10 Things to Know About Mediclaim Policy
10 Things to Know About Mediclaim Policy
Posted On : 18 February 2021, 7 Months Ago. Health-Insurance
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A mediclaim policy is a long-term investment that could provide you with financial support and relief in the event of a medical emergency, unexpected illness or accident. Nowadays having a mediclaim or health insurance policy is considered to be more or less essential. As a result, the market has a vast number of health insurance policies available for individuals to purchase, each with unique advantages suited for different requirements . In this article, we will have a look at 10 things to know about mediclaim policies, which might help you make a better decision while purchasing a health insurance plan for you and your family.


10 Things to Know About Mediclaim Policy -


1. Types of Mediclaim Policy


There are a number of mediclaim insurance plans available in the market. Identifying your needs might help you ascertain better what it is that you are looking for. An individual mediclaim policy, for instance, will provide you with medical coverage for one person, most likely yourself, under one premium payment. A family floater plan, on the other hand, includes your direct family under its umbrella as well. Having a better understanding of your requirements could potentially help you pick a plan that is better for you.


2. Inclusions of the Mediclaim Policy


The features included in a mediclaim policy usually vary based on the insurance provider. Some common offerings under your mediclaim policy could include coverage against pre and post hospitalisation charges, medical treatments, doctor visits and consultations, as well as cover against maternity care. Knowing the specificities of your mediclaim policy (such as the per day limit on a hospital room charge) can help you better tailor a plan for you and your family.


3. Exclusions of the Mediclaim Policy


When you purchase a mediclaim policy, the risk is transferred over to the insurer. As a result, they are likely to exclude some illnesses etc. from their coverage due to the high volatility and risk of said conditions. Policies usually have strict criteria for covering pre-existing conditions and are unlikely to offer medical coverage for cosmetic surgeries.


4. Types of Mediclaim Insurance Plans


Mediclaim policies offer a number of plans that affect how you receive your payout. Indemnity plans offer you coverage against any medical expenses, whereas fixed benefit plans offer a lump sum payout of a pre-decided amount.


The next few additions to this list will focus on features and clauses pertaining to mediclaim policies that you might not have been previously aware of:


5. Cashless Mediclaim


The ability to avail of cashless facilities at your hospital of choice is an essential requirement where mediclaim policies are concerned. Given that in medical emergencies, time is of the essence, it would be beneficial to ensure that the policy of choice offers cashless facilities in hospitals you are likely to visit.


6. Riders


Riders are ‘add ons’ that you can purchase in addition to your base health insurance policy. From a maternity cover rider to riders for room rent (in order to ensure there are no surprise charges based on high hospital room fees that might crop up later) there are a vast number of add ons available in the market. Some notable examples include critical illness riders which extend coverage to certain critical illnesses such as cancer and paralysis, and personal accident cover which extends coverage for death and disability caused by an accident.


7. Sub Limits


These are what most will recognise as ‘hidden costs’ and price limits that are present in a mediclaim policy. A general rule of thumb followed by most is that a ‘good’ mediclaim policy will have little to no sub-limits. This means that the policy is completely transparent with the insured, telling them exactly what they are and aren’t covered against.


8. Claim to Settlement Ratio


The claim to settlement ratio is one of the prime tells of the credibility of a health insurance provider. The claim to settlement ratio is an indicator of how many of its previous claims the provider has fulfilled, subsequently giving us an idea about the likelihood of being able to successfully make our claim. The higher the claim to settlement ratio, the higher the possibility of success.


9. Rules for NRIs


As a Non-Residential Indian, you still possess the ability to invest in a health insurance plan in India. This however comes with some attached clauses. The customer has to provide proof of residence, and any treatments and claims that one seeks and makes under the mediclaim policy have to be within the country.


10.  Cash and Reimbursement Claims


In the event that you have to claim your policy, there are a number of ways this can be done. Reimbursement policies require customers to keep track of all their expenses while at the hospital, which will then be reviewed and reimbursed by the insurer at a later date. Cashless payouts on the other hand allow the insurer to send funds directly to the hospital, omitting the need for you to run from pillar to post to get your policy benefits.




Mediclaim policies are considered an almost necessity in today’s day and age. However, going about figuring out how to purchase mediclaim insurance plans can be a daunting task due to the number of options available in the market. Based on the aforementioned points about mediclaim policies, you might be able to make a more informed decision while purchasing health insurance for yourself and your family.

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