About Mediclaim

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What is Health Insurance ?

Health Insurance also known as Mediclaim in India provides you the cover against the medical care costs arising from disease or accidental injuries. Health insurance is a crucial financial product that every individual must have irrespective of their age. It allows you to focus on getting the best treatment without bothering about the financial costs of the same.  

Depending on the terms of the health insurance policy it covers all or part of the medical costs of treating the disease or injury including doctor's consultation charges, medicine and nursing costs.  Treatment can be sought in any recognized nursing home or hospital across India. This policy however usually does not cover routine medical expenses like outpatient care, and daily medicines.

Health insurance in India can be bought both as an individual or a family or as a group. Group Health Insurance is bought by either an employer or an association for its members. In this article we will be covering only health insurance for individuals.


How does health insurance work ?

To purchase health insurance, you need to pay an annual fee to the company for this coverage known as “premium. You choose the amount of coverage that you want, by paying a high or low premium. The higher the premium the more the coverage. Lets say, you choose a coverage of Rs 500,000 for the year. If during the course of the year,you incur some medical costs due to disease or injury – the insurance company will reimburse you up to the maximum of Rs. 500,000. This Rs. 500,000 can be used in one time or through multiple claims in one year. ”

This payout by the insurance company can be claimed in two ways :

  1. After the charges have been paid by your upfront. Claimed as a reimbursement where in you bear the costs first and then file a claim to the insurance company and its paid back to you.
  2. Cashless settlement – where if the treatment is sought in a hospital  which is associated with the insurance provider , the insurance company pays the hospital directly.


What are the Different Kinds of Health Insurance?

Individual Mediclaim Policy

This is the plain vanilla mediclaim or health insurance policy for an individual protecting this person from the expenses incurred due to disease or injury.

Floater Policy

A floater health insurance policy covers your entire family under one policy with one sum insured and one premium. It covers all the expenses as covered under mediclaim only the cover is now extended to the family instead of one person. This cover can be used by any member of the family any number of times. The advantage of this policy is that saves money by spreading the cover across family members.

Critical Illness Policy

Insurance companies define certain specified illness or diseases as “critical”. If you have a critical illness policy, then the insurance company will pay you a lump sum payment if you are diagnosed with a critical illness as defined by the insurance company.

Some of the diseases/conditions which are usually deemed critical are Cancer ,Heart Attack, Kidney Failure, Major Organ Transplant, Stroke,Paralysis and Heart Valve Replacement Surgery.

(For a more comprehensive list check with your insurer)

Unlike other general insurance policies, these policies come with multiple options in terms of sum assured and term of the policy. For example ICICI Lombard provides critical cover for 5 years for a Rs. 12,00,000 coverage. These policies are also available with disability coverage to ensure that you are also covered for loss of income during that critical period.

Overseas Mediclaim Policy

An Overseas Mediclaim Insurance policy provides cover for medical expenses incurred abroad for treatment of illness and diseases contracted or injury sustained during the insured period of overseas travel.  Anyone who is traveling abroad for business or pleasure or for educational purposes should have this policy.

Student Medical Insurance

Student Medical insurance covers the cost of health care while studying abroad. It is an essential requirement of many foreign universities for its overseas students. Students are generally advised to buy it in India as it is substantially cheaper than buying it abroad.

Tax Saver

This is a new class of insurance launched to take full advantage of the income tax benefit under section 80 D of the Income Tax Act 1961. The premium is fixed at Rs 15,000 for all plans. For Senior Citizens aged 65 and above, the premium is Rs. 20,000  This plans includes reimbursement of OPD expenses upto Rs. 10,000. This includes diagnostics tests, dental treatment and related expenses. This insurance is suitable for people who are looking to cover all their medical expenses in a tax free manner.

About Mediclaim