Many people are aware of the term ‘mediclaim’ and think of
it as a synonym for health insurance. This hesitancy makes most people stay
away from mediclaim, making India a nation with the lowest insurance density. Even though both mediclaim and health insurance
offer financial assistance in case of emergencies, there is a slight difference
between them.
To save you from this common confusion, the following
comprehensive overview serves as a guide to demystifying mediclaim policy,
denoting its benefits, offerings, exclusion, and key differences with health insurance
plans.
What is a Mediclaim Policy?
Mediclaim is a type of health insurance that offers
financial coverage for a host of medical expenses due to hospitalisation,
accident, or certain illnesses. The goal of this policy is to bring down the
financial burden that is incurred for medical costs.
Mediclaim policies offer manifold benefits, including
cashless treatment at network hospitals and reimbursement for pre- and
post-hospitalisation at non-network facilities. Dental insurance, while
distinct, addresses oral healthcare costs.
Just like a health insurance policy, mediclaim can also be
classified primarily into two types. Take a look:
Individual Mediclaim Policy:
An individual mediclaim policy provides extensive medical
coverage for a monthly premium. This insurance covers personal medical expenses
like hospital bills, treatment fees, room charges, and ambulance costs. It
works best for people who live alone and do not have dependents, as they can
take full advantage of the coverage.
Family Floater Mediclaim Policy:
The main benefit of a family floater mediclaim policy is
that it covers multiple family members under one premium. This means the whole
family shares a single coverage amount that any member can use as needed.
This is an advantage over individual policies, especially
when one person has leftover coverage that another family member might need.
However, this coverage cannot be transferred. In a mediclaim policy for family,
any member can use the shared coverage when necessary.
Additionally, interested individuals can also opt for:
- Mediclaim Policy for Senior Citizens: A Mediclaim plan for
senior citizens helps people over 60 with their medical needs. It covers costs
for age-related illnesses that basic mediclaim policies do not. You can buy a
senior citizen plan for your parents, in-laws, or any family member over 60.
- Mediclaim Policy for Critical Illness: Treatments for
chronic conditions like cancer, heart disease, and kidney failure can be
extremely expensive. That is why it is smart to invest in a critical illness
mediclaim.
- Personal Accident Medical Policy: Personal accident
mediclaim policies provide medical coverage for partial disability, total
disability, and accidental death. While not mandatory, these policies can help
protect you and your family’s future.
Why Choose a Mediclaim Policy?
Here is a detailed breakdown reflecting the advantages of
mediclaim policies:
- Lowers High Medical Costs: Mediclaim policies support
individuals in coping with rising healthcare costs and save them from the
economic burden of medical emergencies and treatments.
- Access to Quality Healthcare: It provides seamless access
to quality healthcare where you can avail yourself of cashless treatment.
- Emergency Readiness: Since medical policies come with a
selection of top-graded network hospitals, they offer a safety net during
unexpected health crises.
- Tax Benefits: Mediclaim policies tax benefits make the
premiums eligible for tax deductions under Section 80D of the Income Tax Act.
How a Mediclaim Policy Works?
To get the most benefit of a mediclaim policy, it is crucial
to know how it works. Here is a detail:
Step 1: Purchase a mediclaim policy online or offline,
considering your budget and needs.
Step 2: Pay a premium regularly, just like with other health
insurance.
Step 3: The policy pays for hospital costs due to accidents,
surgeries, or serious illnesses during the policy period.
Step 4: A mediclaim policy comes with a set coverage amount.
An individual needs to renew the policy at the end of each term to keep getting
its benefits.
Step 5: At the time of buying or renewing the policy,
policyholders can choose between cashless hospitalisation or reimbursement.
With cashless hospitalisation, the insurance provider pays the hospital
directly. Reimbursement allows you to pay the hospital first, and then the
insurer pays you back later.
What is Covered under a Mediclaim Policy?
A Mediclaim policy includes several types of coverage
options, however the details may vary between insurers. Here are the primary
inclusions:
- In-Patient Hospitalisation: This covers medical costs when
you stay in the hospital for 24 hours or more.
- Day Care Treatment: This refers to the treatments that do
not require an overnight hospital stay.
- Pre- and Post-Hospitalisation Cover: This includes
expenses you incur before being admitted to the hospital and after you leave.
- Domiciliary Hospitalisation: The policy covers treatment
at home if you cannot get a hospital bed or if moving you is not possible.
- No Claim Bonus: You receive a bonus for each year that you
do not file a claim, which can be applied to the next policy year.
What is Excluded from a Mediclaim Policy?
Certain ailments and health conditions are uncovered by
mediclaim policies. Take a look:
- Maternity and IVF: Most mediclaim policies do not cover
expenses related to maternity, pregnancy, childbirth, or fertility treatments
like IVF.
- Cosmetic Procedures: You cannot claim coverage for
cosmetic or dental surgeries unless they are needed due to an injury or
accident.
- Self-inflicted Injuries: Injuries from self-harm, substance
abuse, or suicide attempts are not covered by the mediclaim policy.
- Outpatient Treatment: Most outpatient consultations,
preventive health tests, and elective procedures are not usually covered by
mediclaim policy.
- Participation in Hazardous Activities: Injuries from
high-risk activities, like adventure sports or racing, are not covered by the
mediclaim policy.
Please note: Certain illnesses and procedures, like
cataracts, joint replacement surgeries, and pre-existing conditions of the
policyholder, have specific waiting periods. One cannot use the coverage for
these treatments until the period ends.
Is Health Insurance and Mediclaim Policy Same?
Now that you have walked through the basics of a mediclaim
policy, you might have started to think that mediclaim is nothing but another
word for health insurance: old wine in a new bottle. But that is where you will
go wrong. Take a look at some of the key differences between mediclaim and
health insurance:
|
Criterion |
Mediclaim Policy |
Health Insurance |
|
Coverage Inclusion |
The coverage of a medical policy mostly encompasses hospitalisation
charges. |
Health insurance offers coverage for various other aspects including
hospitalisation, such as AYUSH treatment, ambulance charges etc. |
|
Coverage Amount |
The coverage limit relies on the plan you opt for. |
The coverage limit can reach crores if required. |
|
Add Ons |
Mediclaim does not usually have additional riders. |
Health insurance allows individuals to customize the plan by adding riders.
|
Final Words
Once you understand what mediclaim policy is and why it
matters, investing in a 10 lakh health insurance can be a great choice. Ensure to keep in mind the
points discussed earlier and carefully read the policy details before you
invest.