Jun 02, 2016 9

What you should know Mediclaim Insurance Policies

Medical insurance is way too much different from a simple medical or health insurance policy that was invented earlier to ensure that you do not need to worry about expenses that may incur in the event of a medical emergency. Even a single insurance company has multiple plans, based on the coverage offered and the premium payable. Therefore, you should be very careful while choosing one, as it is about your health and every decision matters a lot.

Mediclaim policies bring along various rider benefits to enhance the policy coverage for additional scenarios. Some rider features overlap with the existing policy features while the others give an extension to the policy coverage. However, you must ensure that the policy you choose for your family or yourself is affordable and has adequate coverage in its mixed bag of benefits. In the below section, read the basics you need to understand before buying a mediclaim policy:

The Coverage

Mediclaim policies cover hospitalization expenses, which also includes both pre and post hospitalization expenses subject to the policy norms (usually 30 days before getting hospitalized and 60 days after discharge from the hospital). Insurance companies have tie-ups with various reputed hospitals across the country, which provide cashless service in the event of a medical emergency. If you buy mediclaim insurance policy online, then you may additional discount on the premium payment.

The expense reimbursement in case of hospitalization has two further categories – planned hospitalization and unplanned hospitalization.

1. Planned Hospitalization

Hospitalization of this type requires you to inform your insurer about the illness or disease you are planning to take treatment of. In such a case, you are supposed to get in touch with your insurer or the TPA (Third-party Administrator) directly and let the authority complete all the formalities with the hospital before the date of hospitalization. Once things are planned and executed correctly, your insurer is liable to bear the hospitalization expenses.

2. Unplanned Hospitalization

Unplanned or emergency hospitalization refers to an event of a medical emergency that requires doctor’s consultation immediately. This usually happens in the event of heart attack, stroke, blood pressure etc. To avoid any issue at the hospital, you can show up the health card issued by the health insurance company. However, you must inform the insurer or TPA about such a sudden hospitalization to make sure the formalities are taken care of in the meantime. Also, you could file a claim reimbursement if you did not get medical expenses taken care of by your insurer.

Policy Exclusions

Generally, mediclaim policies do not cover any disease or a leading hospitalization during initial 30 days of documents submission. Below is the list of medical conditions that even the best mediclaim policy does not cover:

• Any dental problem except the ones arising from an accident

• Treatment of any condition related to cosmetic, obesity, and aesthetic

• AIDS/HIV or Sexually Transmitted Diseases

• Any Plastic or Cosmetic Surgery or any such circumstances that relate to any accidental injuries

• Pregnancy or Childbirth if any

• Inoculation and/or Vaccination

In addition to above, health insurance policies do not cover any bodily injuries to the policyholder as a result of nuclear weapons, war or riots, any ionizing radiation etc. Any injury caused outside India requiring treatment, any unproven or experimental treatment, contact lenses is also excluded.


Insurance companies offer protection or coverage to their customers in exchange for a certain amount of money referred to as the premium. Generally, the premium amount varies with the insurance coverage availed by a policyholder. An additional payment is required to be made by the insured for availing additional coverage, usually through the inclusion of riders.

For instance, you can avail coverage against any critical disease like heart attack, stroke, kidney failure, any major organ transplant, and cancer etc.

Tax Benefit

Under section 80D of Income Tax Act, a mediclaim policy entitles you to get the tax benefit of the premiums payable towards the coverage offered by the insurer. It deducts Rs. 25, 000 from your annual taxable income based on the premiums payable towards the coverage you avail, whereas a senior citizen can deduct Rs. 30, 000 from his/her annual taxable income. On the other hand, if you pay the premiums for health insurance policies for your parents (age>60 years) along with yours, then you can deduct Rs. 55, 000 from your annual taxable income. Thus, do not forget to file you income tax return to claim the benefit.

The Verdict

Insurance documents include a myriad of terms and conditions that you usually overlook when purchasing the policy. However, these terms, in a nutshell, only decide how much coverage you can avail and on what all conditions. Thus, it is recommended to go through the policy terms to avoid any coverage-related issues in a medical emergency. If possible meet an insurance agent in person.