Mediclaim policy meaning and types
With medical issues and inflation on the rise, a Mediclaim policy is a must in today’s times. However, before you buy one, you must understand how the policy works, what its types are and other relevant information. Here’s everything you need to know.
What is a mediclaim insurance policy?
A Mediclaim policy is a type of health cover that pays for hospitalisation expenses arising due to an illness or accident. It is often confused with regular health insurance. However, unlike health insurance, it does not cover specific illnesses, preventive care or any treatment outside of hospital stays.
How does the mediclaim policy work?
A Mediclaim policy covers hospitalisation costs. If admitted due to a medical issue, the policyholder can file a claim with the insurer. The insurer then reimburses the expenses up to the policy’s coverage limit. Some plans also offer cashless treatment at network hospitals. In other cases, you must pay first the hospital bill and claim the amount later.
What is the difference between Mediclaim Policy and Health Insurance?
Below are some differences between a Mediclaim policy and health insurance:
| Point of difference | Mediclaim policy | Health insurance |
|---|---|---|
Coverage |
Covers hospitalisation expenses, including the cost of treatment, room rent and other related expenses |
Covers hospitalisation expenses, preventative care, pre- and post-hospitalisation expenses, ambulance costs, cost of prescription drugs, Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) treatments and more |
Add-on riders |
Usually does not offer any riders and provides basic financial protection |
May offer riders like critical illness protection, maternity benefit and more |
Premium |
Costs relatively less as the scope of coverage is limited |
May cost more as the coverage is broader and includes a wider range of medical expenses |
Sum assured |
The sum assured is relatively lower as the policy only covers limited expenses |
The sum assured is relatively higher as the policy covers a broad range of expenses |
What are the benefits of mediclaim policy?
Below are some benefits of a mediclaim policy:
Coverage against hospitalisation expenses:
A Mediclaim policy offers financial coverage against hospitalisation expenses, ensuring you have sufficient funds in your hour of need.Affordable premium:
Mediclaim policies come with low, budget-friendly premiums, making them accessible to a wider range of people.Cashless hospitalisation:
A Mediclaim policy provides cashless hospitalisation at network hospitals, allowing you to enjoy a hassle-free experience.Tax benefits:
A Mediclaim policy may qualify for tax benefits under Section 126^ of the Income Tax Act, 2025.
What are the different types of mediclaim policies available in India?
Below are the different types of mediclaim policy available in India:
Individual mediclaim policy:
The policy covers individual policyholders and provides financial protection in case the policyholder is hospitalised due to an illness or accident.Family floater mediclaim policy:
The policy covers an entire family, including spouse, children, parents and parents-in-law. The sum assured is shared by all members and can be claimed if any one of them is hospitalised.Senior citizen mediclaim policy:
The policy is tailored for individuals above 60. It offers suitable coverage for health issues commonly faced by older adults.Women mediclaim policy:
The plan is designed for women and covers hospitalisation due to illnesses specific to women, accidents and maternity-related expenses.
How to choose the right kind of mediclaim policy for yourself?
Below are some things that you must ensure to select the right Mediclaim insurance policy for yourself:
Evaluate your medical needs:
Evaluating your health history and risks can help you make a choice.Consider your dependents:
If you have a spouse, children or elderly parents relying on you, a family floater plan might offer better value than individual policies.Assess your budget:
It is important to know how much you can comfortably spend on premiums without straining your finances.Compare plans:
Look at multiple options to understand their benefits, coverage limits, exclusions and premium costs. This helps you make an informed choice.
What is covered under the mediclaim policy?
A Mediclaim insurance policy covers hospitalisation expenses due to an accident or illness.
What is not covered under mediclaim policy?
A Mediclaim insurance policy does not cover the following:
- Pre-existing conditions, unless specified after a waiting period
- Pre- and post-hospitalisation expenses
- Ambulance charges
- Preventive care, such as routine health check-ups
Who should consider buying a mediclaim policy?
The following people can consider buying a mediclaim policy:
Single individuals:
Even without dependants or major health concerns, having Mediclaim ensures financial protection during unexpected medical emergencies.Married people:
It offers a safety net for medical costs, helping couples stay prepared for emergencies.Families:
A family floater plan can provide cost-effective coverage for all members under a single policy.Senior citizens:
With higher chances of hospitalisation, mediclaim can help cover the rising healthcare costs of older people.
Frequently Asked Questions - Mediclaim Insurance Policy
Why should you buy a Mediclaim Insurance Policy online?
Buying a Mediclaim insurance policy online can offer discounts and is more convenient. It saves time, and you can compare different plans easily before making a choice.
What are the factors that affect Mediclaim Insurance Policy premiums?
Factors such as your age, gender, health history and policy tenure can influence your Mediclaim premium.
Why buy a Mediclaim Insurance Plan at an early age?
Purchasing a Mediclaim policy at a younger age can help you get a lower premium, as you are generally healthier and less likely to have pre-existing conditions.
How to calculate Mediclaim Insurance Premium?
The premium for a Mediclaim policy is calculated based on factors like age, gender, tenure and health history. You can use a premium calculator to get an estimate of the plan’s premium.
Does mediclaim provide tax benefits?
Yes, some mediclaim plans may provide tax benefits under Section 126^ of the Income Tax Act, 2025. You need to check this with your insurer for more details.
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