Mediclaim Policy

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Mediclaim Policy: The general explanation

Mediclaim policy is a financial product that covers the whole or a portion of the risk of a person incurring heavy or unforeseen medical expenses. The fact that acquiring these documents is relatively simple and helps in emergency health situations adds to why it’s a mandate.

What exactly is a Mediclaim Policy?

Mediclaim policies are as straightforward as they come. They are a kind of health insurance policy that cover the individual’s medical expenses if there has been any emergency pertaining to their health, up to the amount insured. The Insurance company pays the funding for the treatment cost, be it an illness or an accident that led to hospitalization, covering day-care treatment, in-patient cover, etc.

Mediclaim Policy

Advantages and features of a Mediclaim Policy

Prior to availing a mediclaim policy, you should be able to understand its options and advantages. Moreover, amid the increasing number of health-related expenses, types of diseases, and hospitalization expenses, it’s inevitable to shop for a mediclaim policy that will supply financial backing throughout the period of treatment. In addition, it offers a cushion just in case of a medical emergency. Also, it offers varied different insurance advantages like :

  • Reduces the Financial burden: It eases the monetary concerns on the insured individual and their family.
  • Daycare Hospitalization: Covers finances for treatments that do not need around the clock hospitalization service.
  • Benefits in Tax: A number of tax benefits, especially those that come under section 80 D, can be used with respect to the policy premium for each tenure year.
  • Cost-Effectiveness: Mediclaim is quite an economical way of leveraging health/medical-related services.
  • Cashless Treatment: This facility is available in certain medicare facilities, which in turn helps you save hard cash in emergencies.
  • Pre and Post Treatment Expenses: These policies can also be used to pay hospitalization expenses both before and after the whole medical treatment term.
  • Lifelong Renewability Service: An insured individual has the option to avail the service of lifelong renewability cover under their mediclaim policy.
  • Add-ons: Mediclaim policies usually cover expenses that come through alternative treatments, ICU usage, annual diagnostic tests, etc.

Popular Read: Health Insurance Plan & its Benefits

Where can you get the Best Mediclaim Policies in India?

You don’t have to look elsewhere as we’ve compiled some of the few best, most consumer-centric mediclaim policies in the expertly curated list below :

Mediclaim Policy Sum Insured (Rs.) Network Hospitals Renewability
Aditya Birla Mediclaim Policy 10-30 lakhs 8200 Lifelong
Bajaj Allianz Mediclaim Policy 1.5-50 lakhs 6500+ Lifelong
Bharti AXA Mediclaim Policy 3,4,5 lakhs 4300+ Lifelong
Care Health Insurance Mediclaim Policy Rs. 3 Lakh to Rs. 60 Lakh 4987 Lifelong
Cholamandalam Mediclaim Policy 2-15 lakhs 6500+ Lifelong
Digit Mediclaim Policy 2-25 lakhs 5900+ Lifelong
Edelweiss Mediclaim Policy 5 lakh-1 Crore 2578+ Lifelong
Future Generali Mediclaim Policy Vital: 3, 5,10 lakhs Superior: 15, 20, 25 lakhs Premier: 50 lakhs-1 Crore 5000+ Lifelong
IFFCO Tokio Individual Medisheild Mediclaim Policy 50,000-5lakhs 5000+ Lifelong





To know more about these policies, go to the official site of Dialabank and fill up a form so that the relationship manager can contact you with expert advice to offer.

Medicaid Policy & its Types

Typically, insurance providing institutions make a number of mediclaim policies available to the consumer, which are reasonably suited to their situation and requirements. The most prominent kinds of mediclaim policies are mentioned below :

Individual Mediclaim Policy – This type of policy means that it provides medical coverage only to the policyholder. Just as its name suggests, the health insurance benefits can be availed against the premium only by the insured individual.

Family Floater Mediclaim Policy – This type of policy means that it offers financial cover to the policyholder and can also be extended to other family members.

Senior Citizen Mediclaim Policy – This type of policy covers expenditures pertaining to the hospitalization of elderly people above at least 60 years of age.

Critical Illness Mediclaim Policy – Money spent on hospital bills due to critical health conditions are usually quite exorbitant. This type of policy means that it covers critical health conditions like cancer, cardiovascular diseases, kidney failure, etc.

Mediclaim Policy and Health Insurance: What’s the Difference? 

Mediclaim Policy Health Insurance
It reimburses your actual medical expenses. It gives you a lump-sum amount on diagnosis of any pre-specified critical diseases, irrespective of your medical expenditure.
It has a much broader scope than critical illness because it covers hospitalization and treatment for accidents. It 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 hospitalization. It pays the expenses of a critical illness and compensates for financial loss that may arise due to critical illness.

Some Important Terms related to Mediclaim Policy:

  • Policy Premium: The Mediclaim policy premium amount one pays for contracts vary from insurer to insurer. However, the few factors influencing the sum include the policy period, age, sum insured, etc.
  • Age: These policies can be availed by individuals who have completed a specific age limit. Typical insurers accept deals that cover people aged from 18 to 65 yrs. However, in some cases, the insurer allows age groups starting from 5 yrs up to 80 yrs.
  • Family cover: In this, the insured individual can give an overall premium to cover their whole family instead of buying each of them separate policies.
  • Overseas Mediclaim policies: Numerous insurance providers offer overseas Mediclaim policies, which dedicates that the insured individual can get treatment in both India and abroad if and when a medical emergency comes up. There are usually few terms and conditions that come with these policies as baggage.
  • Claims: Typically, third-party administrators (TPA) take care of claims for insurers, but some of them accept policy claims in-house.
  • Tax benefits: As stated earlier by us, policyholders can claim a tax deduction of around about 25,000 rupees against their premium. The same tax exemption limit stands at almost 30,000 rupees for senior citizens.

What is all covered under a typical Mediclaim Policy?

  • Day-care facility for treatment: It covers up all of the expenditures pertaining to advanced medical facilities/treatments that don’t need the individual to stay in the hospital day-care for a whole of twenty-four hours.
  • Pre and post-hospitalization charges: These policies can also be used to pay hospitalization expenses both before and after the whole medical treatment term. Varying between different insurers, the tenure can range from 5 days to 90 days. These kinds of expenses usually cover lab testing, the doctor’s consultation charges, and follow-up visits too.
  •  Staying rent: Hospital rooms can have reasonable to exorbitant rent amounts, which can be an ordeal in case of an emergency/accident. All this aside, Mediclaim policies usually include paying for the room ren. The insurers fully recompensed rent for using private rooms, wards, or even ICUs are availed under the cashless facility.
  • Medical professional’s fee: A few types of Mediclaim policies may cover the costs of medical professional’s fees and consultation fees such as nurse’s fee, doctor’s fee, etc.

Expenses that are not covered under a typical Mediclaim Policy

The exclusions differ from one insurer to another. However, here are some medical conditions that are usually excluded from the policy:

  • Dental problems
  • Plastic surgery
  • Already existing diseases
  • STDs or Sexually-transmitted diseases (Including HIV/AIDs)
  • Pregnancy & childbirth
  • Vaccination purposes
  • Cosmetic surgery
  • Hearing aid, contact lenses, and so on…

Popular Read: Why Diabetic Patients don’t Get Health Insurance?

Claim Process for Mediclaim Policies

Wondering how to file & process claims? Then, read the below-mentioned points to get a good idea about it:

  • Reimbursement claims: When going for such claims, the insurance company or the third-party administrators (TPA) must be immediately informed when the policyholder gets hospitalized. Therefore, it is imperative to preserve and keep track of the entirety of the bills & expenses during hospitalization. These bills have to be submitted along with the hospital papers while filling the claim form, and all details are to be filled accurately. A delay in reimbursement can be caused due to the slightest error, so be careful.
  • Cashless claims: The policyholder may sign a ‘pre-authorization form’ way before planned cashless hospitalization. The insured individual can show their Medi Assist identification card issued by the insurance provider. In case of emergency treatments, This has to be done at the network hospital, and then the individual in question will be given four hours to fill the pre-authorization form.

FAQs about Mediclaim Policy.

How is the mediclaim policy premium calculated?

Insurance companies usually consider a number of factors to determine the premium amounts for the consumers’ mediclaim policy. A few of those factors are the insured person’s geographical location, age, amount insured, any already existing health condition, the extent of coverage, number of members to be insured, etc.

What is usually the age criteria for claiming a mediclaim policy?

The age criterion usually changes from one insurer to another, but the trend shows that it stays between age groups 18 to 65 years. These mediclaim policies are also known to cover infants starting from the age of 91 days.

Does Mediclaim cover accidents?

Typically, accidents and other such clauses are covered under personal accident insurance plans. One can always amend an add-on to their basic mediclaim policy.

What is an overseas Mediclaim Policy?

This is a type of mediclaim that covers hospitalization charges in the event of an emergency while travelling abroad/overseas.