Medical emergencies come unannounced and if you haven’t got health coverage, be ready for a vast medical expenditure owing to hospitalization. Despite the escalating healthcare costs, several of us overlook and do not insure our family and ourselves with Mediclaim coverage.
A medical is a sort of health insurance wherein the insurance companies compensate the policyholder for medical expenses they might have incurred throughout the policy term. The policyholder can either submit the medical bills to seek reimbursement or cashless access facilities at the network hospital of the insurance carrier.
Mediclaim coverage is an insurance cover that covers you against increased medical bills coming out of hospitalization. It gives financial protection in case of hospitalization due to illness or an accident. Similar to other forms of insurance, Mediclaim policy benefits can be exercised by paying a premium annually. This sort of insurance coverage comes with a specified policy time and needs to be renewed to continue enjoying the advantages of the policy.
Mediclaim is a sort of health insurance through which you can either be compensated for expenses arising out of hospitalization, or you can choose the cashless approach to cover your hospitalization charges. Additionally, the premium you pay is qualified for tax exemption under Section 80D of the Income Tax Act 1961, making it a beneficial investment.
Why is mediclaim policy important?
Here are some reasons why a mediclaim policy is crucial. We are surrounded by the increasing number of lifestyle diseases and hospitalization bills, which is why mediclaim policy is inevitable. It offers a cash cushion in case of a medical emergency. At the same time, it gives several benefits such as:
- Cashless hospitalization facility
- A cost-effective technique of acquiring healthcare services
- Lowers financial burden
- Offers peace of mind
- Eliminates out-of-pocket expenditures
- The insurance company manages hospitalization bills
- Offers solo as well as family floater mediclaim policies
- Tax benefits are offered on premiums paid towards mediclaim policy
Mediclaim policy coverage
Coverage under mediclaim policy differs from one policy to another. Following are some recurring expenses covered under a mediclaim policy.
It includes all the costs incurred while hospitalization, such as OT charges, blood, oxygen, chemotherapy, diagnostic procedures, x-ray, radiotherapy, pacemakers, radiotherapy, room rent, etc.
Expenses incurred on technically complex procedures which do not require hospitalization for more than 24 hours, such as cataract treatment, dialysis, etc.
Pre and post hospitalization expenses
Medical expenses incurred on hospitalization for a period of 30 to 60 days before admission and up to 60 to 90 days following release are reimbursed. The number of days may vary from one policy to another.
Hospital room charges
Expenses incurred room rent towards standard wards or ICU are fully compensated or taken care of with cashless hospitalization facilities in the network hospitals. Consultation costs levied by medical professionals: Fees charged by the medical professionals, doctors, surgeons, etc., are covered by the insurance company.
Benefits of Mediclaim Policy
Mentioned below are a few key points that show why the mediclaim policy is beneficial.
Medical emergencies: A mediclaim policy helps prevent any financial hardship during a medical emergency.
Cost-effective: Mediclaim policy is an affordable approach to tackle escalating healthcare expenditures.
Cashless facility: Mediclaim coverage offers a cashless hospitalization facility where the policyholder doesn’t have to spend any money from their pocket during medical crises. The insurance company settles the medical fees directly with the network hospital.
Income tax benefit: Investing in a mediclaim policy helps the policyholder save on income tax under Section 80D of the Income Tax Act, 1961.
The claim process for mediclaim policies
Mediclaim insurance allows policyholders an opportunity to enjoy a cashless hospitalization facility or reimburse the claim amount. In the case of a cashless facility, the policyholder can obtain treatment in any of the network hospitals of the insurance provider without having to pay for the medical charges. However, suppose the insured decides to receive treatment at a hospital, not in the insurance company’s network. In that case, they need to face the medical expenditures which the insurance company would repay upon filing a claim.
Mentioned here is the process of filing a claim under the mediclaim policy.
Reimbursement claim: In the case of a reimbursement claim, it is necessary to inform your insurance company about the medical emergency or hospitalization about to take place shortly or within the required period once it has occurred. It is crucial to maintain all the medical bills and track expenses made during hospitalization. To claim compensation for the costs spent, you need to present the payment receipts you have made relating to medical bills. It is crucial to maintain all the original medical bills and payment receipts to be submitted to the insurance company to collect the reimbursement amount.
Cashless claim: The insured is obliged to submit a pre-authorization form along with the medical card in advance in case of planned hospitalization. In case of emergency medical treatments, the policyholder can exhibit the medical card issued by the insurance company to access the cashless hospitalization facility at the network hospital and then submit the pre-authorization form within the given time limit.
You may easily find the proper mediclaim coverage online with the help of web platforms that offer different mediclaim policies. It is essential to compare and get mediclaim coverage from top health insurance firms in India. These mediclaim policies ensure the most excellent coverage at economical rates. We hope that now you understand why mediclaim coverage is necessary, and you will be able to choose the most acceptable plan that matches your requirements.
What is Not Covered in Mediclaim Policy?
Every Mediclaim coverage has specific exclusions and varies from one insurance carrier to another. Here are some of the usual limitations in Mediclaim policies:
- Pre-existing diseases.
- Dental procedures.
- Sexually transmitted illnesses.
- Birth control and hormonal therapies.
- Plastic surgery.
- Cosmetic surgery and obesity-related treatments.
- Maternity expenditures if not opted as an Add-on feature.
- Non-medical expenses such as service charges, administrative charges, toiletries, etc.
- Ailments and diseases contracted within a defined period from the policy purchase date.
How is Mediclaim Premium Calculated?
Insurance companies compute the Mediclaim insurance premium depending on parameters such as age, geographical location, the sum covered, pre-existing medical condition (if any), the scope of the coverage, number of members to be insured, etc. However, the insurer will establish the final premium based on your unique needs and financial needs, which is as per the IRDAI norms.
Things to Remember When Buying a Mediclaim Policy:
If you’re planning to get a Mediclaim insurance policy, here are the aspects that you need to consider:
Sum Insured (Coverage): When choosing the best Mediclaim policy, you must select an acceptable sum insured or the coverage amount. You might pay a more significant premium for a higher sum promised, but you must buy coverage depending on your needs.
Individual or Family Floater: Before you conclude your Mediclaim insurance, you need to examine if this coverage is for an individual or your whole family. However, with a family floater type Mediclaim insurance, the entire sum insured will be jointly owned by the members of your family who are beneficiaries of the policy amount.
Co-Payment: Under this clause, you, as a policyholder, are expected to pay a set percentage of the claims, and the insurer bears the balance of the medical expenses.
Network Hospitals: Choose an insurance carrier with an extensive range of network hospitals as the cashless facility is available exclusively with these hospitals. This will help you choose from numerous possibilities.
Waiting Period: While registering a claim, insurance providers have a waiting period before which you cannot claim for any medical expenses. Also, insurance firms have a waiting time for pre-existing conditions or illnesses. Check for these exclusions to make the best decision to acquire a Mediclaim policy.
Add-ons: Usually, insurance companies do not offer Add-ons on Mediclaim policy; but, if they do, you can acquire these extra features and expand your insurance cover. Please do remember that Add-ons will increase your insurance price.