financial protection to the policyholder in the event of accidental death, permanent total disability or partial disability.

What Is Included In Mediclaim Policy ?

1. Hospital Fees –

A Mediclaim policy covers all the charges that are incurred during hospitalization. Like- oxygen cylinder, blood, organ donor expenses, room charges, organ donation, tests etc.

2. Day Care Treatment –

If the treatment does not require hospitalization and the patient is released within 24 hours, then it is covered under the Mediclaim policy.

3. Before and after hospitalization –

A mediclaim policy also covers pre and post hospitalization expenses as there are a lot of medical expenses before and after hospitalization which are covered in a mediclaim policy.

4. Hospital Stay –

Any kind of medical cost incurred during the hospital stay such as bed charges, private room, ward, ICU etc. is covered.

5. Consultation Fee / Doctor Fee –

The mediclaim policy also covers the doctor’s consultation fees or the fees paid for advice taken by a specialist.

Exclusions In Mediclaim Policy

• Pre – existing diseases will not be covered
• Plastic surgery and cosmetic surgery
• External devices ( such as hearing aids or contact lenses.)

How To Choose Mediclaim Insurance Policy ?

Currently, there are many types of Mediclaim insurance plans available in the insurance market. You can choose any one of these insurance plans as per your requirement. Each plan available in the market offers you a different range of features and benefits. Choosing the right policy out of these can be quite difficult. Therefore, to provide you with a solution to this problem, here we are going to throw light on some of the important points which will help you in buying a suitable Mediclaim insurance policy.

1. Wide network of cashless hospitals :

Before buying a Mediclaim insurance policy from any insurance company, it is necessary to know about their network of cashless hospitals.

Through the network of cashless hospitals, you can pay your medical bills directly to the hospitals through the insurance company. However, it is necessary that you have to get your treatment done in the network of cashless hospitals of the insurance company. Hence, by taking a Mediclaim policy from an insurance company that provides a wide network of cashless hospitals, your medical cost claims are settled immediately by the insurance company by paying the hospital bills.

2. Claim Settlement Ratio:

Before taking a Mediclaim insurance policy from an insurance company, you must check its claim settlement ratio. A claim settlement ratio is the percentage of claims that an insurance company is able to successfully settle out of the total claims it receives in a year. Hence, you should go with an insurance company whose claim settlement is high while taking a Mediclaim insurance policy. With this, you can be sure that in case of a claim, your claims will be settled in your favor.

3. Limits and Capping:

Many insurance companies impose various limits and capping in their Mediclaim insurance policies. The hospital bill in the hospital consists of different types of expenses such as ambulance charges, room rent charges, and so on. Some insurance companies set a limit on such expenses, beyond which you are not reimbursed. For example, the hospital room rent compensation may be limited to 1% of the sum insured. If your room rent cost exceeds 1%, you will have to pay it yourself. So it is necessary that you should go with the mediclaim policy of such insurance company which does not have any limit and even if it is there, it is very less. This will help you to get maximum compensation in case of your claim.

4. Shorter Waiting Period:

All mediclaim policies have some waiting period for pre-existing diseases. This waiting period can range from 1 year to 4 years. During this waiting period you will not be provided any medical cover related to those diseases under the medical policy scheme. So it is necessary that you should go with a company providing mediclaim policy which offers working waiting period. Some insurance companies offer the option of paying some additional premium to reduce the waiting period. If you are financially capable then you can also opt for it otherwise you can go with a company which offers you mediclaim policy with less waiting period.

5. Premium:

The main part of any insurance policy is the premium paid in it. Lower the premium, lesser will be the burden on your pocket. While buying a medical policy from a company, you must carefully check the premium charged by it. You can compare their premium amount with the premium amount of other insurance companies. After comparing, you can choose a good Mediclaim insurance policy according to your budget. But you have to keep in mind while taking a low premium mediclaim policy that you should not opt ​​for a low coverage mediclaim insurance policy because of its very cheap otherwise you may have to bear the financial burden during medical emergencies.

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