Know The Features, Benefits And Coverage Of Mediclaim Policy


Know The Features, Benefits And Coverage Of Mediclaim Policy

Medical emergencies are inevitable and can lead to unwanted financial burdens. A mediclaim policy is a policy that reimburses the medical costs incurr

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Medical emergencies are inevitable and can lead to unwanted financial burdens. A mediclaim policy is a policy that reimburses the medical costs incurred by the policyholder during hospitalization. 

It is valid for only a specified period and needs renewal. The mediclaim policies offer reimbursement or cashless methods for settling claims. 

Types of Mediclaim policies

Individual Policy

It offers coverage for the medical expenses of the policyholder only arising due to the hospitalization. 

Family Floater Policy

The policy covers the insured and all the other family members and requires the payment of a single premium for the entire year. 

Group Mediclaim Policy

It is purchased by the employer to provide medical coverage to the employees of their organizations. 

Senior Citizen Policy

The medical expenses of those above 60 years are covered under the senior citizens’ mediclaim policy.

Overseas Mediclaim Policy

It covers the hospitalization expenses incurred in a foreign country by the policyholder. 

Features and Benefits of Mediclaim Policy

  • It protects an insurer from the financial burden and prevents out-of-pocket expenses. 
  • It is available for self as well as family members. 
  • It can be easily bought online by visiting the insurance company’s official website. 
  • It offers tax benefits on the premiums under section 80D of the 1961 IncomeTax Act.
  • It needs to be renewed as it has a predefined policy tenure. 
  • It provides a cashless hospitalization facility at the network hospitals. 
  • It promises cost-effective medical services to an insurer with a pre-decided limit of specific treatments.
  • It offers enough coverage depending on the plan chosen.
  • The insurance provider can meet the expenses incurred during the pre and post hospitalization if the policy specifies the same.

Factors to consider while buying the mediclaim policy

Sum Insured 

It refers to the maximum amount that an insurer pays to the insured in case of hospitalization. If the amount of treatment exceeds the sum insured value, the policyholder has to bear the remaining expenses.

Network Hospitals

To receive a cashless treatment facility during medical emergencies, you must look for an insurance provider with many network hospitals. The insured doesn’t have to worry about the documents for receiving treatment at the network hospitals during medical emergencies. 

Claim Settlement ratio

It refers to the percentage of claims settled by an insurer against the total claims received in a year. You must buy the mediclaim policy from an insurance company with a high claim settlement ratio. In 2019-2020, manipalcigna health insurance had an excellent claim settlement ratio of 85.72%. 


Before finalizing the mediclaim policy, you must check the premium amount you need to pay. Take a budget-friendly insurance plan that suits your needs. It is advisable not to buy the cheapest possible plan as it may not offer adequate coverage. 

Comparing the insurance online 

The first step you need to make while selecting the most affordable medical insurance policy is to compare the existing policies to pick out the best one according to their requirements. Use the online premium calculation to precisely calculate your costs of getting such beneficial insurance covers. If you do not know how to compare and select your plan then consult your insurance solicitor. Be frank with your budget cap and ask for suggestions. 

Coverage Offered by a Mediclaim Policy

It is important to purchase a mediclaim policy that offers coverage against various medical expenses. However, coverage may vary from one insurer to another and depends on the policy plan you choose. Some common costs covered under mediclaim policies are: 

Pre and Post Hospitalization Expenses

The expenses incurred before and after the hospitalization of the insured are covered by various mediclaim policies. These include doctor’s fees, medicine costs, diagnostic tests, follow-up treatments, etc. The mediclaim policy covers pre-hospitalisation and post-hospitalisation expenses from 30 and 60 days. 

Consultation Fees

Doctor’s consultation fees or the charges to meet a healthcare professional are covered by the mediclaim policy. 

Hospitalization Charges

Hospitalization Charges

It covers the medical expenses such as diagnostic procedures, room rent, OT charges, oxygen cylinder, x-ray, blood, chemotherapy, anesthesia, organ donor expenses, pacemakers, and radiotherapy incurred when the policyholder is hospitalized. 

Hospital Room Costs

It covers the expenses incurred for the hospital’s Intensive Care Unit or wards. These are fully reimbursed or settled with the network hospitals’ cashless facility. 

Day Care Treatment Expenses

Day care treatment doesn’t require the hospitalization of the insured and can get over within 24 hours. Radiation, cataract treatment, lithotripsy, chemotherapy, dialysis, and tonsillectomy are some expenses covered by the mediclaim policy. With rising lifestyle disorders and medicines, treatment, and hospitalization expenses, the need for mediclaim insurance policy has increased only. 

What does Mediclaim Policy not cover?

Following are some standard exclusions in mediclaim policies:

  • Plastic surgery
  • Pre-existing illnesses
  • Vaccinations
  • Cosmetic surgery
  • Dental treatments
  • Sexually transmitted diseases
  • External cosmetic devices like contact lenses
  • Birth control expenses

To Sum Up

A mediclaim policy has become necessary for every individual in this fast-changing world. A person can avoid future financial difficulties from expensive medical treatments with a good insurance policy. Thus, getting a mediclaim policy offering adequate coverage and benefits is one of the best decisions. It is important to read the terms and conditions of the policy in detail before buying it.