What is a Mediclaim Policy?

Mediclaim policy is nothing but a health insurance policy that is designed to take care of one’s healthcare expenses up to the sum assured, in case the person faces any sort of medical emergency, be it an illness or an accident that has led to hospitalization.

One must also take note of the fact that a mediclaim policy in India is issued for a defined time period. Once the renewal date nears, the person needs to pay the premium before the due date so as to continue enjoying its benefits.

Why one should opt for Mediclaim Policy?

Ever increasing health care costs have made it necessary to opt for mediclaim policies in India. When it comes to health care, everyone wants to opt for best in class healthcare services. However considering the steep price rise in this sector, many of us are pushed to opt for a relatively lower quality of healthcare. But with a mediclaim policy, an individual is able to opt for the best type of medical healthcare, without having to worry about arranging large sums of money.

Types of Mediclaim policies in India

There are mainly two types of mediclaim policies in India.

  • Individual Mediclaim Policy – Under individual mediclaim policy, only a single person can be covered. The premium to be paid is based on the age of the person, who is being offered with health cover. The insured person can claim the entire sum insured, when needed.
  • Family Floater Mediclaim Policy – Under family floater mediclaim policy, one gets coverage for his or her family as well. The family comprises of self, spouse, dependent children and in some policies even dependent parents. The premium for this type of policy is based upon the family member who has highest age. Furthermore, the entire sum assured can be used by both the entire family jointly or by a single member alone.

Benefits of Buying a Mediclaim Policy

  • Cost-effective way of health care
  • Reduces one’s financial burden
  • Offers peace of mind
  • Availability of cashless hospitalization
  • No out of pocket medical expense
  • Medical expenses managed by the insurance company itself

Also see the dos and don’ts of buying a health plan Points to consider while buying Mediclaim Policies in India:

  • Health Care Coverage – Look for the kind of coverage being offered by the plan you are opting for. Make sure you opt for sufficient sum insured.
  • Co-Payment – One should check if there is any co-payment along with its percentage well in advance. Co-payment is the percentage sharing of the claim amount divided among you and your insurance company.
  • Look for Treatment Specific Limits – While buying a mediclaim policy, you should look if there are any limitations on certain specific treatments. At times insurers levy limits on certain specific treatments, like, cataract, cardiac treatments, etc.
  • Waiting Period – Ensure if your insurer has a waiting period for certain diseases. Furthermore, to get a much clear picture of the policy, it is necessary to check the policy terms and conditions as well.
  • Maternity Cover – Check if there is any health cover for maternity along with its terms and conditions. Also, check for the kind of maternity benefits being offered by the policy. Read here why every woman needs a separate health cover?
  • Network Hospitals – Check if the hospitals near your residence are empanelled under the insurance company from which you are to buy a mediclaim policy. Doing so makes it easier to avail cashless hospitalization as and when the need arises.
  • Policy Exclusions – Make sure you are aware of what all is being excluded from the policy. This, in turn guards you against last minute surprises, especially when filing a claim.
  • Policy Inclusions – Always check out what all things are being covered by the policy. This further helps you in selecting a policy that matches your health care needs.
  • Policy Terms and Conditions – It is necessary that you go through the terms and conditions of the policy. This helps in getting in depth knowledge about the entire policy.

The buyer must understand that mediclaim is mainly a hospitalization benefit policy that takes care of medical expenses that follows Hospitalization as well as domiciliary hospitalization of the insured person. It is also important to know that in this type of policy, the premium is based on the sum assured.


If the expenses towards medical treatment are approved by the insurance company, the insured is reimbursed subject to the sum assured.

Insurers provide cashless mediclaim policy which makes it easy for the insured to claim expenses without payment of cash. This is so long as he is treated at hospitals included in the insurance company’s network. The insurance company makes the payment directly to the hospital subject to specified terms and conditions.

If the policy does not provide cashless facility, the insured will have to foot the bill himself and then claim the money from the insurance company, assuming the expenses are approved by the insurance company.

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