Medical expenses can create a financial burden on individuals, especially in times of unexpected illnesses or accidents. Mediclaim policies can alleviate this burden, making it a popular choice among people. It helps individuals and families cope with the rising costs of healthcare services. Thus, you get complete financial security during medical emergencies.
What is a mediclaim insurance policy?
A mediclaim policy is a type of health insurance that covers you against unexpected medical expenses. You can get cashless treatment at network hospitals or reimbursement against your medical bills.
A mediclaim policy typically covers inpatient hospital expenses, pre- and post-hospitalisation expenses, ambulance charges, and more. It is important to carefully read the policy terms and conditions and choose a plan that suits your healthcare needs and budget. A mediclaim insurance policy is a vital investment in protecting your health and finances.
Key features of a mediclaim insurance policy
Here’s a quick look at the key features of a mediclaim insurance policy offered at Bajaj Finance Insurance Mall:
Features |
Specifications |
Sum insured |
Rs. 5 lakh to Rs. 50 lakh |
Cashless treatment |
6,500+ hospitals |
Daycare treatment |
Included |
Pre-and post-hospitalisation expenses |
Covered |
Tax benefit |
Available |
Know in detail about the key features offered by a mediclaim policy.
Hospitalisation expenses:
The policy covers room rent, nursing expenses, surgeon fees, and doctor consultation fees. It also covers operation theatre charges and other related expenses.
Cashless treatment:
Get medical treatment at any of the insurer network hospitals without paying any money upfront. The insurance company settles the bills directly with the hospital before you get discharged.
Sum insured:
Choose the sum insured based on your medical needs and budget. The insurance company will pay for medical expenses up to the sum insured by the policy.
Tax benefits:
You get tax benefits for the premium paid towards a mediclaim policy. Claim for tax exemption under the relevant sections of the Income Tax Act, 1961.
Key benefits of buying a mediclaim policy
Here are some key benefits of the best mediclaim policies in India:
Cost-effective:
A mediclaim policy helps manage high medical expenses by covering a significant part of hospitalisation costs. This saves you from spending a lump sum out-of-pocket, making quality healthcare more affordable.
Access to quality healthcare:
Mediclaim policies often include a wide network of hospitals, ensuring you have access to reputable healthcare providers. This access promotes timely treatment without compromising on quality, especially during medical emergencies.
Beat medical inflation:
With the rising costs of medical treatments, a mediclaim policy shields you from inflation. It covers treatments and hospital charges that are continuously increasing, offering financial stability in times of need.
Cashless treatment:
Many mediclaim policies offer cashless treatment facilities, where the insurer settles the bills directly with network hospitals. This reduces financial burden and stress, allowing you to focus solely on recovery.
Tax exemption benefits:
Premiums paid toward mediclaim policies are eligible for tax deductions under Section 80D of the Income Tax Act. This offers dual benefits of financial security and tax savings, making mediclaim a wise investment.
Peace of mind:
Having strong financial security provides peace of mind. Mediclaim policy ensures you have an adequate financial backup at the time of need, helping you stay stress-free.
Financial security:
You get complete financial assistance with a mediclaim policy, as it covers all medical-related expenses. It provides coverage for hospitalisation, surgery, and other medical procedures.
Lifelong renewability:
The lifelong renewability benefit enables you to renew the policy anytime, without any age limit. Many mediclaim policies in India come with the option of lifelong renewability.
Types of mediclaim policies in India
There are different types of mediclaim policies available in India to suit the varying healthcare needs of individuals. Here are some of the common types of mediclaim policies:
Individual mediclaim policy:
This policy covers the medical expenses of an individual policyholder. It includes costs like room charges, surgery, and diagnostics, but does not typically cover outpatient or non-hospitalisation expenses.
Maternity health insurance:
Maternity health insurance covers expenses related to childbirth, prenatal, and postnatal care, as well as newborn baby care. These policies help manage the high costs of delivery, hospital stays, and medical check-ups, ensuring financial support during pregnancy and reducing the financial burden on families.
Family floater mediclaim policy:
This policy covers the medical expenses of the entire family (self, spouse, and dependent children) under a single sum insured. It covers hospitalisation expenses like room rent, surgery, and diagnostics, ensuring financial protection for the entire family at a lower cost than individual policies.
Senior citizen mediclaim policy:
A senior citizen mediclaim policy caters to individuals aged 60 and above, covering hospitalisation costs, pre- and post-hospitalisation expenses, and often including additional benefits like coverage for pre-existing conditions and age-specific treatments, offering tailored healthcare protection for the elderly.
Group mediclaim policy:
This policy caters to the medical needs of a group of people. Most employers or any organisations offer the group mediclaim policy to their employees or members. It mainly covers the medical expenses of the employees or members and their dependants.
Critical illness mediclaim policy:
A critical illness mediclaim policy provides a lump sum payout upon diagnosis of specified serious illnesses like cancer, heart attack, or stroke. This financial support helps cover high treatment costs, loss of income, and additional care expenses during recovery.
What are the tax benefits of a mediclaim insurance?
- Mediclaim insurance offers various tax benefits to policyholders.
- Section 80D of the Income Tax Act allows for tax deductions on the premium paid towards a mediclaim policy.
- Up to Rs. 25,000 in premium payment can be deducted for self, spouse, and dependent children.
- Additional deductions under section 80D of up to Rs. 25,000 are allowed for payment of health insurance premiums for parents.
- Senior citizens can avail of deductions up to Rs. 50,000 in a financial year for their mediclaim policy.
- This makes mediclaim insurance not just a means of protecting one's health but also a tax-saving investment.
Hence, choosing the best mediclaim policy suitable for one's needs can help in availing these tax benefits while ensuring financial security in times of medical emergencies.
Comparison between mediclaim policy and health insurance
When it comes to health insurance, the terms mediclaim policy and health insurance can be confusing. The main difference between them is the coverage. Discussed below are the key points of comparison to help you compare mediclaim policy with general health insurance. Discussed below are the key points of comparison between the two:
Aspect |
Mediclaim policy |
Definition |
A policy focused on reimbursing hospitalisation costs |
Coverage |
Limited to hospitalisation and treatment costs |
Hospitalisation requirement |
Necessary for claims |
Pre and post-hospitalisation expenses |
Typically not covered or very limited |
Ambulance charges |
Generally not covered |
Preventive care |
Not covered |
No-Claim bonus |
Limited or none |
Customisation |
Less flexible, with predefined coverage limits |
Premium cost |
Generally lower due to limited coverage |
Cashless facility |
Available in network hospitals but limited |
Best Suited For |
Basic hospitalization needs |
Tax Benefits |
Provides tax benefits under Section 80D |
Therefore, before choosing a policy, one must evaluate their medical needs and select the plan that best suits them.
Also read: Mediclaim vs health insurance
What is covered in mediclaim policy?
Here are some of the common coverages offered under mediclaim policy.
Hospitalisation expenses:
The policy covers hospitalisation expenses incurred due to an illness or injury. Hospitalisation expenses in mediclaim insurance include costs for room accommodation, nursing charges, surgeon fees, anesthesia, blood transfusions, diagnostic tests, medications, and other necessary medical services during hospital stays.
Room rent:
The policy covers room rent expenses incurred during hospitalisation. Room rent coverage in mediclaim insurance refers to the reimbursement or direct payment for the cost of hospital room accommodation during the insured's hospitalisation, subject to the policy's terms and limits.
Ambulance charges:
The policy covers ambulance charges incurred for emergency transportation to the hospital. Policies may include reimbursement or direct payment for these expenses.
What is not covered in mediclaim policy?
Here are some key exclusions of mediclaim insurance policy:
Pre-existing diseases:
Many insurers cover pre-existing medical conditions after a certain period, known as waiting period.
Cosmetic treatments:
The policy does not cover cosmetic treatments, plastic surgeries, and other related procedures.
Self-inflicted injuries:
The policy does not cover medical expenses incurred due to self-inflicted injuries or suicide attempts.
Non-allopathic treatments:
The policy does not cover medical expenses incurred due to non-allopathic treatments such as ayurveda, homoeopathy, or unani.
How does a mediclaim policy work?
A mediclaim policy works in the following ways:
Medical expenses coverage:
Choose a coverage amount on the mediclaim policy basis your medical requirements and budget. The policy will offer coverage up to the sum insured for hospitalisation, treatment, and other medical-related expenses.
Reimbursement claim process:
Reimbursement of the hospital/treatment bills is one of the ways of claiming the benefits on your mediclaim policy. You only need to share the bills, prescriptions, discharge summary, and other required documents to raise the medical reimbursement bill claim.
Cashless claim process:
Another way of claiming benefits is opting for a cashless mediclaim policy. You can take treatment at any of the insurer’s network hospitals. The hospital will contact the insurer with all the details and share the required documents with them. You do not have to bother about the paperwork in this process. Upon verifying the details, the insurer will directly settle the bills with the hospital.
Policy renewal:
Simply renew the mediclaim policy online by paying the premium. Some mediclaim policies also offer the benefit of lifelong renewability. So, you can renew the policy whenever you want to.
Factors to consider while buying a mediclaim policy
Here are some factors that you must consider while buying the best mediclaim policy in India:
Coverage:
Check the policy coverage including the sum insured, inclusions, and exclusions. Look for a policy that covers your medical needs and fits your budget.
Premium:
Compare the premium of different policies and choose one that offers the best value for money. However, do not compromise on coverage for the sake of a lower premium.
Network hospitals:
Check the list of network hospitals associated with the insurance company. This will help you get cashless treatment in case of a medical emergency.
Claim settlement ratio:
Look for the insurance company’s claim settlement ratio in health insurance. This ratio represents the number of claims settled against the total number of claims received by the insurance company. A higher ratio indicates a better claim settlement process.
Waiting period:
Check the waiting period for pre-existing illnesses and other medical conditions. This will help you understand when you can make a claim for such conditions.
Age criteria:
Age is essential as it determines policy eligibility, ensuring that the coverage aligns with your current age and future needs.
Exclusions:
It is crucial to understand what medical conditions or treatments are not covered. Ensure that the policy covers all the required conditions and treatments that may be relevant to you.
Pre- and post-hospitalisation:
It is vital to assess coverage for expenses before and after hospitalisation, ensuring comprehensive support.
No claim bonus:
Significant for enhancing coverage and saving on premiums with each claim-free year.
Co-payment clause:
Co-payment clause: Important to know if you have to share costs with the insurer, impacting your out-of-pocket expenses.
Also, read: Health Insurance plans for family
