Mediclaim Insurance Policy

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A mediclaim policy is the one that offers the cashless hospitalisation, at the network hospitals so that no health emergency becomes a financial burden to you.

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Mediclaim policy gives you a lot advantages and covers the hospitalisation and domiciliary hospitalisation in the following cases:

  • In case of sudden illness or surgery
  • If you are met with an accident
  • In case of surgery during the policy tenure
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Working of a mediclaim policy

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Under the mediclaim policy, there are two types of claims available:

  • Claim procedure

    Under this, insured can have all the medical treatments, hospitalisation and post hospitalisation etc done without paying a single thing to the hospitals which are under the list of registered network hospitals. The entire cost is born by the insurance company. There is a certain procedure that you need to follow to ensure the smooth claim.

    An insured person has to obtain the form from insurance registrations desk of the hospital and submit it back there only, after having filled it with complete details which are all correct because any false detail will only delay the process. Then this form has to reach to the third party administrator or insurer after having been duly stamped by the hospital. The third party then will fax the hospital that certain amount has been sanctioned by the policy for the treatment.

    In case the cash sanctioned by the insurance company is less than the amount sanctioned, the insured patient can do either of the two. He can either send the discharge papers and the bills to the insurer which is a process that would take time to finish. The other option is that the insurer can pay the extra amount from his pocket and then send the discharge paper and original bills and the entire amount shall be transferred to you by your Mediclaim Insurance Policy provider.

  • Reimbursement

    In case you are going to get the amount due, through this process you have to inform your insurer that a hospitalisation has taken place or is going to take place in future, through an e mail or through a direct phone call. If you want to get the reimbursement, you need to submit the bills of all the medicines that you took from outside and hospital bills etc to the insurance provider. Original discharge papers, final receipts and payment bills are to presented in case of reimbursement.

Milestones if you are buying a Mediclaim Insurance Policy

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If you have not yet invested in the insurance policy, but you are planning to buy an insurance policy, here are the check points that must see.

Individual and family health plan

An individual health insurance plan, covers just an individual while a family health plan covers the health of more than 2 members of the family. However, in a family health insurance plan, the policy ceases to exist when the eldest member in the plan reaches a certain age and the younger members can not even renew it. But in case of an individual health plan, there is no impact on the policy when the insured reaches a certain age.

Renew-ability age

Generally a policy covers you for a year but you should look for a policy that gives you coverage for entire age.

Because if your policy doesn’t cover you when you need it the most, there is no point buying the policy.

Pre-existing diseases

This is relevant in case you have an existing disease at the time policy inception. It covers those diseases that might arise due to pre existing disease. A best mediclaim insurance policy is the that gives you cover of the pre existing disease as soon as it starts.

Comparison between mediclaim and a health insurance policy

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Mediclaim PolicyHealth Insurance
It reimburses your actual medical expensesIt gives you a lump-sum amount on diagnosis of any of the pre-specified critical disease, irrespective of your medical expenditure
It has much wider scope than critical illness because it covers hospitalization and treatment towards accidentIt covers only certain diseases like heart attack, kidney failure, paralysis, etc.
The policy is taken to defray the hospitalization expenses incurred at the time of hospitalizationIt not only pays expenses of critical illness but also compensate for financial loss that may arise due to critical illness

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