Mediclaim insurance

Posted in: Insurance | on: September 18, 2020

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Mediclaim also known as mediclaim insurance is a type of health cover plan that covers a hospitalization costs which includes treatment costs after incurred on illness or an accident. It offers complete coverage for medical expenses beyond hospitalization charges. Premium is paid annually and the returns will be obtained at the end.

This type of insurance policy comes with a defined policy period and needs to be renewed to continue enjoying the benefits of the policy. Mediclaim is a health insurance which can be reimbursed or claimed for a cashless process. One can avail for tax exemption under Section 80D of the Income Tax Act 1961. It covers pre and post hospitalization costs. The time period will range from 1 month period previously and 2 to 3 months after hospitalization.

Features of Mediclaim Policy

  • Mediclaim policy offers cashless hospitalization benefits as well as reimbursement. The cashless treatment facilities can be availed only at the selected hospitals where the hospital expenses were paid by the company itself.
  • It can be availed either for the individuals or for the whole family.
  • It acts as a financial tool at the time of medical expenses and saves money from the pocket. It provides fixed sum on the amount spent and hospitalization cover does not exceeds than Rs. 5 lakh. 
  • This plan provides tax exemptions of certain limits.
  • Mediclaim policies do not include any optional additional riders/costs or add-ons.
  • It covers hospitalization charges including medicine cost, treatment charges, costs of oxygen, blood, OT charges, clinical tests/ diagnosis costs, chemotherapy, radiotherapy, organ transplantation, etc. It covers charges for nursing, accommodation. It also includes day-care hospitalization costs, ambulance charges, emergency services etc.
  • Pre and post-hospitalization expenses: Hospitalization costs of the previous hospitalization period of 30 to 60 days and the post hospitalization of 60 to 120 days.

Types of Mediclaim Policies

One can gain benefits of mediclaim policy benefits according to the type of policy they chooses. Some of the types of Mediclaim policies are as follows:

Individual Mediclaim Policy

Under this policy, only one person can get the entire benefits. The total insured amount can be gained only by one person when they requires. This policy includes all medical expenses needed for the hospitalization. The coverage includes Rs. 1 lakh up to Rs. 50 lakhs.

Family Floater Policy

Under this policy, the whole family can avail the benefits. The policyholder including their family members like their parents, spouse and children can get the benefits. The coverage ranges from Rs. 2 lakhs up to Rs. 1 crore.

Group Mediclaim Policy

It is the policy which is purchased by an employer for their employees or group members of the company. However, the premium and the shares are shared equally among the employees.

Senior Citizen Mediclaim Policy

Under this plan, senior citizens can get the benefits for the medical expenses including special provisions. Senior citizens can avail minimum of Rs. 1 lakh to maximum of Rs. 25 lakhs.

Critical Illness Mediclaim Policy

This plan covers severe and critical illnesses including cancer, Primary pulmonary arterial hypertension, kidney failure, stroke, cardiovascular diseases, paralysis and other illnesses. But the diseases like Dental treatments,  Birth control and hormonal treatments, Sexually transmitted diseases, Vaccinations, Plastic surgery, Cosmetic surgery and obesity-related treatments will not be covered under this plan.

Overseas Mediclaim Policy

This type of insurance covers all the hospitalization expenses incurred in a foreign nation outside India.

Low-Cost Mediclaim Policy

This type of mediclaim policy is often preferable for the employees belonging to the small and medium scale industries, as it includes low cost premiums.

Factors determining premium

There are a lot of factors which determine the premium policy which includes  Age of the members, amount insured, geographical location, health history, any pre-existing medical condition, morbidity rate, number of members to be insured, the duration of coverage, However, the premium will be set by the insurer based on the requirements and the rules set by the IRDAI.

Types of Insurance claim

There are two types of Mediclaim types. They are Reimbursement and cashless claim. One can either avail benefits under the reimbursement method by submitting all the bills/ receipts to the insurer or get the completely cashless benefits at the network hospitals.

Reimbursement claims

One has to inform the insurance company or third-party administrator as soon as the policyholder is admitted for the treatment. One must collect all the bills and expenses that are spent on hospitalization. These receipts/ bills have to be attached and all the details must be filled in correctly. Any error in the process can delay the reimbursement process.

Cashless claims

The policyholder has to fill up the pre authorization form before getting the planned cashless hospitalization. For emergency treatments, the insured Medi-Assist ID card offered by the insurance provider at the network hospital.

How to Renew Mediclaim Policy Online

One has to visit the National Insurance website and click on ‘Renew Existing Policy’. It will redirect to a new page where one can renew the policy by entering the policy number and the email ID.

It will display the renewal notice and total renewal premium to be paid.

Then, it will be redirected to the secure payment gateway where the policyholder make premium payment using net banking, credit card or debit card.

Documents required

Some of the documents required to be submitted are as follows:

Identity proof

Certificates like PAN Card, Aadhaar card, Voter’s ID card,Driving license, Passport etc. are accepted as ID proofs.

Address proof

Certificates like Aadhaar card, Driving license, Passport, Voter’s ID card, telephone bills, Electricity bills etc. can be accepted as address proofs.

Age proofs

Certificates like Birth certificate, SSLC mark sheets, Passport etc.are accepted as age proofs, Two passport size photographs and Medical reports, if policy requires any pre medical check-ups.

For getting claims, one must include all the documents given as follows:

  • Discharge summary and documents
  • Documents relating to the patient’s illness
  • All medical reports with details of the treatments, medicare and procedures covered
  • A certificate from the doctor/ attending medical person mentioning that the patient has recovered or is recovering from the diseases.

One can use the medical claim as financial tool in the emergency situations. It will be very useful for the policyholder in case of emergencies.


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