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Mediclaim Insurance

You never know when a medical emergency might knock at your door and having an access to the best possible healthcare is the need of the hour. In today’s world, Mediclaim Insurance is quite essential for securing both the individual or family’s health. A mediclaim policy ensures that you receive the best possible quality medical treatment, in case of any medical emergency.

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Need to Buy a Mediclaim Policy

With a medical insurance plan, you can easily afford escalating hospitalization and other related healthcare costs. Considering the annual premiums you pay, the health cover you get is much more valuable. A medical insurance or mediclaim policy provides financial cover in case of treatment of any illness, disease, accident or medical condition, so apart from providing quality health care, it also helps safeguard your hard earned money.

Types of Mediclaim Insurance in India

It is imperative to pick the best mediclaim policy in India, so you can get an adequate health cover against unforeseen health problems. Here are the key categories of mediclaim insurance policy that suit you & your family’s health needs.

Individual Mediclaim

An individual mediclaim policy provides a medical cover for an individual and one can claim reimbursement up to the maximum of sum assured opted towards treatment.

Family Floater Policy

A family floater mediclaim policy provides medical cover for your entire family, including spouse, kids, parents and some medical policy provides cover for parents in laws as well. The sum assured opted is shared among the covered members under the policy.

Senior Citizen Policy

Mediclaim policy for senior citizens

Provides health cover for senior citizens and you can also include your spouse to cover the medical needs. With the right medical cover, you don’t have to pay huge medical bills at this stage of the life.

Critical Illness Policy

A critical illness medical insurance policy covers financial expenses that may incur due to diagnosis of critical illnesses/diseases such as Cancer, Heart attack, Stroke, Kidney Failure, Major Organ Transplant, etc.

Coverage Available Under a Mediclaim Policy

Following are the key benefits and coverage available, when opted for a mediclaim policy:

Hospitalization Expenses

A medical insurance plan covers in-patient hospitalization costs that may incur due to an illness, accident, or any medical procedure. It pays for room rent, blood, oxygen, medical practitioner, operation theater charges, etc.

Pre-Hospitalization Expenses

The medical expenses that incur due to illness before hospitalization. The days covered for pre-hospitalization may differ from insurer to insurer.

Post-Hospitalization Expenses

The medical expenses that incur due to illness post discharge from hospital. The days of post-hospitalization may differ from insurer to insurer.

Day Care Procedures

Day care procedures include some medical or surgical procedures that require hospitalization for less than 24 hours. Several insurers cover the listed day care procedures.

Hospital Daily Allowance

Daily cash benefit is payable on in-patient hospitalization with the required minimum stay in the hospital. This cash benefit depends on the terms applicable under the policy.

Ambulance Charges

Ambulance charges for transferring the insured from home to hospital or to another hospital for betterment of the insured are payable.

Ways to Get Claim under a Mediclaim Policy

Under the mediclaim policy, you can get claim through Cashless and Reimbursement procedure.

Cashless Procedure

With cashless mechanism, you need to get the medical treatment in one of the network hospitals, then the insurer settles claim with the hospital. You don’t need to pay medical bills arising from the treatment.

Here is the procedure to get the cashless mediclaim:

• When looking to get the cashless claim settlement, you firstly need to produce the health card issued by the insurer. The TPA helpdesk then verifies the health card and you also need to produce a photo ID proof.

• After completing the verification process, the hospital sends the pre-authorization request to the insurer’s TPA.

• The TPA verifies your details with the policy opted by you. The assigned TPA then approves/deny/query for cashless treatment.

Reimbursement procedure

In case of Claims Reimbursement procedure, you can get treatment in any hospital of your choice.

Here is the procedure to get the Reimbursement claim settlement:

• Inform your insurer or assigned TPA about hospitalization.

• At the time of discharge, you need to pay the medical bills and collect all the original copy of medical bills and reports

• Send the duly filled reimbursement claim form to the insurer along with the documents as asked by the insurer.

Key Tips to Buy a Right Mediclaim Policy

Following are the essential points that you should consider prior buying a mediclaim insurance policy:

1. Buy Plan Wisely

It is imperative to pick a medical insurance plan that caters all your & your family’s healthcare needs. You may opt for an individual plan, when looking to insure your individual health care requirements. A family floater plan would be the best fit, when looking to cover your family’s healthcare needs.

2. Buy Adequate Cover

Before buying a plan, it is advisable to choose the right sum assured that seems adequate to all your health care requirements. When under-covered, the hospitalization may require you to pay medical bills from your pocket. When over-covered, you need to pay the higher premiums for a health cover that you don’t require.

3. Read the Fine Print

It is important to know the plan in and out. You should not buy a policy unless and until you read the fine print to avoid hassles in the future regarding claim.

4. Compare & Buy Plans Online

There are several insurers that offer a number of medical insurance plans with varying benefits, so it’s wise to compare plans online. At, you can compare, choose and buy a health insurance plan that is right for your healthcare needs.