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What is Mediclaim Health Insurance in India?

Posted On : 20 July 2023, 8 Months Ago. Blog Total Read 1756

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What is Mediclaim insurance?

Mediclaim Insurance, in its simplest terms is a medical insurance policy that covers an individual’s medical needs and costs, including but not limited to hospitalization, pre and post hospitalization charges, transferring the risk from you, the insured, to your insurance company, the insurer. . Similar to any other insurance policy, mediclaim insurance functions on routine premium payments.

Mediclaim policies provides their bearers with an extensive health coverage, including coverage for charges such as treatment, room charges, ICU charges as well as ambulance charges. It is considered an essential for almost all individuals and households, especially during this time of the covid-19 outbreak. Thankfully many insurance providers are providing coverage against the coronavirus in their mediclaim policies.

Oftentimes, “mediclaim” is used interchangeably with “health insurance”, however there are a number of varying characteristics that set the two apart. This article will help outline the difference between the two, as well as provide a more detailed definition and explanation about mediclaim policies.

Mediclaim Health Policy vs Health insurance -

Mediclaim, or medical insurance provides the insured with cover against any medical illnesses, including hospital and hospitalization bills. Health insurance on the other hand, provides its bearer with a more extensive and holistic coverage for their health, with the coverage extending beyond basic medical bills, to cover factors such as consultation with various specialists as well as any specialised tests one might require.

However, there are also a number of services that are provided by a mediclaim policy and the mediclaim health policy that is not provided by health insurance policies. Mediclaim insurance provides its customers with features such as cashless procedures, coverage for pre-existing disease, renewability age as well as reimbursement. Health insurance on the other hand does not provide cashless treatments, cash top-ups or medical checkups.

Types of Mediclaim policy

Primarily, similar to other health insurance policies, a mediclaim policy has two main types. Individual policies and group/family floater health insurance plan.

1. Individual mediclaim policy

An individual mediclaim policy provides its bearer with extensive medical coverage for a monthly premium subscription payment. Individual mediclaim insurance provides a health cover that insures an individual against any medical bills, including hospitalization and treatment charges, as well as room and ambulance charges. This insurance cover is best suited for individuals living by themselves without a family dependent on them, as they can enjoy the complete cover and benefits provided by the policy.

2. Family floater mediclaim policy

The biggest benefit of a family floater mediclaim policy is that it provides an insurance cover for multiple family members under a single premium payment. As part of this policy, the whole family is provided with a single cover, any amount of which can be availed by any member of the family. This proves to be an advantage over individual mediclaim policies as if one person has unused coverage that the other is in need of, this cover is not transferable. With a family floater mediclaim policy however, the common cover can be shared by any member.

Mediclaim Policy Coverage

A mediclaim policy provides customers with a number of benefits that are covered under their policy. In the event of contracting an illness requiring medical treatment, your mediclaim policy will cover all hospitalization costs (assuming your policy does not have hidden limits and sub limits, something it is recommended you check for before purchasing your mediclaim policy). Additionally, the mediclaim health cover will also provide compensation for pre and post hospitalization charges as well.

If you require a longer stay at the hospital due to your illness/ medical problem, your mediclaim insurance policy also covers any room charges that you would incur by your multi-day hospital stay. Your policy will also cover any costs of doctor visitations or consultations that you might require over the course of your treatment.

Benefits of Mediclaim Insurance Policy

There are a number of financial benefits of medical insurance as well. It eliminates out-of-pocket expenses as your insurance company covers these medical expenses. A mediclaim health cover also shields you from a potential financial burden in the event of illness. Furthermore, there are also tax exemptions that can be availed for mediclaim insurance, as well as the ability to buy insurance policies online/add-ons for your current mediclaim insurance online.

Tax Exemption - You can get health insurance tax benefits on the premium paid for the policy under section 80D of the Income Tax Act.
Pre & Post Hospitalisation Benefits - Medical expenses incurred on pre and post-hospitalisation are also covered under the policy. This includes OPD costs, patient-care procedures, ambulance charges, etc.
Coverage For COVID-19 Treatment - With the rise in COVID-19 cases and the high death rate. Insurance companies have to cover the cost of the treatment of the disease.
Cashless Treatment - You can avail the benefit of cashless treatment at the network hospitals mentioned in the policy. You just need to show the medical card issued by the insurer to get the patient admitted to the hospital.

Conclusion:

Statistics show that in the financial year 2019, over 427 million Indian citizens were covered under various mediclaim and health insurance policies. In 2018, just about 35% of the Indian population was covered under mediclaim policies.[1] Mediclaim policies are an essential for any individual or family, as it comes with a plethora of benefits that could prevent a financial or medical crisis in the future, though it might seem like the payoff in the short run is minimal.

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