Mediclaim Policy in India

A Mediclaim policy provides coverage against medical expenses that one might incur. Individuals who have a Mediclaim policy can either raise a cashless or reimbursement claim. These policies also provide tax benefits to policyholders.

A Mediclaim policy provides the policyholder with financial assistance through cashless facilities or reimbursement during medical treatments and hospitalisation. It covers the insured against any medical expense that might occur during the policy period and also offers tax benefits under section 80D of the Income Tax Act of India, 1961.

What is Mediclaim?

A Mediclaim is a form of insurance wherein the insurance providers reimburse the policyholder for any medical expenses that he/she might have incurred in the policy period. The insured can either submit the relevant bills to get reimbursed or avail completely cashless facilities at the insurer's network hospitals.

Skyrocketing medical inflation rates have made Mediclaim policies or health plans a necessity to make healthcare affordable for the larger masses. Mediclaim policy is a type of health insurance that offers a health cover for illnesses and hospitalisation up to a specific sum insured. Such policies are valid for a particular period after which the policyholder has to renew it to enjoy the benefits.

Mentioned below are some important aspects of a Mediclaim policy:
  • Premiums: The premiums paid for Mediclaim policies differ from one insurer to another however, the factors that influence the amount are constant. Age, sum insured, policy period, etc., are a few of the factors that affect the premium.
  • Age: Mediclaim policies can be bought only if the consumer falls in the specified age group. Usually, insurers have an entry age of 18 years and an exit age of 65 years. However, sometimes the age group can start at 5 years and go up to 80 years.
  • Family cover: In a family cover, the policyholder can pay a master premium to cover his/her entire family instead of buying individual policies.
  • Overseas Mediclaim policies: Many insurers provide overseas Mediclaim policies under which the insurer can seek treatment in both India and abroad. However, such policies have certain conditions attached to them.
  • Claims: Claims are usually made through third-party administrators (TPA), but some insurers deal with claims in-house.
  • Types: Mediclaim policies cater to different needs and different individuals. One can choose from individual policies, group policies, critical illness policies, senior citizen policies, and maternity policies.
  • Tax benefits: Under section 80D of the Income Tax Act of India, 1961, policyholders can claim a tax deduction of Rs.25,000 against the premium paid for Mediclaim policies. The exemption limit is Rs.30,000 for senior citizens. Policyholders can claim an additional exemption of Rs.25,000 if they are paying the policy premiums for their parents.

Difference Between Mediclaim Policies and Health Insurance

The terms health insurance and Mediclaim policy are often used synonymously, however, both of them are different in nature. A Mediclaim policy works on an indemnity basis which means that any medical expense incurred by the policyholder will be reimbursed by the insurers. On the other hand, health insurance plans function on the benefit principle where a certain lump sum is paid out if the policyholder meets with a certain eventuality like critical illness, accident, etc.

Listed below are some of the major distinctions between a Mediclaim policy and health insurance:

Feature Mediclaim policy Health insurance
Coverage Mediclaim policies cover medical expenses and hospitalisation charges. Health insurance covers hospitalisation charges along with additional expenses like ambulance charges, daily cash allowance, etc.
Claim Policyholders can make unlimited claims until the sum insured is exhausted. Policyholders are given a lump-sum amount if they meet with an accident or are diagnosed with a critical illness. The cover ceases to exist after the pay-out.
Sum insured Mediclaim policies usually have a lower sum insured. Comprehensive health insurance plans offer a higher sum insured that can go up to a crore at times.

Factors affecting Premium Amount of a Mediclaim Policy:

Top 10 Factors affecting Mediclaim Policy Premium

Types of Mediclaim Policies Available in India:

The following types of Mediclaim policies are available in India for consumers to choose from:

  • Individual Mediclaim: An individual Mediclaim policy covers the policyholder alone against any medical expenses.
  • Family floater: In a family floater Mediclaim plan, a master premium is paid that financially supports the family members against any medical liabilities.
  • Group Mediclaim: In group Mediclaim policies, an employer or a person-in-charge of a group buys the policy for the employees/members. It is usually an addition to the compensation provided by the employer.
  • Senior citizen Mediclaim: Such policies are specifically designed for senior citizens and often have special provisions or require testing.
  • Critical illness Mediclaim: Mediclaim policies cover the medical expenses pertaining to the treatment of critical illnesses like cancer, kidney failure, multiple sclerosis, etc.
  • Overseas Mediclaim: An overseas Mediclaim policy allows the insured to make claims for medical expenses that were incurred outside India.
  • Low-cost Mediclaim: Low-cost Mediclaim policies are targeted at the underprivileged section of the society. Such policies are usually bought by employers in small and medium scale industries to insure their employees at low premiums.

Inclusions in Mediclaim Policies

A good Mediclaim policy can protect the insured against a vast range of medical expenses. Some of the expenses covered under such plans are mentioned below:

  • Hospital charges: It includes all the expenses incurred during the policyholder's hospital stay. Such expenses usually consist of medicines, blood, oxygen, operation theatre charges, organ donor expenses, x-rays etc.
  • Day-care treatment: It consists of the expenses pertaining to advanced medical treatments that do not require the patient to stay in the hospital for 24 hours.
  • Pre and post-hospitalization charges: Mediclaim policies usually cover the expenses incurred during the period before and after hospitalization. The covered period varies between insurers and can range from 30 days to 90 days. Such expenses usually include doctor's consultation fees, lab tests, and follow-up check-ups.
  • Hospital stay: Hospital room rent can get very expensive at times. However, Mediclaim policies cover the room rent as well. Rent for wards, private rooms, or ICU is fully reimbursed by the insurers or availed through cashless facility.
  • Medical professional's fee: Certain Mediclaim policies also cover the costs of consultation fees and medical professional's fees such as doctor's fees, nurse's fees, etc.

Exclusions of Mediclaim Policies

Exclusions refer to the diseases and medical conditions that are not covered under the policy. When buying a policy, the first 30 days are treated as the waiting period where claims can't be made. If the policyholder gets diagnosed with any disease in that duration, it won't be covered by the insurer.

The exclusions differ from one insurer to another. However, here are some medical conditions that are usually excluded from the policy:

  • Pre-existing diseases
  • Sexually transmitted diseases (Including HIV/AIDs)
  • Pregnancy and childbirth
  • Dental treatments
  • Vaccination
  • Cosmetic surgery and obesity-related treatments
  • Plastic surgery
  • Hearing aid, contact lenses, etc.

Benefits of a Mediclaim policy

Mentioned below are some notable benefits of a Mediclaim policy:

  • Cost-effective: It is an affordable way to combat rising healthcare costs.
  • Medical emergencies: Investing in a Mediclaim policy can prevent any financial stress during medical emergencies like accidents.
  • Cashless claims: It offers cashless facilities where the policyholder doesn't have to shell out any money from his/her pocket during hospitalization. The insurer pays the hospital directly.
  • Tax benefits: Investing in a Mediclaim policy allows the policyholder to claim tax benefits under section 80D of the Income Tax Act of India, 1961.

Claim Process for Mediclaim Policies

Mediclaim policies give policyholders the option of cashless facilities and reimbursement claims. In cashless facilities, the insured can get treated in any of the network hospitals of the insurance provider without paying anything from his/her pocket. However, if the policyholder chooses a hospital which is not in the insurer’s network, he/she has to bear the expenses which will be reimbursed by the insurer upon filing a claim.

Mentioned below is the process for filing claims:

  • Reimbursement claims: When going for reimbursement claims, it is imperative to inform the insurers or the TPA as soon as the policyholder gets hospitalized. It is important to keep all the bills and a track of expenses incurred during hospitalization. When filling the claim form, the bills have to be attached and the details are required to be filled in correctly. Even a minute error can delay the reimbursement process.
  • Cashless claims: The policyholder is expected to sign a 'preauthorization form' advance for planned cashless hospitalization. In case of emergency treatments, the insured can show his/her Medi-Assist ID card issued by the insurance provider at the network hospital after which the policyholder will be given 4 hours to fill the preauthorization form.

Factors to Remember When Buying a Mediclaim Policy

Buying a Mediclaim policy seems like a necessity with healthcare costs on a constant rise. However, it is essential to invest in a policy that suits the consumer’s needs. The following factors should be considered when buying a Mediclaim policy:

  • Coverage: Selecting an adequate sum insured is essential to ensure a good coverage. A higher sum insured might result in a higher premium amount but assessing one’s needs and picking the coverage can go a long way in protecting oneself against medical expenses.
  • Co-payment: Under a co-payment clause, the insured is expected to pay a specific percentage of the claims. A policy with a co-pay feature is usually much cheaper.
  • Sub-limits: Before buying a policy, it is crucial to take a closer look at the sub-limits as certain insurers have specific limits on some illnesses and treatments.
  • Waiting period: Claims can’t be made during the waiting period except for hospitalization due to accidents. Additionally, insurers have a waiting period for pre-existing illness and other diseases as well. Checking the exclusions during the waiting period can help the consumer make a better decision.
  • Network hospitals: Cashless facilities can only be availed in the network hospitals of the insurance provider. Therefore, a vast network of hospitals ensures that the policyholder has various options across different geographical locations.
  • Add-ons: Generally, Mediclaim policies do not offer add-on riders. But if the insurer provides it, investing in add-ons can significantly enhance the policy. However, buying unnecessary add-ons will only increase the premium amount without being useful for the policyholder.
  • Exclusions: Being aware of the exclusions in the policy is important as ignorance might lead to confusions when filing for a claim.
  • Free look period: A free look period allows the policyholder to return the policy and get a refund if he/she is not happy with the plan. This period gives the insured adequate time to go through the policy details. Using this time wisely can prevent the consumer from falling into a bad deal.

Mediclaim Policy FAQs:

ANS: Health insurance portability allows a mediclaim policy to be ported from the existing insurer to another insurer at the time of renewal without losing benefits such as waiting period and no-claim bonus. Portability is advisable if no claims have been made and the insurance premium is high or the claim process is challenging with the existing insurer. Only similar policies can be ported. Mediclaim policy can be ported with same insurer. The portability request has to be submitted 45 days prior to the policy expiry date.

ANS: Visit a third-party comparison website like to compare various mediclaim policies across the top insurance providers. Choose one that offers sufficient coverage at an affordable premium. Go to the chosen insurer's official website and apply for the policy, premium payment can be made online through the website using net banking, credit card or debit card.

ANS: Visit the National Insurance website and click on ‘Renew Existing Policy’. It will redirect you to a page where you can renew the policy by entering the policy number and registered email ID. You can view the renewal notice and total renewal premium to be paid. You will be directed to a secure payment gateway where you can make premium payment using net banking, credit card or debit card.

ANS: Before purchasing a mediclaim policy, determine whether you require an individual policy or a floater plan for your family, the renewability age criteria given by the insurance company, and if the chosen policy will cover pre-existing diseases. In order to select the right policy, compare the features and benefits of various mediclaim policies on an online comparison website like

ANS: Most insurance providers have an online insurance premium calculator on their websites. All you have to do is enter few personal details, the number of insured members, chosen sum insured, and the age of the eldest member in the online premium calculator. Click on ‘Proceed’ and the tool will display the insurance premium of your policy

ANS: Mediclaim policy will cover all your medical expenses in the case of hospitalisation or domiciliary care during the policy term. With the rise in healthcare costs and lifestyle diseases, having a mediclaim policy is useful. You don’t have to pay for the medical expenses out of your pocket. With a mediclaim policy, you and your family can get timely and adequate healthcare.

ANS: Employers in India offer a group health insurance policy to their employees as an incentive to retain talent in the company. Government employees receive health cover via central and state government insurance-based schemes. Employees can include their family members in the health cover. Mediclaim policy also gives tax benefits to the assessee on premiums paid towards a health insurance policy under Section 80D of the Income Tax Act, 1961.

ANS: In the case of a cashless mediclaim policy, all medical expenses are paid by the insurance company directly to the network hospital where the treatment is received. Cashless claim is subjected to the sum insured limit. The insured member doesn’t have to pay the medical expenses out of his or her pocket. Mediclaim cashless facility can be availed only in a network hospital of the insurer.

ANS: A group mediclaim policy covers the all employees of an organisation and their beneficiaries in the case of a hospitalisation or domiciliary care during the policy term.

ANS: In the case of a floater mediclaim policy, the sum insured can be shared by any or all members of the family for any number of claims during the policy term subject to the specified sum insured limit. A family floater mediclaim policy covers all the members of your family which includes self, spouse, children, and parents under one plan.

ANS: Overseas mediclaim policy covers medical expenses incurred due to an accident or sudden illness when traveling overseas. Your regular health insurance policy may not cover medical expenses incurred on a foreign soil. The healthcare costs in foreign countries are exorbitant, having an overseas mediclaim policy can be beneficial.

ANS: Health cover is a dynamic concept which keeps changing with time and the varying needs of the customers. Innovations in health insurance over the years are as follows:

  • Health insurance portability: Your mediclaim policy can transfered from one insurer to another without losing out on the policy benefits such as waiting period and no-claim bonus at the time of policy renewal.
  • Family floater plan: One policy will cover all the members of your family including self, spouse, children, and parents.
  • Add-ons or riders: Critical illness cover, personal accident insurance cover, hospital cash benefit, and maternity benefit cover are some of the riders that can be attached to your base health insurance policy for an enhanced health cover.
  • Lifelong renewability: Choose plans with a lifelong renewability option so that you can get health cover when you need it the most. Nowadays, most health insurance policies come with a lifelong renewability option.
  • Top-up health insurance plans: You can opt for a top-up health plan with a health cover of Rs.7-8 lakh and attach it to your base policy health cover of Rs.2-3 lakh to get a higher sum insured at a cost-effective rate.
  • Conditional cover replenishment: If no claims have been made, the health cover will be doubled for the following year at no extra cost.
  • Unit-Linked Health Insurance plans: These mediclaim policies offer health cover combined with investment. However, the returns will be affected a claim is made.

ANS: An individual mediclaim policy covers only one person in the case of hospitalisation or domiciliary care due to sudden illness or accident during the policy term.

ANS: National mediclaim policy covers hospitalisation expenses incurred for treatment of illness or injury of the insured member during the policy term. Individuals between 18 to 65 years of age are eligible for this policy. You can get coverage for children between the ages of 3 months to 18 years along with a parent. Over 140 day-care procedures are covered. You can avail cashless facility, tax benefits, and family discounts.

ANS: Listed below are some of the top mediclaim policies for parents in India:

  • Red Carpet Health Insurance Policy by Star Health and Allied Insurance for senior citizens aged between 60 to 75 years.
  • Silver plan Health Insurance Policy by Bajaj Allianz for senior citizens till 75 years of age.
  • Easy Health Insurance Policy by Apollo Munich for senior citizens till 65 years of age.
  • Heatbeat Health Insurance Policy by Max Bupa for senior citizens with no age restriction.
  • Rishtey Health Insurance Policy by ICICI Lombard General Insurance for senior citizens till 70 years of age.

ANS: Most insurers offer cover for pre-existing diseases after a 4-year waiting period. Group health insurance plans cover pre-existing diseases from day one.

  • Red Carpet Health Insurance Policy for senior citizens from Star Health and Allied Insurance covers pre-existing diseases from first year.
  • Silver Health by Bajaj Allianz covers pre-existing diseases from second year.
  • SBI Life Smart Health Insurance covers pre-existing diseases after completion of 2 years.
  • ICICI Lombard Complete Health Insurance with a coverage of Rs.3 lakh or more will cover pre-existing diseases after 2 years.

ANS: Listed below are some of the top mediclaim cashless policies available in India:

  • Easy Health Standard by Apollo Munich
  • Bajaj Health Guard by Bajaj Allianz
  • Mediclassic by Star Health and Allied Insurance
  • Health Companion by Max Bupa
  • Health Care Supreme by Bajaj Allianz
  • Optima Restore by Apollo Munich

ANS: Cosmetic procedures like LASIK surgery are usually not covered under regular health insurance policies.

ANS: Dental treatments are usually not covered by health insurance plans in India. However, special dental cover plans can be attached to the base policy to get dental cover. Here are a list of health insurance policies that cover dental expenses:

  • Bajaj Allianz Health Guard Policy
  • Apollo Munich Maxima Health
  • Bharti Axa Smart Health
  • ICICI Prudential Health Saver
  • SBI Life Smart Insurance

ANS: Here are a list of health insurance policies that cover pregnancy-related medical expenses:

  • Easy Health Family Floater by Apollo Munich
  • ProHealth Plus Plan by Cigna TTK Health Insurance
  • Total Health Plus by Royal Sundaram Master Product
  • Star Health Wedding Gift Pregnancy Cover
  • Heartbeat Family Floater by Max Bupa

ANS: Here are a list of top mediclaim policies for families in India:

  • Family Floater Mediclaim Policy by New India Assurance
  • National Insurance Mediclaim Policy by National Insurance Company
  • Family Floater Health Guard by Bajaj Allianz
  • Family Health Optima Insurance Plan by Star Health and Allied Insurance
  • Family Medicare Policy by United Health Insurance

News About Mediclaim Policy:

  • ESAF SFB and IFFCO Tokio General Insurance Enter Strategic Partnership

    IFFCO Tokio General Insurance Co. Ltd., one of the most renowned general insurance companies in India, has decided to join hands with ESAF Small Finance Bank (ESAF SFB), a scheduled bank based in Kerala, to enter a strategic partnership. This collaboration will allow the customers of the ESAF SFB to avail the benefits of the organized financial protection products related to their health and assets. IFFCO Tokio signed a Corporate Agency agreement with ESAF SFB at an event that was held at the IFFCO Sadan in New Delhi. This partnership also entails that ESAF SFB will further expand its range of financial services in order to offer value-packed insurance benefits while catering to its growing client-base. Furthermore, the customer of ESAF SFB will be able to access a plethora of value-rich general insurance services and products.

    As per the statements of the Managing Director and Chief Executive Officer at IFFCO Tokio General Insurance, Mr. Warendra Sinha, during the signing ceremony, the company is looking forward to the partnership with ESAF Small Finance Bank. With the help of this collaboration coupled with the unique model of ESAF SFB for delivering financial services to the unserved and under-served segments, IFFCO Tokio envisions to offer the customers exclusive insurance products at affordable rates.

    26 March 2019

  • Not more than 26% of individuals are covered under health insurance

    The level of penetration of health insurance in the Punjab, Haryana, and Chandigarh region still remains abnormally low. The lack of awareness is the basic reason behind these abysmal figures. As per the data published in 2017-18, only 1.53 crore individuals of this region were covered under a health insurance scheme. This figure is equivalent to just 26% of the entire population in the 2 states and the Union Territory (UT).

    In spite of the expansion of private sector health insurance coverage in this area, the growth of health insurance schemes is mostly dependent on the government run schemes or the social insurance schemes. The private sector coverage is mostly availed by the urban public. The individual health insurance coverage is also extremely low. In Haryana, about 44.15 lakh individuals are covered under certain group health insurance which is offered by their employers. Punjab, on the other hand, has only 4.98 lakh individuals who are covered under such group health insurance schemes. As per the data, only 22 lakh individuals across the states of Punjab and Haryana, as well as the UT of Chandigarh are covered under individual health insurance policies. Most insurance providers are of the opinion that the lack of awareness among the mass, is the main reason behind such poor figures.

    18 March 2019

  • IRDAI says Insurance Companies should spread wide and far to the remote areas to help increase health coverage

    The IRDAI has recently urged private insurance providers to spread out to the remote areas as well. It has also asked the healthcare providers to come up with plans to keep a check on the cost of treatment. The decision will help boost the health coverage across the nation.

    The chairman of Insurance Regulatory and Development Authority of India (IRDAI), Subhash Chandra Khuntia said that as per the statistics, in India about 62% of the average expenses related to health are borne out of the pocket. The world average for the same is 18%. He emphasised on the fact that the standardisation of procedures and rates which was offered by the healthcare providers was an important step. The penetration of overall insurance in India continues to be abnormally low. About 34% of the nation’s population, that is about 43 crore individuals, came under the regime of any health insurance in 2016-17. The data had been released by the National Health Profile (NHP) in 2018. The data was compiled by the Central Bureau of Health Intelligence. Experts are of the opinion, that the conditions have improved after the launch of the Ayushman Bharat scheme. However, the coverage is still estimated to be a little more than 40% of the total population.

    15 March 2019

  • Settlement of health insurance claims must improve: IRDAI Chief

    The Insurance Regulatory and Development Authority of India (IRDAI) has asked health insurers and health providers to raise the benchmark on claim settlements. IRDAI stated that the majority of the complaints they received were related to health insurance policies. Subhash Chandra Kuntia, Chairman of IRDAI, suggested that health insurers must practice the highest standard of ethics and make sure that there is no delay in the claim settlement process.

    The IRDAI Chief revealed that many policyholders find out about the exclusions of their health plans only after making the claim. He stressed on the need for simpler plans. He added that both the client and the business must benefit from the process. Subhash Chandra Kuntia further stated that health insurers should look into the affordability aspect of their policies. To make health plans available for common people, the landscape of health provision in the country must be changed. He opined that a change can be brought in the health situation in the country if the engagement with policyholders gets intense.

    14 March 2019

  • Rakesh Jhunjhunwala awaiting IRDA's approval to invest in Star Health Insurance

    Rakesh Jhunjhunwala, a billionaire investor, has cleared the air about buying a stake in Star Health Insurance company. Jhunjhunwala recently confirmed in an interview and his consortium is still interested in investing in the insurance company. Many rumours had circulated about Jhunjhunwala backing out from the deal.

    A well-known figure in the stock market, Jhunjhunwala confirmed that he still wants to invest in Star Health. He clarified that the consortium is awaiting the Insurance Regulatory and Development Authority's (IRDA) approval. Jhunjhunwala along with WestBridge AIF, Madison Capital, and Safecorp Holdings have signed deals with Star Health for purchasing 35 per cent of the insurance provider's stock. The 35 per cent stake will be sold for approximately Rs. 2,500 crore.

    Rakesh Jhunjhunwala is a billionaire investor and stock trader. He is well-known for his foresight in business investments. He is a partner in his asset management firm called Rare Enterprises and manages his own portfolio.

    13 March 2019

  • NHA and IRDAI Collaborate to Provide Support to Ayushman Bharat

    For the health insurance economy of the country to thrive and for Ayushman Bharat to achieve great heights, Insurance Regulatory and Development Authority of India (IRDAI) and National Health Authority (NHA) have come together to work on areas such as data standardisation, effective management of network hospitals, and so on.

    The working group set up by both entities currently has around 11 members in total. In the span of a year, the committee is planning to have a national repository of empanelled hospitals under the Government insurance schemes, with predetermined standards of quality and package rates and codes. The committee has further set itself a deadline in order to create standard data formats across all the health insurance players in the market, in order to analyse and focus on policy making.

    12 March 2019

  • Karunya Scheme in Kerala to be Implemented by Reliance General Insurance

    Recently, a number of insurance providers in the State of Kerala bid on the premium amount of the new scheme Karunya. The result of this bidding was the sure shot win of Reliance General Insurance, which quoted a total premium amount of Rs.1,671 for the scheme. Being the lowest bidder, Reliance General Insurance will henceforth be providing the Karunya scheme to the people of the state.

    Karunya scheme has replaced the RSBY scheme that has remained in the state of Kerala since the year 2008. Reliance General Insurance has offered a total premium of Rs.1,671 against a Rs.5 lakh health coverage. According to a report, this scheme has been said to be benefitting more than 49 lakh families overall.

    Health insurance has become an inevitable part of one’s life, as it offers comprehensive protection and coverage to the family of the insured individual and the insured individual himself. Owning a health insurance policy is as important as owning a life insurance policy. Many times, people rely on the health insurance provided to them by their employers. While this is a good and effective way of getting coverage, one has to remember that there are certain limitations to the benefits offered by such policies. For starters, you will not be able to get coverage for most illnesses and conditions from your employer’s health scheme. Second of all, the amount that you may receive as a claim will not be sufficient enough for the whole treatment. It is always advisable to purchase one’s own comprehensive individual health insurance policy.

    8 March 2019

  • TTK Healthcare Limited will Henceforth Circulate i-Health Inc Products in India

    Health insurance policies are a must in today’s date for they not only protect you against the ongoing disease you are suffering from but they also offer some relief on the financial front as well. These days, because of change and utter modification in people’s lifestyles, critical and lifestyle illnesses have become more than common. This is the reason why more and more health insurance providers are commencing offering comprehensive health covers to offer protection against any unforeseen or unannounced medical emergency or contingency.

    Therefore, it also becomes important for pharmacies and other entities to stay in tandem with the changing rules of the health insurance sector. In such a case, TTK Healthcare has just established an agreement with m/s I-Health Inc based out of United States of America for the distribution and circulation of their health and wellness products in the whole of the Indian subcontinent. This has come as a huge news as more involvement from the West will in turn ensure the establishment of a standard market in India.

    24 November 2018

  • Residents of Lakshadweep to get medical insurance

    The Department of Health Services of Lakshadweep administration is planning to roll out a comprehensive medical insurance scheme for all the residents of the island. As per the administrative officers, the scheme will offer free medical treatment to all the residents of the island. The Lakshadweep has a population of 64,429 as per the 2011 census. This scheme will cover all the people who are official residents of the island.

    General insurance companies have already received invitations from the administration for the tender through which the Universal Health Insurance for the residents of Lakshadweep will be implemented. The due date for the submission of tenders is on or before 12 December 2018. An officer stated that the administration that a similar insurance scheme was launched earlier by the administration which benefitted more than 5,300 families. He further added that the scheme will be very helpful for the residents as almost 80% of the residents have to travel for their treatment to the mainland and thus incur huge medical expenses.

    23 November 2018

  • IRDAI Mandates Coverage of Diseases After Purchase of Policy

    The Insurance Regulatory and Development Authority of India recently stated that chronic illnesses and conditions such as Alzheimer's, Parkinson's, AIDs/HIV infection and morbid obesity will obligatorily have to be covered under health insurance policies, even if the disease has been contracted after purchase of the policy.

    In addition to this, the working group has also suggested 17 diseases (in the form of a compiled list) wherein which includes chronic medical and health conditions such as Hepatitis B, chronic kidney disease, epilepsy, Alzheimer’s, HIV infection, and AIDS which could in turn be excluded from health insurance policies. Earlier this year the IRDAI had set up a working group for the purpose of standardisation of exclusions that exist in health insurance policies. The panel has therefore submitted a list of their suggestions that can make the entire mechanism smooth and convenient.

    The report that has been placed on IRDAI’s website says ‘The Working Group recommends that all health conditions acquired after policy inception, other than those that are not covered under the policy contract (such as maternity and infertility) should be covered under the policy and therefore cannot be excluded. Thus, exclusion of any chronic and serious health disorder cannot be excluded from any health insurance policy moving forward.

    Another observation that the panel has made is that misrepresentation of important material facts is matter of grave concern in health insurance policies. Therefore, more provisions will be in place soon enough.

    21 November 2018

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