What is Covered And Not Covered Under Mediclaim Policy?
What is Covered & Not Covered Under Mediclaim Policy?
Posted On : 12 February 2021, 8 Months Ago. Health-Insurance
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Advancements in medical technology have helped reduce the mortality rate of humans while increasing the recovery rate from any infections or diseases. Although this has seen a sharp rise in expenses of medical procedures by the day. It is hence crucial and essential to enrol for a health insurance or mediclaim policy for yourself, in case you do not have any existing health insurance policy to your name.

Having said that, it is also important for you to know what are the benefits of health insurance and mediclaim policy coverage, the list of diseases covered under mediclaim policy, and what is not included under your mediclaim policy. Here we will detail out the important aspects of mediclaim policy coverage and the diseases covered under mediclaim policy in general and inform you on what they cover and what they exclude.


What Is Covered Under Your Mediclaim Policy?


Here we shall look at the various aspects covered under mediclaim policy:


1. Taxation Benefits 


Premiums paid for self, spouse, dependent children and parents under mediclaim are absolved from taxation as under section 80 D of the Income Tax Act of 1961.


2. Pre-Hospitalization and Post-Hospitalization Costs


All costs related to pre hospitalization and post hospitalization expenses like the treatment, diagnosis, specialists' charges, medication expenses, and so on are included in mediclaim insurance plans.


3. Free of Cost Annual Check Ups


Mediclaim insurance plans can get you access to free check ups on a yearly basis. It incorporates tests for ECG, kidney function, blood glucose, urine test, and blood groups.


4. Day Care Treatments


Diseases covered under mediclaim likewise covers day care treatment, i.e., you don't need to be admitted in the emergency clinic for 24 hours. Chemotherapy, cataract, dialysis, and so forth are incorporated in this section.


5. Domiciliary Hospitalization


You may likewise take the benefit of domiciliary hospitalization for diseases covered under mediclaim policy, if you are not in the condition to travel to the clinic. You will be reimbursed for treatments exceeding 3 days under mediclaim.


6. In-Patient Hospitalization


In the case of any health-related crisis, you can get the benefit of cashless hospitalization under diseases covered under mediclaim policy. You can avail the treatment without having to pay in cash. Costs incorporated under mediclaim coverage including room charges, nursing costs, ICU, specialist's expense, blood, oxygen, and OT charges can be paid through cashless mediclaim.


7. Extra Cover


Organ donor cover, ICU charges, NCB, elective medicines, complimentary ambulance service, and secondary opinions are additionally covered under mediclaim cover.


8. No Claim Bonus (NCB)


This is a bonus that you can get for not asserting your right to mediclaim cover during any year of your tenure with the company.


Aspects Not Covered Under Mediclaim Policy


Here we shall look at what all is not covered under your mediclaim coverage:


1. Corrective Cosmetic Surgery


Plastic surgery, cosmetic corrections, and implants are additionally not covered under mediclaim.


2. Inherent Diseases


Expenses brought about for congenital illnesses additionally don't get covered under medical. These illnesses or handicaps happen because of birth deformity.


3. Infertility Treatment


Tests and treatment identifying with infertility and in vitro fertilisation.


4. Pregnancy


Treatment emerging from or related to pregnancy, child labor, unnatural birth cycle, abortion, etc.


5. Sexually Transmitted Diseases


Medical costs brought about for the treatment of sexually transmitted diseases such as Chlamydia, HPV, HIV, Syphilis, Herpes and other such sexually transmitted illnesses are diseases not covered under mediclaim policy.


6. Prior Diseases


Any determination of infections/diseases/event of an occasion, where manifestations initially happen within the initial 30 days from the start date of the mediclaim insurance policy constitute the diseases not covered under mediclaim policy.


7. Injuries inflicted Due to Alcohol Consumption


Expenses emerging from or relating to alcohol or medication misuse or abuse.


8. Self-Induced Injuries


Expenses owing to self-caused injuries such as but not limited to suicides, attempted suicide, suicidal tendencies, and bungee jumping.


9. Permanent Exclusions


Hospitalization costs induced due to mob strikes, riots, war, and nuclear warfare are excluded in your mediclaim insurance.




We hope that these details will help you to make a better and more informed decision while buying health insurance plans or a mediclaim insurance policy. Max Bupa offers the best health insurance plans in India offering fast and easy claims to all its customers. Make sure you are choosing the right health insurance plan by opting for Max Bupa Health Insurance.

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