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What Exactly Does a Mediclaim Insurance Cover?

What Exactly Does a Mediclaim Insurance Cover?

Insurance is constantly changing and evolving. Today the discussion turns toward Mediclaim insurance which is actually one of the newest forms out there. The concept behind Mediclaim is quite simple: to ensure that all of your medical expenses are properly reimbursed by the insurance company on an indemnity basis. Mediclaim is the only voluntary health insurance policy in India that had about 8 billion subscribers in 2012 and the number has been rising since then. Older policies, before the Mediclaim revolution would have required you to pay the cost of the procedure or office visit beforehand, and claim your refund later on, after it had been determined that the insurance company would in fact cover it. With Mediclaim you can now hand over a cashless insurance card, and the insurance company will be billed directly. For those who do not have cash in hand, this is a vast improvement. That being said, in a way, Mediclaim covers a lot that’s needed.

A Cost Effective Solution 

Without a doubt, health insurance is the most cost effective insurance method, ensuring that you are covered for your ailments which are either happening now, or those that will become an issue in the future. This is one policy that is recommended for all to reduce the costs of hospitalization.

In the event you find yourself hospitalized, the cost of the Mediclaim policy will only be a small fraction of what it would have been otherwise. Typically one would expect to pay anywhere between 0.5% and 2% of the full cost, meaning the policy has great benefits for anyone needing medical care. Generally, insurance providers cover up to INR 10 Lacs as it does in the case of ICICI Lombard’s mediclaim insurance.

Peace of Mind: Purchased 

Very rarely can you actually purchase peace of mind, but Mediclaim makes it more than possible. You will pay only a fraction of your income and in return, you will receive the assurance that all of your medical bills will be covered, and that you will be able to continue living your life in peace. From that perspective, this is without a doubt one of the most important investments that you can make, at least as far as your healthcare is concerned.

What is covered by Mediclaim?

When you obtain any type of insurance policy, you will obviously have a number of questions, mostly pertaining to the type and amount of coverage that you will be receiving. For example, will it cover all of the potential injuries that you might receive? Will it work for your lifestyle? These are all important questions, and to that end, we have compiled a list of coverage items from Mediclaim:

  • Expenses of Inpatient Hospitalization in India as a result of Illness or Accident
  • Patients from ages of 3 months to 80 years receive full coverage
  • Range of coverage goes from Rs.50000 to Rs.500000
  • Pre-existing diseases are covered under Mediclaim after five years so long as there is no break in coverage.
  • Policy can be taken out for the paying individual, or for the members of their family.
  • Family members covered are eligible for a 10% discount off the premium
  • No medical examination is required for acceptance so long as the beneficiaries of the policy are younger than 45 years.
  • The premium is now eligible for income tax benefit under section 80D.

Mediclaim Covered Risks

This form of coverage takes care of medical expenses that are the direct result of covered disease or surgery assuming the insured individual is admitted as an inpatient. In addition to that, the cover extends to both pre-hospitalization and post-hospitalization for 30 and 60 days.

Items that are excluded by the Mediclaim Coverage

As is to be expected, there are some things that will simply be excluded from Mediclaim coverage, and the last thing you want is to be surprised when you visit the doctor’s office. To prevent that, please read the following list and understand the limitations.

  • Pre-Existing diseases in the first 30 days will not be covered
  • Incidents occurring in the first 30 days will not be covered except for injury
  • Treatments related to pregnancy and childbirth
  • Treatment for cataracts
  • Treatment for benign prostatic
  • Hypertrophy
  • Hysterectomy
  • Menorrhagia
  • Fibromyoma
  • Hernia Fitula
  • Sinusitis
  • Asthma
  • Bronchitis
  • Psychiatric/Psychosomatic Disorders

There are several restrictions, obviously, but that does not mean that this type of coverage should be entirely discounted. As a matter of fact, it is one of the most useful coverage packages in India at the moment. Rather than being forced to part with your life savings, you can have everything paid ahead of time, and you will never need to empty your pockets entirely for your medical bills again. The cost of paying for Mediclaim is very small compared to what you would be paying for hospital visits, stays, and related healthcare. This is the start of the rest of your life, and it’s a great one to try out.

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