ICICI Pru MediAssure - How does MediAssure work?

What does MediAssure cover?

The policy provides you cover against inpatient hospitalisation, procedures and surgical expenses that require a minimum of 24 hours hospitalisation. In addition, over 125 day-care procedures are also covered.

The following expenses incurred during hospitalisation are covered, subject to your annual limit:

a. Room, Boarding and Nursing Expenses as charged by the hospital where the Insured availed medical treatment
b. Intensive Care Unit (ICU) charges
c. Fees for Doctor, Surgeon, Anaesthetist, Medical Practitioner, Consultant and Specialist
d. Anaesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical Consumables, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Cost of Artificial Limbs
e. Pre and Post hospitalisation expenses related to the hospitalisation

Please note:
Payout for Doctors’ fees (including surgeon, anaesthetist) will be limited to 30% of eligible claim amount for inpatient claims.
Payout for artificial limbs would be limited to lower of Rs 25,000 or 10% of the Annual Limit.

How does my plan work?

Choosing your plan is very simple

Step 1: Set your Annual Limit 

The Annual Limit is the maximum benefit payable under the policy towards all the eligible medical expenses described above and incurred during a policy year. You can select between various Annual Limit options i.e. Rs 2 Lacs, Rs 3 Lacs, Rs 5 Lacs, Rs 7 Lacs or Rs 10 Lacs.

Step 2: Select your Network 

You can choose between the Premium and Classic plans. The Premium plan gives you access to all List A and List B hospitals across India. The Classic plan gives you access to all List A hospitals across India along with limited access to List B hospitals as shown in the table below. 

Please Note: The Hospitals which are included in List A and List B will be available with your policy kit and also on this website in the Downloads section

What happens when I access out of network facilities?

A co-pay of 20% on the eligible medical expenses will be applicable in case you either

• Upgrade to a higher room type in the network hospitals, eg, a single A/C room at List B hospital, or,
• Access facilities at hospitals not listed in the chosen network, eg, if you have chosen the Classic plan and access care at a List B Mumbai hospital, or, if you access care at a hospital not given in List A or B.

Please Note: Co-pay is that percentage of the total eligible medical expenses that is borne by you while the balance is settled by the Company

What happens in an emergency?

In case of emergency hospitalisation related to cardiac or trauma cases, co-pay will not be levied even when the hospital is outside your chosen network. However your room eligibility in such a case will be to the extent of twin-share A/C room only.