Nobody likes to spend their hard-earned income on medical expenses, which are very large in amount because any check-up, surgery or treatment that you get from hospitals or clinics is very expensive & to pay for them is not everyone’s cup of tea.
An insurance policy called a mediclaim provides financial protection and security in situations of medical emergencies. It covers medical costs that can arise from hospitalization or surgery following illness or accident. In return for the coverage of these expenses, you need to pay the mediclaim premium (it is the amount of money that you need to pay to the insurer to take the medical coverage).
Paying for your treatment is done through either a cashless facility or through means of reimbursement offered by your insurance company. Mediclaim insurance plans reimburse your costs upon submission of appropriate proofs like medical bills.
What is a mediclaim policy?
Mediclaim, which is often referred to as Medicare insurance, is a method of mitigating your risk via monetary means. It is health insurance that covers your hospitalization expenses as well as any specific ailments and treatments you may receive while in the hospital.
In addition to your health insurance plan, you can also gain tax benefits under section 80D of the Income Tax Act, which allows you to take a deduction under tax laws for the insurance premium paid for your family members.
Difference between mediclaim & health insurance policy:
- Nature of expenses: Medications are usually covered by mediclaim policy while health insurance covers hospital stays as well as pre and post hospitalization expenses, along with a variety of other benefits, such as capped loss compensation, ambulance charges, and the like, depending on the policy.
- The necessity to get hospitalized: It is mandatory for an insured to obtain mediclaim benefits to receive them, while this is rarely the case under a health insurance policy as it doesn’t force you to get hospitalized and only then they will pay the expenses.
- Amount of cover: Medical insurance plans offer comprehensive coverage for ailments that are not included in mediclaim policies. A comprehensive plan offers greater coverage and can be tailored to fit your needs. Mediclaim policies are limited in scope and can be restricted but health insurance plans cover a variety of ailments.
- Add on benefits: Adding additional benefits to your health insurance policy, such as critical illness coverage, accident coverage, accident disability coverage, maternity coverage, etc., is not possible with mediclaim policies
- Flexibility: Health insurance plans offer more flexibility with regards to the duration and the premium amount of a medical insurance plan. A medical insurance policy lacks flexibility concerning these factors.
What factors decide the eligibility of mediclaim policy?
- Age: In general, mediclaim policy eligibility is determined by your age. The standard entry age is 91 days to 65 years; however, many insurers accept different age groups, based on the policy offered. Additionally, ageing may increase the likelihood of you undergoing medical treatment, so the sooner you begin your policy, the better.
- Medical check-ups: Some insurance companies do not request medical reports for young people. But insurers make it compulsory for people over the age of 45 to get a check-up.
- Mediclaim premium: Smokers and alcohol drinkers are more likely to need higher premiums if they smoke, whereas those who consume alcohol usually pay a lower premium. The premium for a policy depends on the age, sum insured chosen, policy type and the number of insured members.
What all is included in a mediclaim policy cover?
Mediclaim coverage may be provided for different reasons depending on the insurance company. These are the most common coverage benefits:
- Expenses of the hospital:Costs incurred by hospitals associated with hospitalization, such as medicines, oxygen, blood, laboratory services, medical tests and diagnosis, chemotherapy, radiotherapy, and organ transplants.
- Accommodation expenses of the hospital: Company reimbursements cover expenses related to ICUs either through cashless hospitalisation or by meeting the company’s reimbursement policy
- Medical expert charges: Medical professionals like doctors, nurses, and other healthcare providers that are involved during hospitalization are also covered by mediclaim
- Expenses before & after hospitalization: It may also include medical assistance for emergency services like an ambulance to recover from hospitalization. Expenses may cover 30-60 days before and 60-120 days after hospitalization.
Cashless coverage is only available for insurance policies that are associated with a network of hospitals. Examine the network of hospitals in your policy and visit the website of the insurer and its affiliated hospitals before you make a final choice.
Keep your medical insurance policy active, pay the premiums consistently, and deal strictly with the terms and conditions to avoid rejection of claims. For the best mediclaim policy, reach to Care Health Insurance & avail variety of benefits along with your health policies.