With increasing cost of healthcare and lifestyle diseases has made it necessary for individuals to have health insurance . Mediclaim policy is health insurance policy that offers health cover up to the sum insured in the case of an illness or accident leading to hospitalisation. Mediclaim policy in India is issued for a specific time period. The policy has to be renewed for continued benefits.
Premiums – that are payable on Mediclaim policies differ between insurers but are based on certain criteria like age of the proposer, geographical area of treatment, sum insured, term of plan, etc.
Age – of insured persons can range from 5 years to 80 years, although age criteria and range insurable varies between companies.
Family cover – You can provide Mediclaim cover for your entire family with the payment of one master premium. This may also make you eligible for discounts on your premium, depending on your provider.
Overseas Mediclaim Policies – A large number of insurance companies offer Mediclaim policies that cover you in India and overseas, subject to certain predetermined conditions.
Claims – are administered largely through Third Party Administrators (TPAs) these days, but a few insurers deal with claims in-house.
Types – Mediclaim policies are available in a range of types, depending on the need and the category of those to be insured. You can get individual policies, group policies, senior citizen policies, critical illness policies and special maternity policies.
Tax benefits – under Section 80D are available up to Rs.15,000 on mediclaim premiums for yourself, spouse and dependent children. An additional Rs.15,000 of tax exemption is available if you insure your parents, and the amount goes up to Rs.20,000 if they are senior citizens.
Mediclaim policies offer excellent benefits and coverage for a wide range of expenses, depending on your insurance provider. Mediclaim policies in general offer the following benefits and cover:
Hospital charges – all direct charges that you incur as a result of hospitalization like OT charges, medicines, blood, oxygen, diagnostic material, x-rays, chemotherapy, radiotherapy, pacemakers, donor expenses during organ transplants, etc.
Day-care treatment – expenses towards specified technologically-advanced treatments where 24-hour hospitalization is not needed.
Pre and post-hospitalization expenses – for a period of 30 days before and up to 60 days after hospitalization and may include assistance in availing emergency services like ambulance, etc.
Hospital accommodation charges – in regular wards or in ICUs are fully reimbursed, or taken care of with the cashless hospitalization facility.
Medical professional’s fees – like doctor’s fees, nurse’s fees, anaesthetist’s charges, etc.
However Mediclaimdoesnot cover below stated things
All pre-existing diseases, medical conditions and injuries that are present before the policy comes into force.
All diseases and medical conditions (unless otherwise specified in your policy document) that arise within the first 30 days of your policy commencement date.
Injuries or medical conditions caused by war (whether it be declared or not), hostile foreign invasion or attack, war-like operations, etc.
Plastic surgery and circumcision (which is not necessary as treatment for illness or accident), cosmetic or aesthetic treatments of any kind.
Cost of spectacles, hearing aids, contact lenses, etc.
Dental treatment and surgery whether it is corrective, cosmetic or aesthetic – unless it arises due to an accident and requires hospitalization.
Intentional self-injury and attempted suicide.
Alcohol / drug abuse.
STDs like HIV / AIDS, human T cell lymphotropic virus type III (HTLB III), lymphadenopathy associated virus (LAV) or their variations.
X-rays, laboratory tests and other expenses incurred not in direct relation to the treatment.
Injury or disease arising from nuclear radiation or exposure to nuclear weapons and materials.
Pregnancy, childbirth, miscarriage, abortions, caesarean section, etc. or any complication arising from these.
Nautropathy related treatments.
Mediclaim policy is the most common health insurance policy available in India. Your health insurance policy can ensure you receive timely and adequate healthcare without worrying about putting a huge dent in your pocket. Here are some benefits of purchasing a mediclaim policy:
It is a cost-effective solution to afford adequate healthcare.
It reduces the financial burden faced by an individual in the event of a sudden illness or accident that leads to hospitalisation.
Mediclaim policy offers cashless hospitalisation wherein the insured member doesn’t have to pay for medical expenses upfront. The insurer will pay for the treatments received at a network hospital.
Cashless mediclaim policy ensures you don’t have out-of-pocket medical expense. Instead, the medical expenses will be paid for by the insurance company.
You can get tax deductions on premiums paid towards a mediclaim policy for self, spouse, and children under Section 80D of the Income Tax Act, 1961, for a maximum of Rs.15,000. You can get another Rs.15,000 tax benefit on premium paid towards a mediclaim policy for parents, Rs.20,000 if parents are senior citizens.It is strongly recommended that you take a Mediclaim policy for every member in your family, including children (perhaps through a family floater), as it is one large policy that covers everyone under it. It’s an excellent alternative to taking separate health insurance policies.