What is Mediclaim?

The Basics of Mediclaim Insurance

What is mediclaim? This is one of the common questions that linger in the minds of most individuals who are planning to buy a health insurance policy. Common people often get confused between mediclaim and health insurance. They do share a few features but vary in terms of coverage and other factors. Let’s clear up this confusion for you.

What is Mediclaim?

Mediclaim is a financial tool that covers your medical expenses, like health insurance. It is a safety net that protects your savings from being drained due to medical emergencies. You own a mediclaim policy, pay the premiums on time, and get the medical expenses reimbursed after verification by the service provider. It is the same with health insurance. The only difference is that mediclaim policies do not have add-ons to increase the coverage features.

Types of Mediclaim Policy

There are various mediclaim policies, just like different health insurance plans, and these different mediclaim plans are designed to provide financial protection against medical expenses. Some of their popular plans include:

1. Medi Classic Insurance Policy

With this insurance, you can be reimbursed for hospitalisation expenses due to illness, disease, or accidental injuries. It also offers sum insured options, pre- & post-hospitalisation, daycare procedures, and health check-ups.

2. Comprehensive Insurance Policy

It is a high-coverage policy that offers extensive benefits such as hospitalisation coverage, pre & post-hospitalisation, maternity benefits, and outpatient costs.

3. Family Health Optima Insurance Plan

It is a cost-effective insurance policy that covers not just the policyholder but the policyholder’s spouse, children, and parents. The top benefit of family health optima insurance is that it provides very affordable premiums.

4. Senior Citizens' Health Insurance Policy

This is a plan specialised for individuals aged 60 to 75 years, and it specifically covers expenses for age-related diseases and illnesses. No pre-medical screenings are required to purchase a senior citizens' health insurance policy.

5. Women's Care Insurance Policy

This is a specialised plan for women, covering maternity expenses, delivery costs, and wellness benefits. This policy ensures financial security and peace of mind for women at every stage of life.

How Does Mediclaim Insurance Work?

As mentioned, mediclaim offers a financial backup for medical expenses. It also has a coverage limit set annually. Once you cross the coverage cap, you will have to pay the rest of your medical bills with cash. This coverage limit resets every year.

A mediclaim policy has premiums like other health insurance plans. Learn how to find my health insurance premium online. Top health insurance companies provide an online calculator to get a glimpse of a premium before you buy a plan. After getting an idea, you can afford a mediclaim plan.

1. Coverage: Mediclaim insurance helps cover hospital and medical expenses when you need treatment. Instead of paying the full amount yourself, your insurance company pays a part of it.

2. Purchase a mediclaim policy: You can buy a mediclaim policy by paying a yearly premium to the insurance company, and if at all you wish to renew the coverage, you can pay the premium on time and renew it.

3. Make a Claim – You can claim your insurance in two ways:

Cashless Claim – If treated at a network hospital, the insurance pays directly to the hospital.
Reimbursement Claim – If treated at a non-network hospital, you pay first and get the money back later.

Benefits of Mediclaim

1. Inpatient hospitalisation costs: A mediclaim policy will cover the medical expenses of an insured individual admitted to a hospital. The only factor is that the patient should be hospitalised for more than 24 hours.

2. Daycare: Some policies cover treatments that don’t require hospitalisation. All these terms are mentioned in the Clauses section of a mediclaim policy document.

3. Pre and post-hospitalisation expenses: Many policies also cover the pre- and post-hospitalisation costs.

4. Domiciliary treatment costs and annual health checkups: Some plans cover the treatment a patient is receiving at home. Annual health checkups are also covered.

5. No-claim bonus: Policyholders are often rewarded with a no-claim bonus when they don't seek medical coverage for a specified period. This bonus increases the coverage amount without increasing the premium amount.

Difference between Mediclaim and Health Insurance

Aspect	Mediclaim	Health Insurance
Coverage	Covers hospitalization expenses only	Covers hospitalization + additional benefits
Scope	Limited coverage for medical expenses	Broader coverage including OPD, critical illness, maternity, etc.
Claim Process	Requires hospitalization for claims	Claims can be made for various treatments beyond hospitalization
Sum Insured	Fixed sum insured	Offers flexibility with higher sum insured options
Additional Benefits	No additional benefits beyond basic coverage	Includes preventive healthcare, wellness benefits, and more
Premium Cost	Lower premiums	Higher premiums due to extensive coverage
Customization	Not customizable	Allows customization with add-ons and riders
Pre/Post-Hospitalization	May not cover pre & post hospitalization expenses	Covers pre and post hospitalization expenses
Ideal For	Individuals seeking basic coverage for emergencies	Individuals looking for comprehensive medical protection

Why to Opt for a Mediclaim Policy

In the case of a medical emergency, it offers a financial safety net.
In the event of an emergency, receiving medical care is made more convenient by the availability of a cashless hospitalisation service.
The insurance company handles hospitalisation expenses, and it lessens the financial strain and is an inexpensive way to obtain medical care.
It provides you with the assurance that you can afford the expenses and obtain high-quality medical care.
There are options for both individual and family floater mediclaim insurance, so you may select the one that best suits your needs in terms of both money and health.
Tax benefits are available for premiums paid for health insurance.

Know how to reduce health insurance premiums by affording mediclaim at an early age. Opt for a family floater plan to do the same.

Mediclaim offers tax benefits like health insurance policies. Under Section 80d, you can claim a sum of up to Rs. 25,000 from taxes every year. Senior citizens can claim up to Rs. 50,000 while filing income tax returns by using the details of their mediclaim. Get your mediclaim plan today!

Also Read:

→ Which mediclaim is best for a family

→ What Is the Co Payment Percentage for Dependent Parents Under the Mediclaim Policy

HELP CENTRE

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FAQs

What is mediclaim, and how does it work?

Mediclaim is a type of health insurance that pays for hospital stays brought on by disease, accidents, or surgery. The coverage assists in covering medical expenses in the event of hospitalisation, and you pay a premium to the insurer.

What is the rule of mediclaim?

The basic rules of mediclaim include:<ul><li>Only hospitalisation costs are covered.</li><li>With the exception of nursery procedures, you must stay in the hospital for at least 24 hours.</li><li>Reimbursement or cashless claims are both possible.</li><li>After waiting, pre-existing conditions are covered.</li><li>Certain costs are not covered, such as dental work and cosmetic surgery.</li></ul>

Which is better, health insurance or mediclaim?

Mediclaim can be sufficient if you're just searching for basic emergency hospitalisation coverage. Health insurance is a preferable option if you desire more financial stability for all medical costs.

Does Mediclaim cover pregnancy?

In most cases, pregnancy is not covered by basic mediclaim coverage. Maternity benefits, which cover hospitalisation of the infant, prenatal and postnatal care, and delivery costs, are included in certain comprehensive health insurance policies.

Is hospitalisation necessary for mediclaim?

Yes, with the exception of nursery procedures like chemotherapy or dialysis, hospitalisation is required for Mediclaim claims. You are not eligible for Mediclaim insurance coverage if you are not hospitalised.

What is Mediclaim?

The Basics of Mediclaim Insurance