Mediclaim insurance in India, also known as Health insurance, is a vital financial tool that provides coverage for medical expenses incurred during illness or accidents. It safeguards policyholders against high medical costs by offering Cashless Hospitalization or Reimbursem*nt for treatment, hospitalization, and related expenses.
Further, COVID-19 has highlighted the importance of maintaining good health and being prepared for unforeseen medical emergencies. With the rising healthcare costs and increasing instances of lifestyle-related diseases, having a mediclaim policy is essential to ensure access to quality healthcare without financial strain.
Mediclaim policy covers below mentioned risks:
Hospitalization Expenses: Coverage for in-patient hospitalization expenses, including room charges, nursing, boarding expenses, and operation theatre charges.
Pre-Hospitalization and Post-Hospitalization: Reimbursem*nt of medical expenses incurred for a certain period before and after hospitalization.
Surgeon, Doctor, and Specialist Fees: Coverage for fees charged by the medical professionals involved in the treatment.
Diagnostic Tests: Coverage for medical tests and investigations, including X-rays, blood tests, etc.
Medicines and Implants: Coverage for prescribed medications and drugs during and pre-post hospitalization and recovery.
Ambulance Charges: Reimbursem*nt for ambulance services required during an emergency or hospitalization.
Organ Donor Expenses: Coverage for medical expenses related to organ transplantation procedures, including the donor’s surgery.
Domiciliary Hospitalization: Coverage for medical treatment taken at home due to non-availability of a hospital bed or when the patient cannot be moved to a hospital.
Daycare Treatments: Coverage for specific medical procedures that don’t require overnight hospitalization but are completed within a few hours like Eye Surgeries, ENT procedures, Cancer therapies etc.
Additional coverage provides enhanced protection and financial support beyond the basic health insurance policy on extra premium.
Add On Cover:
Critical Illness Cover: This coverage provides a lump-sum payment if you are diagnosed with a specified critical illness, such as cancer, heart attack, stroke, kidney failure, etc. It helps cover the high costs of treatment and other expenses during the recovery period.
Hospital Cash Benefit: With this coverage, you receive a daily cash allowance for each day of hospitalization.
Maternity Cover: This add-on is designed to cover expenses related to childbirth, including pre and postnatal care, delivery, and any complications that may arise during pregnancy.
Newborn Baby Cover: This coverage takes care of medical expenses for newborns immediately after birth, including any congenital conditions or complications.
Outpatient Department (OPD) Cover: OPD expenses like doctor consultations, diagnostic tests, and medications are covered under this add-on. Normally, OPD expenses are not covered under regular health insurance plans.
Alternative Treatments Cover (AYUSH): Some health insurance providers offer coverage for alternative treatments like Ayurveda, Homeopathy, Unani, etc., in addition to conventional medical treatments.
Personal Accident Cover: While not strictly a mediclaim coverage, this policy provides a lump-sum benefit in case of accidental death or disability resulting from accidents.
Sum Insured Restoration Benefit: With this add-on, your sum insured is restored to its original amount after it gets exhausted during the policy period. This is helpful in case of multiple hospitalizations in a year.
Cashless Facility: Many insurance providers offer cashless hospitalization where the insurer directly settles the medical bills with the hospital.
No-claim Bonus & Free Health Check-up: Some policies offer a bonus in the form of increased coverage or reduced premiums for every claim-free year and also offer free annual (or time bound) health check up benefits.
Exclusions:
There are a number of exclusions in the mediclaim policies, the important exclusion is related to the Pre-existing Diseases. Pre-existing Disease: is a health of condition of having diseases like diabetes, chronic obstructive pulmonary disease (COPD), cancer, and sleep apnea, Hypertension etc. At the time of taking an insurance policy. These preexisting diseases can be covered with a waiting period 1 year/ 2 years / 4 years. Some of Existing disease and/ or complications arising from it are permanently excluded in the policy.
Premium calculation for a Mediclaim policy takes into consideration of various factors that help assess the risk and determine the appropriate premium for the policyholder. These factors include:
- Age of the members to be Insured
- Opted Sum Insured
- Coverage and Benefits
- Health Condition in reference to Pre-existing Disease
- Lifestyle and habits
Many insurance companies in India offer diverse plans, allowing individuals and families to find suitable coverage as per their specific healthcare needs.
- Individual Health Insurance Plans
- Family Floater Health Insurance Plans
- Senior Citizens Health Insurance Plans
- Critical Illness Insurance Plans
- Women-Specific Health Insurance Plans
- Disease-Specific Health Plans
- Divyangjan Sanjeevani Health Policy
- Top-Up Health Insurance Plan and Super Top-up Health Insurance Plans
Insurance Policies can be specially designed as Group Health Insurance Policies for Corporate Houses as their Employee Benefits Scheme for the employees and their family. Group Health Insurance Policies can be given to Non employee- non employer groups also.
It is essential to choose a suitable policy based on coverage, exclusions, and network hospitals to ensure comprehensive health protection.
Our Role in Risk Evaluation & Suggesting in Proper Cover for our Valuable Customers
It’s important to note that healthcare costs can be substantial, and having mediclaim insurance can provide a safety net, peace of mind, and better access to quality medical care. It is advisable to carefully evaluate healthcare needs and financial situation before making a decision about health insurance coverage. It’s important to note that the specific benefits and coverage can vary based on the insurance provider, policy type, and terms and conditions. Before purchasing a mediclaim policy, it’s essential to carefully read the policy documents and understand the coverage offered to ensure it meets your specific healthcare needs.
At RM Insurance Broking Pvt. Ltd., with our in-depth knowledge and expertise, we understand the unique risks faced by Individuals and Families and can recommend suitable insurance products to mitigate those risks effectively. Our extensive network and strong relationships with leading insurers enable us to negotiate competitive premiums and provide prompt claims assistance. We advise the insureds obtain an appropriate insurance coverage through a risk management process, as below mentioned.
We, RM Insurance Broking Pvt. Ltd., are eagerly waiting for your patronage. We request you to provide an opportunity to serve you. We believe, you shall experience the difference.
