Types of Mediclaim
More About Mediclaim
A Mediclaim policy is a type of health insurance that provides financial coverage for medical expenses incurred due to illness, accidents, or hospitalisation. It helps policyholders manage healthcare costs by reimbursing expenses or offering cashless treatment at network hospitals. The policy typically covers in-patient hospitalisation, pre and post-hospitalisation costs, surgeries, and daycare procedures. Some plans may also include additional benefits like ambulance charges, domiciliary treatment, and critical illness coverage. Policyholders can choose between individual or family floater plans based on their needs. Mediclaim policies also offer tax benefits under Section 80D of the Income Tax Act in India.
Here are some of the notable benefits of buying a Mediclaim Policy:
The following are covered in Mediclaim Policies offered by HDFC Bank:
Typically, a Mediclaim policy does not cover certain medical expenses and conditions. These may include pre-existing diseases during the waiting period, cosmetic and aesthetic treatments like plastic surgery (unless medically necessary), and self-inflicted injuries or those caused by substance abuse. Expenses related to maternity and childbirth may not be covered in all plans unless specifically included. Dental treatments, infertility treatments, and experimental procedures are often excluded. Also, some policies do not cover non-prescribed treatments, OPD consultations, or alternative therapies unless stated. It is important to check the policy terms for specific exclusions and limitations.
Here are some key factors to consider before buying a Mediclaim Policy:
Choosing the right Mediclaim policy requires proper evaluation of your healthcare needs, budget, and policy features. Start by selecting an adequate sum insured based on medical costs and family requirements. Make sure the policy offers a wide network of cashless hospitals for hassle-free treatment. Check for pre and post-hospitalisation coverage, daycare procedures, and domiciliary treatment. Compare waiting periods for pre-existing diseases and maternity benefits. Look for no-claim bonus, lifetime renewability, and additional benefits like ambulance cover and organ donor expenses. Finally, compare premiums, exclusions, and co-payment clauses to find a policy that offers the best value for money.
To buy a Mediclaim policy, you must provide certain documents for verification and processing. These typically include identity proof (such as Aadhaar Card, PAN Card, Passport, or Voter ID) and address proof (such as Aadhaar Card, Utility Bill, Passport, or Rental Agreement). Age proof like a Birth Certificate, Aadhaar Card, or Passport is also required. Additionally, insurers may ask for passport-sized photographs and income proof (such as salary slips, bank statements, or ITR documents) if applicable. In some cases, medical reports may be necessary, especially for individuals above a certain age or those with pre-existing conditions.
Please note that the required documents may vary depending on the policy and insurer, so it is best to check the specific requirements before purchasing a plan.
Frequently Asked Questions
Yes, you can avail cashless hospitalisation with a Mediclaim policy at network hospitals. The insurer settles bills directly with the hospital, covering eligible expenses as per policy terms, reducing out-of-pocket costs.
An Individual Mediclaim Policy covers only one person, with a dedicated sum insured for their medical expenses. In contrast, a Family Floater Mediclaim Policy provides coverage for multiple family members under a shared sum insured, which any insured member can use as needed. The family floater option is often more cost-effective, especially for younger families, since the risk is distributed. However, an individual plan ensures that the full sum insured is available for one person, making it ideal for those with higher medical needs. Choosing between the two depends on family size, healthcare requirements, and budget considerations.
Yes, Mediclaim policies cover day-care procedures that do not require 24-hour hospitalisation. These include dialysis, chemotherapy, cataract surgery, and other advanced treatments. Coverage varies by insurer, so check policy details.
No Claim Bonus (NCB) in a Mediclaim policy is a reward for not making any claims during a policy year. It typically increases the sum insured by a fixed percentage (e.g., 10%-20% per year, up to a maximum limit like 100%). Some policies offer a discount on premiums instead. For example, in Niva Bupa Health Companion, the sum insured increases by 10% for every claim-free year. If a claim is made, the accumulated NCB may reduce or reset. NCB helps policyholders get enhanced coverage without higher premiums, making it a valuable benefit for long-term healthcare planning.
Yes, many Mediclaim policies cover alternative treatments like Ayurveda, Homeopathy, Unani, and Siddha under AYUSH treatments. For example, Arogya Sanjeevani, Niva Bupa Health Insurance Co. Ltd covers hospitalisation expenses up to ₹5 lakh, including day-care AYUSH treatments and a cumulative bonus of 5% per claim-free year (maximum 50%).