Mediclaim – Part 2

How much Mediclaim to take?

There is no fixed rule for how much Mediclaim one requires. However I would suggest a cover of Rs 5 lakh for people earning up to Rs 20 lakh, 10 lakh for people earning up to 50 lakh and Rs 20 lakh for people earning Rs 50 lakh and above.

How to choose best Mediclaim?

We always feel that the group Mediclaim which we receive from our company or private Mediclaim which we have taken is sufficient for our protection. Have you ever thought that we take insurances to provide support to our family and dependents and not always for self?  So, it is very important to choose the best Mediclaim. Let us see how:

1) Cashless Tie up: Always choose a Mediclaim which has a cashless tie ups with the hospital nationally or internationally so that you or your family doesn’t have to wait to get the treatment. Out of 50000 hospitals,  only 8000 hospital have cashless facility.

2) Room Rent: It is important to know that what percentage of sum assured is covered under room rent expenses or there is no cap. Per day bed charges is very  aspect while choosing the Mediclaim policy. Single private room should be allowed. Rs 5000/- as of today per day is must because the entire quality and line of treatment depends on which room occupancy is done by the patient.              

3) Pre & Post Hospitalization expenses: Check always whether it covers the treatment expenses after diagnosis , before hospitalization and the treatment expenses post discharge till the time it is cured. Usually 30 days pre and 60 days post is good. 

4) Sub Limits: Sometimes in Mediclaim policy there is a sub limit for a specific treatment. For example: If you go for a kidney stone treatment which requires hospitalization, the Mediclaim only covers for a specific amount for this treatment. If the treatment costs you Rs. 1 lac, the sub limit of your coverage will be only Rs. 40000, so you will have to shell Rs. 60000/- from your pocket. So be aware of the sub limit in Mediclaim.

5) KWP (Key Waiting period) is the waiting period for preexisting illness. Usually it varies from 2 to 6 years. Lesser the KWP better the policy.

6) No claim bonus is an amazing benefit. The NCB is the bonus money added to your sum assured for every claim free year. This increase the amount in sum assured which you have already taken.      

7) Restoration benefit is a benefit wherein the insurance company restores the original sum insured after it gets fully exhausted for the treatment of the illnesses. So, even if you consume the entire sum insured, you need not worry as you have this benefit of restoring the entire amount which you can use it in the future.

8) Premium Comparison: Always compare the cost of the premium given by insurance company. You must check which insurance company is giving the maximum benefit with a lower premium.

9) Claim settlement Ratio, As I said earlier always take Mediclaim from an insurance company which have at least 95% & above claim settlement ratio. This means the insurance company is having a good track record of settling the claims.

10) Always prefer in house claim settlement instead of TPA’s (Third Party Administrators).

11)Health insurance is a “promise” so who is promising you? Is extremely important. You must be comfortable with brand and the insurance company should have good past track record , as these are all long-time commitments.

Things to be Considered

• Claim Process
• Selecting the right insurance amount
• Network hospitals
• Avoid TPA prefer in house claim settlement
• Pre/Post Hospitalization
• Free medical check up
• Don’t hide your health information
• Don’t hide your family health history
• Check the policy papers once you get it
• Communicate to your family 

I think this was an exhaustive detail on the features and benefits of Mediclaim. I also explained what are the important factors while choosing the Mediclaim.

Let us now move to Critical Illness Mediclaim. Mediclaim Policy covers only the hospital expenses. But it is also important to protect the major organs of the body, which can be insured under Critical Illness Mediclaim. Let me show a comparison between Mediclaim Policy and Critical Illness Mediclaim.