• Mediclaim Policy in India

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    What is Mediclaim?

    Mediclaim is an insurance product that reimburses the expenses you incur in the event of hospitalization or domiciliary care. It can either reimburse your expenses when you submit relevant bills, or enable you to have an entirely cashless hospitalization where your insurer will directly deal with the hospital – letting you focus on treatment and healing.

    Ever increasing cost of healthcare and lifestyle diseases has made it necessary for individuals to have health insurance in India. Mediclaim policy is health insurance policy that offers health cover up to the sum insured in the case of an illness or accident leading to hospitalisation. Mediclaim policy in India is issued for a specific time period. The policy has to be renewed for continued benefits.

    • Premiums – that are payable on Mediclaim policies differ between insurers but are based on certain criteria like age of the proposer, geographical area of treatment, sum insured, term of plan, etc.
    • Age – of insured persons can range from 5 years to 80 years, although age criteria and range insurable varies between companies.
    • Family cover – You can provide Mediclaim cover for your entire family with the payment of one master premium. This may also make you eligible for discounts on your premium, depending on your provider.
    • Overseas Mediclaim Policies – A large number of insurance companies offer Mediclaim policies that cover you in India and overseas, subject to certain predetermined conditions.
    • Claims – are administered largely through Third Party Administrators (TPAs) these days, but a few insurers deal with claims in-house.
    • Types – Mediclaim policies are available in a range of types, depending on the need and the category of those to be insured. You can get individual policies, group policies, senior citizen policies, critical illness policies and special maternity policies.
    • Tax benefits – under Section 80D are available up to Rs.15,000 on mediclaim premiums for yourself, spouse and dependent children. An additional Rs.15,000 of tax exemption is available if you insure your parents, and the amount goes up to Rs.20,000 if they are senior citizens.

    How is Mediclaim Different from Health Insurance?

    Insurance companies offer health insurance products under two broad categories – indemnity policies and benefit policies:

    • Benefit policies are mostly traditional health insurance policies which pay out a pre-determined “sum insured” amount on the occurrence of an accident, or diagnosis of any of the illnesses, diseases, conditions, etc. that have been insured against. Traditional insurance policies work this way, offering you a financial benefit up-front and not necessarily requiring you to submit hospital bills, etc.
    • Indemnity policies compensate or reimburse you for the expenses incurred during your hospitalization or domiciliary care, on the submission of necessary proofs, up to the limiting amount mentioned in the policy. Mediclaim is an example of such a product. Although with recent advancements, mediclaim enables cashless hospitalization facilities wherein the insurer pays the hospital directly.

    The most important difference between mediclaim and health insurance is that mediclaim will only reimburse your expenditure, and not provide you with a large-sum financial benefit in case you are rendered unable to earn.

    Types of Mediclaim Policies in India:

    • Individual Mediclaim - where you basically insure yourself against the financial liabilities of hospitalization.
    • Family Floater - where you can provide additional coverage for your entire family, and be tension-free in matters of hospital bills and related expenses.
    • Group Mediclaim - where an employer or person in charge of a group of people wishes to add to their remuneration the benefits of cashless hospitalization and / or reimbursement on hospitalization expenses.
    • Overseas Mediclaim - where all your hospitalization and related expenses are taken care of during your stay (or travel) outside India.
    • Low-cost Mediclaim - is for the underprivileged masses. Employers of small-scale and medium-scale industries insure their employees and their dependants for as low as Rs. 1,600 per annum.
    • Senior Citizen Mediclaim - while this type of mediclaim requires testing and/or special provisions, it’s a huge step forward for the industry as they can safely insure senior citizens at competitive premium rates.
    • Critical Illness Mediclaim - among the most expensive treatments in the field today are those incurred on treatment of critical illnesses. Critical Illness Mediclaim policies usually offer a higher claimable amount, and include some of (but are not strictly limited to) the following:
      1. Aorta graft surgery.
      2. Cancer.
      3. Coronary artery bypass surgery.
      4. First heart attack.
      5. Kidney failure.
      6. Major organ transplant.
      7. Multiple sclerosis.
      8. Paralysis.
      9. Stroke.
      10. Primary pulmonary arterial hypertension.

    Factors affecting Premium Amount of a Mediclaim Policy:

    Top factors that decides premium of mediclaim plan

    What does a Best Mediclaim Policy Cover?

    Mediclaim policies offer excellent benefits and coverage for a wide range of expenses, depending on your insurance provider. Mediclaim policies in general offer the following benefits and cover:

    • Hospital charges – all direct charges that you incur as a result of hospitalization like OT charges, medicines, blood, oxygen, diagnostic material, x-rays, chemotherapy, radiotherapy, pacemakers, donor expenses during organ transplants, etc.
    • Day-care treatment – expenses towards specified technologically-advanced treatments where 24-hour hospitalization is not needed.
    • Pre and post-hospitalization expenses – for a period of 30 days before and up to 60 days after hospitalization and may include assistance in availing emergency services like ambulance, etc.
    • Hospital accommodation charges – in regular wards or in ICUs are fully reimbursed, or taken care of with the cashless hospitalization facility.
    • Medical professional’s fees – like doctor’s fees, nurse’s fees, anaesthetist's charges, etc.
    • Investigation charges.

    What Does Mediclaim Policies not Cover?

    Different providers have different exclusions in their policies, some may not even consider the standard exclusions and provide benefits anyway. Nevertheless, a standard Mediclaim policy would not cover you for treatment or expenses arising from or attributable to the following:

    • All pre-existing diseases, medical conditions and injuries that are present before the policy comes into force.
    • All diseases and medical conditions (unless otherwise specified in your policy document) that arise within the first 30 days of your policy commencement date.
    • Injuries or medical conditions caused by war (whether it be declared or not), hostile foreign invasion or attack, war-like operations, etc.
    • Plastic surgery and circumcision (which is not necessary as treatment for illness or accident), cosmetic or aesthetic treatments of any kind.
    • Cost of spectacles, hearing aids, contact lenses, etc.
    • Dental treatment and surgery whether it is corrective, cosmetic or aesthetic – unless it arises due to an accident and requires hospitalization.
    • Intentional self-injury and attempted suicide.
    • Alcohol / drug abuse.
    • STDs like HIV / AIDS, human T cell lymphotropic virus type III (HTLB III), lymphadenopathy associated virus (LAV) or their variations.
    • X-rays, laboratory tests and other expenses incurred not in direct relation to the treatment.
    • Injury or disease arising from nuclear radiation or exposure to nuclear weapons and materials.
    • Pregnancy, childbirth, miscarriage, abortions, caesarean section, etc. or any complication arising from these.
    • Nautropathy related treatments.

    How do I Claim the Benefits of My Mediclaim Policy?

    Reimbursement:

    It is important to keep the insurer or the TPA informed of your hospitalization as and when it happens. This is important because insurers and TPAs have a very strict definition of the term “hospital” and will not honour claims for treatment received in medical facilities that fall outside their definitions. It’s important to know which hospitals are in their list, before being admitted.

    Upon hospitalization, you must keep a careful tally of all expenditures and maintain records of all bills that you have been given. Don’t take a high-end room and lavish hospital facilities if you can’t afford it without insurance (as insurers will scrutinize these claims and judge whether that extra-comfortable hospital bed was a vital requirement for your recovery). Avoid listing personal comfort items as they will most likely not be honoured.

    Fresh approval needs to be sought for changes in treatment. If you are being treated for an injured leg, the insurer will reimburse the x-ray costs for your leg, but if you develop a headache and require a CT scan, another approval will be required for this.

    You will need to fill up a claim form clearly and without any ambiguity or falsehoods (as any of these could set your reimbursement back by weeks, even months). Keep your hospital bills available upon request and attach the same to you claim form and submit it to your insurer. A clean and duly filled up claims form with all necessary attachments easily available will help you a lot.

    There are instances where insurers do not honour claims and give very vague reasons for the same. In case your claim is denied for any reason, ask the insurer for a detailed explanation as to why it was rejected with specific clause numbers and details. This will help you take the matter up in a relevant consumer forum or even legal court, if necessary.

    Cashless claims:

    In order for the insurer to process your claim, you will need to fill in a detailed “preauthorization request form” and submit the same to the company.

    Cashless Planned Hospitalization:

    If you have time to plan your admission to the hospital, you need to send your preauthorization at least 72 hours before your actual hospitalization. This results in a smooth, cashless mediclaim experience.

    Cashless Emergency Hospitalization:

    In an emergency like a car accident, there won’t be time to send a preauthorization, etc. In such a situation, you need simply produce your Medi Assist ID Card at the network hospital. This will facilitate cashless hospitalization and get you four hours in which you must send your preauthorization request. As we can see here, it’s important to carry your Medi Assist ID Card with you at all times.

    What should I Look for when Choosing the Right Mediclaim Policy?

    Choosing the right insurance policy today means navigating a maze of providers and heavily scrutinizing the hundreds of plans available. There are plans which provide the best and most comprehensive cover, but will cost you a high premium, and those which give you skeletal cover for a paltry premium, primarily used for securing benefits on income tax. In addition to this, there are riders that provide different covers and benefits but may overlap in their features, making you pay more per rider, for overlapping benefits.

    It’s important to look at sub-limits in your policy documents. A sub-limit is a method by which insurers are limiting their liability in a world of rising healthcare costs. For example, if your sum insured amount is Rs.1 lakh and your sub-limit for room rent is 1%, the insurer will only cover Rs.1,000 under your “room rent” expense heading. If your room costs, say, Rs.1,400 – you will have to pay that extra Rs.400 from your own pocket.

    Tick off parameters in the following checklist:

    • Sum assured and coverage required.
    • Do you need maternity benefits?
    • Do you want to pay regular premiums or a single premium?
    • What are the sub-limits specified for various expenditures?
    • Do you want a traditional health insurance lump sum benefit, or just want your hospital bills reimbursed?
    • Up to what age do you want to renew your policy?
    • What is the range of eventualities you want covered in terms of critical illnesses?
    • Does it have enhanced features like cashless claims, quick processing, etc.?
    • How does it rank in terms of customer service?
    • What is their claim settlement ratio?

    Your answers to these simple questions could help you make your decision based on your personal requirements.

    Compare and Buy Mediclaim Policies Online:

    It is strongly recommended that you take a Mediclaim policy for every member in your family, including children (perhaps through a family floater), as it is one large policy that covers everyone under it. It’s an excellent alternative to taking separate health insurance policies, as Mediclaim requires the payment of only one premium.

    It is important to note that Mediclaim is not an alternative for a life insurance policy as it will not provide a benefit in case the earning member of the family is rendered unable to earn anymore. Look for the right balance between benefits offered, ease of claim settlement, and cost of premiums to find the right policy for you.

    Benefits of Buying a Mediclaim Policy:

    Medical expenses can put a dent in your pocket if you don't have a suitable health cover to pay your hospitalisation costs. Mediclaim policy is the most common health insurance policy available in India. Your health insurance policy can ensure you receive timely and adequate healthcare without worrying about putting a huge dent in your pocket. Here are some benefits of purchasing a mediclaim policy:

    • It is a cost-effective solution to afford adequate healthcare.
    • It reduces the financial burden faced by an individual in the event of a sudden illness or accident that leads to hospitalisation.
    • Mediclaim policy offers cashless hospitalisation wherein the insured member doesn't have to pay for medical expenses upfront. The insurer will pay for the treatments received at a network hospital.
    • Cashless mediclaim policy ensures you don't have out-of-pocket medical expense. Instead, the medical expenses will be paid for by the insurance company.
    • You can get tax deductions on premiums paid towards a mediclaim policy for self, spouse, and children under Section 80D of the Income Tax Act, 1961, for a maximum of Rs.15,000. You can get another Rs.15,000 tax benefit on premium paid towards a mediclaim policy for parents, Rs.20,000 if parents are senior citizens.

    Points to Consider When Buying a Mediclaim Policy:

    To choose the right mediclaim policy, keep the following points in mind:

    • Health insurance coverage: Selecting the right mediclaim policy is important so as to avoid ending up with insufficient health cover. Pick sufficient sum insured to cover all your medical expenses.
    • Co-payment: A health insurance policy with a co-pay clause is one where the policyholder agrees to pay a part of the medical expense out of his or her pocket while the insurance company pays the rest. Co-pay can reduce the insurance premium of your mediclaim policy. It is a common feature in senior citizen health insurance policies.
    • Treatment specific limits: Insurers levy limits on certain medical treatments like cardiac treatments or cataract. Before purchasing the policy check for any treatment specific limits.
    • Waiting period: Health insurance policies have an initial 30-day waiting period for all illnesses except in the case of an accident that leads to hospitalisation. Pre-existing disease cover usually begins after a 4-year waiting period. During the waiting period, policy benefits can't be availed. Therefore, it is important to check waiting period clause of the policy.
    • Network hospitals: Cashless hospitalisation facility can be availed only at a network hospital of the insurance company. Check the list of network hospitals in your location.
    • Maternity cover: Pregnancy related medical expenses are usually not covered by regular health insurance policies. Therefore, check if your insurance providers offers maternity cover and what is including in the coverage.
    • Exclusions: Read the policy document carefully, especially the exclusions of the policy. Exclusions usually include suicide attempts, dental treatments, self-inflicted injuries, alcohol or drug abuse, etc.
    • Free-look period: Go through the terms and conditions of the policy during the free-look period, if you have any objections, you have the option to return the policy within the free-look period, and get a refund on the premium paid after certain deductions.

    How Does a Mediclaim Policy Works?

    Many organisations in India offer mediclaim policies to their employees as an incentive to retain talent in the company. Mediclaim policy basically covers the hospitalisation costs during the policy term. The insurance premium depends on the sum assured of the policy. In addition to hospitalisation costs, mediclaim policy also covers domiciliary hospitalisation.

    Most insurers offer customised mediclaim policies to suit the size and requirements of the organisation. In addition to group mediclaim policy, there are mediclaim policies for individuals, couples, and families. Mediclaim policies can be purchased by paying the cost of the insurance plan upfront or in instalments.

    Checklists Before Buying a Mediclaim Policy:

    Here is a 10-point checklist before buying a mediclaim policy:

    1. Buy a health insurance policy before it's too late: It is advisable to purchase a health insurance policy with a lifelong renewability option when you are young and in good health so that you may be covered when you need it the most. You can accumulate no-claim bonus with every claim-free renewal over the years. There is an age limit on purchasing a health insurance plan. Moreover, senior citizen health insurance plans can be restricting compared to regular health insurance plans.
    2. Assess who in your family needs health cover: In the case of a family insurance plan, the sum insured is shared by the entire family which is why it is important to assess who needs health cover and their health condition at the time of purchasing the policy. The insurance premium of a family floater plan depends on the age of the eldest member of the family. If there are members with a medical conditions and are aged above 50 years, there can be certain time-bound exclusions in the policy.
    3. Keep a check on your health and lifestyle: There is an increase lifestyle diseases due to an individual lifestyle choices and habits like smoking, drinking, and eating out often. Exercise regularly and keep a check on your diet. Avoid a sedentary lifestyle. It can protect you from contracting an illness.
    4. Determine whether you require an individual cover or a family floater plan: Though a family floater plan is cost-effective, having a high-risk family member as a part of the cover can lead to other members being left without any cover when they need it.
    5. Choose sum insured on a long-term perspective: When choosing the sum insured don't consider just the current costs of healthcare. Healthcare costs keeps increasing rapidly, therefore consider your insurance requirement on long-term basis, and choose a sufficient sum insured.
    6. Sub-limit on room rent: Check if your chosen health insurance policy comes with a sub-limit on room rent. For instance, for a health insurance policy with a sum insured of Rs.2.5 lakh, you can stay in a room with a rent of Rs.2,500. Any additional cost on room rent has to be paid by the policyholder out of his or her pocket. The reason for setting a sub-limit is to reduce the liability of the insurer to the policyholder.
    7. Check for co-pay clause in your chosen policy: If you have an existing policy, review the insurance coverage and determine whether you require additional coverage. If you are dissatisfied with the current insurer, you can transfer your mediclaim policy to a new insurer at the time of renewal.
    8. Network hospitals of your insurer: Cashless facility can be availed only at one of the network hospitals of the insurer. The list of network hospitals can be found on the insurer's website. Check for the network hospitals in your location.
    9. Opt for top-up plans: To get a high sum insured for a longer policy term, you can opt for a super top-up plan. For instance, you can chose a base cover of Rs.5 lakh and a super top-up cover of Rs.15 lakh. This can help you save on insurance premium. Ensure you purchase the super top-up plan along with the base policy tenure and same renewal dates.
    10. Review your existing policy: If you have an existing policy, review the insurance coverage and determine whether you require additional coverage. If you are dissatisfied with the current insurer, you can transfer your mediclaim policy to a new insurer at the time of renewal.

    Mediclaim Policy FAQs:

    1. How to port a mediclaim policy?

      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.

    2. How to get a mediclaim policy?

      Visit a third-party comparison website like BankBazaar.com 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.

    3. How to renew mediclaim policy of National Insurance?

      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.

    4. How to choose a mediclaim policy?

      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 BankBazaar.com.

    5. How to calculate mediclaim policy premium?

      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.

    6. Why choose a mediclaim policy?

      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.

    7. What is mediclaim policy for employees?

      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.

    8. What is cashless mediclaim policy?

      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.

    9. What is group mediclaim policy?

      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.

    10. What is floater mediclaim policy?

      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.

    11. What is overseas mediclaim policy?

      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.

    12. What is innovative mediclaim policy?

      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.
    13. What is individual mediclaim policy?

      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.

    14. What is national mediclaim policy?

      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.

    15. Which is the best mediclaim policy for parents in India?

      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.
    16. Which mediclaim policy covers pre-existing diseases?

      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.
    17. Which cashless mediclaim policy is the best?

      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
    18. Which mediclaim policy covers LASIK surgery?

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

    19. Which mediclaim policy covers dental treatment?

      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
    20. Which mediclaim policy covers pregnancy in India?

      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
    21. Which mediclaim policy is best for family?

      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

    • Poor households in Chandigarh to receive Rs.5 lakh health insurance

      More than 70,000 poor households in Chandigarh will be provided with a health insurance cover worth Rs.5 lakh starting from 15 August 2018. The benefits will be offered under the Pradhan Mantri Rashtriya Swasthya Mission (PMRSM) and will deliver secondary and tertiary healthcare services to the vulnerable families in the state. Around 68,447 eligible beneficiaries reside in the urban areas while 2,821 reside in the villages and these numbers have been identified from the data recorded by the Socio-Economic Caste Census. The scheme will be executed collectively by the state government and the National Health Agency (NHA).

      25 May 2018

    • Ayushman Bharat Scheme to be launched on the occasion of 127th Ambedkar Jayanti

      To commemorate the 127th birthday of Dr. BR Ambedkar, the Prime Minister of India (PM), Narendra Modi will roll out the first phase of the Ayushman Bharat scheme for which around 1.5 lakh health and wellness centres will be set-up throughout the country, starting from Bijapur district in Chhattisgarh. A local SBI branch will also be inaugurated by the PM. Through the network of health and wellness centres, comprehensive primary healthcare services will be delivered to the beneficiaries as part of the Ayushman Bharat scheme. During his Chhattisgarh visit, the PM will also distribute tamarind deseeding machines and visit an Anganwadi centre.

      16 April 2018

    • $1.54 billion allotted for Modicare health cover

      The National Health Protection Scheme (NHPS) or Modicare, announced in this year’s budget has been allocated $1.54 billion for its implementation. Also tagged as Ayushman Bharat Scheme, the scheme intends to provide a medical cover of Rs.5 lakh per household per year to approximately 10 crore vulnerable households in the country and will be the world’s largest government funded health insurance scheme. With this scheme, the government of India aspires to cut down on the number of households who are pushed into poverty due to catastrophic medical expenses, by lending financial support. India has been known to spend only 1% of its GDP on public health and this scheme will be a reform measure in the health insurance segment.

      30 March 2018

    • 12 states without central or state health insurance

      As per the IRDAI’s latest report, 12 states in India do not have state or central health insurance. Delhi, Nagaland, Haryana, Madhya Pradesh, and Sikkim are included in the list. Households in these states could take advantage of the central government planned ‘Ayushman Bharat’ scheme as a reprieve. Since the launching of the Rashtriya Swasthya Bima Yojana (RSBY) in 2008, the number of states participating in the scheme has dropped to 15 in 2016-17. The number of families enrolling for the scheme and empanelled private hospitals have also dropped.

      Among one of the reasons for the drop in these numbers, political expediency is the major one. The ruling-party states preferred not to participate in the scheme while some states like Tamil Nadu and Andhra Pradesh, have a state health insurance of their own. Other reasons behind the numbers lowering is the reluctance of private hospitals to treat patients under the RSBY scheme, delays in settlement of claims, and the lack of awareness about the coverage. Overall however, the number of households enrolling for government sponsored health insurance have increased.

      26 February 2018

    • Government’s new health insurance plan may have implementation issues

      The National Health Protection Scheme (NHPS) of the Central government aims to provide medical insurance coverage to 10 crore poor families in India. The sum insured under the plan is Rs.5 lakh for each family. Experts are of the opinion that the scheme will be difficult to implement.

      Historically, there have been several schemes like this that have not taken off well. For instance, the 2016-17 Budget proposed a healthcare scheme of similar magnitude but it has not been implemented as yet.

      Illegal payments that the hospitals claim is another issue that needs to be addressed. State-run hospital pharmacies also do not have adequate stock of medicines, pushing patients to approach private pharmacies for the same. Usually, the payment will be done from their own pockets as well. The number of doctors per lakh of population is also very low. This could lead to issues at the time of implementation of the programme.

      20 February 2018

    • Covering 10 crore people under health insurance ambit doesn’t appear feasible

      Arun Jaitley, in this year’s budget, proclaimed a health insurance cover of up to Rs. 5 lakh to 10 crore households under the National Health Protection Scheme. Though the target appears ambitious and progressive, many economists are posing questions on whether it is realistic and achievable. 10 crore individuals on an average equals to 5 beneficiary per family which means that the scheme will cover 50 crore beneficiaries. If the government really intends to keep up to its promise, it will need at least Rs.1,25,000 crore. But does the government have enough funds, the health insurance economists ask. And if not, how does the government plan on acquiring the funds? Seems like only after its implementation a better clarity can be expected.

      8 February 2018

    • Budget 2018: Health Care Industry Hopeful Towards A Better Role For Private Sector

      The Modi government is to present it’s last budget this Feb, and the healthcare sector is hoping to see a better deal for the country’s private sector, in terms of tax benefits.  This view was given by Ms. Sunneta Reddy, MD, Apollo Hospitals, who also said that healthcare must be given a national priority status. To do this, the government must show some signs of intending to provide an environment that will attract not only financial but also intellectual capital to boost creation of high-quality capacity. Some examples of this can be developing public-private partnership models, or even giving much-needed incentives to the private sector such as structured tax benefits.

      25 January 2018

    • Renewal of Health Insurance Without Aadhaar Cannot Be Denied Till March 31

      In the past few weeks, several instances have come to light where health insurance companies have refused to renew health policies without the Aadhaar being provided. In light of these incidents, the IRDAI has recently issued a circular to all insurance providers in the country instructing that the last date till which policyholders have to submit their Aadhaar has been extended to March 31, 2018. Therefore, insurance providers are mandated to renew policies till March 31, 2018 without asking policyholders to provide their Aadhaar details.

      19 January 2018

    • Magma HDI enters health insurance market with OneHealth policy

      Magma HDI, a joint venture between Germany’s HDI Global SE and Magma Fincorp, have launched the “OneHealth” health insurance policy to move the company into the health insurance market. With an ever increasing risk of lifestyle diseases threatening the health of the people in India, the company aims at tackling these problems with their “OneHealth” plan that covers the policyholder and his/her family. MD and CEO of Magma HDI, Rajive Kumaraswami, stated that the company has kept these problems in mind while developing the “OneHealth” plan. The plan covers a number of different lifestyle diseases and medical conditions such as bariatric surgery, Lasik, psychiatric treatments, etc. With over 300 different branches located across India, the company caters to needs and requirements of the underserved residing in urban India and currently has an Asset Under Management (AUM) of over Rs.15,200 crore.

      8 December 2017

    • 75% of Coimbatore covered under a health insurance policy

      Coimbatore stands first in the list of cities whose citizens are covered under a health insurance cover. The high numbers are mainly due to the increased awareness about the importance of a health insurance policy that has been created among the people. According to a survey done by the National Family Health Survey (NFHS), over 75% of the households involved in the survey have at least one family member who is covered under a health insurance scheme. Dr. S. Prakash, Chief Operating Officer at Star Health Insurance, stated that insurance companies have been doing their best to educate people on the importance of health insurance. This has led to an increase in the number of people purchasing a health insurance policy in the city. Major metros like Hyderabad, Delhi, Chennai, and Bengaluru have all fared lesser in the polls when compared to Coimbatore.

      5 December 2017

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Mediclaim Policy in India Reviews

  • Page 1 of 50 1 2 3 4 5
    • Max Bupa Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with MAX BUPA from last 3 years and it is one of the good policy. It is a family coverage where spouse and children are covered. I pay a premium of Rs 18000 for this health insurance. My claim experience was good and they covered 70% of the billed amount.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 19, 2018
    • Religare Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I was using health insurance policy with Religare from last 2 years, i am happy with the coverage value of this insurance policy. I am satisfied with the claim experience and it was a cashless treatment. I have a coverage value of Rs 3 lakhs for this insurance policy.
      Was this review helpful? 0
      , navi mumbai
      Reviewed on Jun 19, 2018
    • ICICI Lombard Health Insurance
      "Good Policy"
      0.5 5.0/5 "Blown Away!"
      I took health insurance from Icici health insurance . I have choose this insurance mainly because of convincing premium with too many benefits . This policy covers Cashless hospitalization. Pre diseases coverage . Overall am satisfied with customer care and service. Am getting income tax benefits
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 19, 2018
    • New India Health Insurance
      "Very good service"
      0.5 5.0/5 "Blown Away!"
      New India Assurance was the first health insurance provider with the Employer provided health insurance, They've partnered with the many hospitals in Pan India and also offered protection for the entire family. They were also offering cashless treatment facilities. Overall it has been a smooth experience.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 18, 2018
    • SBI General Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance with SBI general insurance from last 2 years, i am happy with the coverage value of this insurance policy. I have not claimed anything so far from this insurance company. I pay a premium of Rs 50 per month for this insurance policy.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jun 18, 2018
    • Star Health Health Insurance
      "Good to have insurance policy"
      0.5 3.0/5 "Satisfactory"
      Idon't have any experience of claim hence i never get a chance to call their customer care. They used to call me for renewing the policy. I can claim about 3.5 lakhs per annum. If i use 10% or not claim the policy, they wont give additional benefits for the next year. Their is a insured amount by 10%. My premium amount will be same but the claim amount they will increase by 10% next year. Cashless treatment is available in this policy
      Was this review helpful? 0
      , noida
      Reviewed on Jun 18, 2018
    • National Insurance Health Insurance
      "Very late back policy"
      0.5 3.0/5 "Satisfactory"
      My company people have taken health insurance policy to the employees. Once i have claimed the policy for my mother. The service is not good as per experience. They have a separate hospital list, in that they have mentioned cashless facility is available but when i went for those hospital, they said their is no cashless facility for this insurance. They will not response from the National Health insurance. The number will keep on ringing. After that my company asked me to send the bill. But i never done to this company. The claim is very low which is less than 20000.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 18, 2018
    • Religare Health Insurance
      "BEST"
      0.5 4.0/5 "Great!"
      From past 7months i am using this health insurance. Documents i have done through the on line. The coverage is for 10k. Per annual i pay of rupees 7-8k. Disease coverage is there. Free medical checkup once in a year is also available in my insurance.
      Was this review helpful? 0
      , new delhi
      Reviewed on Jun 17, 2018
    • New India Health Insurance
      "Chatting with customer at clamp time"
      0.5 0.5/5 "Unacceptable"
      This is a type of fraud company.This does not pass the claim.When they go to the customer to make a claim, it only rotates it, this time of direction can be more than 8 months.thay do not have any response anymore, only you have to call them these times and you have to consider the information.Out of which it does not raise your phone more than half the time. Each time they constantly ask for something new, they never tell you once and after 8 or 9 months of the final, you cancel your claim according to the new rule.They do not deliberately describe the whole processor, either by either losing the customer tired or in the last. I will request all individual personal and special corporate offices to never do any bonding with this type of company.Because the new rules which it says in 8 or 9 months, how will the customer know at first sight, they deliberately conceal the rules so that the customer does not get disturbed and do not claim.
      Was this review helpful? 0
      , neemuch
      Reviewed on Jun 16, 2018
    • National Insurance Health Insurance
      "Good Service"
      0.5 4.0/5 "Great!"
      I've a health insurance policy from the National Insurance. I am paying the premium of 1400 per year. You can claim this policy at any network hospitals in the country. The need to nofity the customers about the partnered hospitals. If they have tie up with the a new hospital they need to send updates to the customers or publish it on their website.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Star Health Health Insurance
      "Average Service"
      0.5 2.0/5 "Expected more"
      I'm using the Star Health insurance policy. I do not have any claim experience yet. I pay a premium of 8000 Per year. They don't send any renewal notifications. Their Service is good. The coverage is 1 lac for whole family per year. They need to improve their notifications and keep the customer posted about important dates.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Royal Sundaram Health Insurance
      "Good Service"
      0.5 3.5/5 "Pretty good"
      I've been using the health insurance policy from Royal Sundaram for a while. I am paying the premium of 8000, many of my friends recommended Royal Sundaram. I never had any claim experience with the policy. Overall it has been a smooth experience. I'll have to wait and see how they respond to my requirement in future.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 16, 2018
    • Apollo Munich Health Insurance
      "The Best"
      0.5 5.0/5 "Blown Away!"
      Since I'm working with health insurance. It is easy to claim in Apollo Munich. The best hospital list covered in this policy. The best health insurance company in PAN India. In my company, they are paying the insurance premium for me and my family.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jun 14, 2018
    • HDFC Ergo Health Insurance
      "Good Service"
      0.5 3.5/5 "Pretty good"
      I've a health insurance policy with the HDFC Ergo. I pay a premium of 6100 Per year, I do not have any claim experience with the policy and it offers full coverage for my entire family. They offer a coverage 2 lacs annually which is pretty good for me. Overall it has been a good experience with the features of the policy. .
      Was this review helpful? 0
      , ghaziabad
      Reviewed on Jun 14, 2018
    • Bajaj Allianz Health Insurance
      "Good Health Insurance policy"
      0.5 5.0/5 "Blown Away!"
      So far i have never claim the health insurance. I can claim upto 7 lakhs. I have taken this insurance policy for me and dependent. The employer take care of the premium amount. I have never contact the customer care. Almost most of the hospital has been covered in this health insurance
      Was this review helpful? 0
      , coimbatore
      Reviewed on Jun 14, 2018
    • Universal Sompo Health Insurance
      "Average"
      0.5 3.0/5 "Satisfactory"
      I have a health insurance policy taken from Universal Sompo, it was the best deal I came across when I was looking for the policy, the premium amount that I paid was quite reasonable and not too high, the sum assured amount was also good. I never got chance to take the services of this policy I have no claim experience from them so far.
      Was this review helpful? 0
      , kolkata
      Reviewed on Jun 14, 2018
    • Universal Sompo Health Insurance
      "Best Health insurance policy"
      0.5 5.0/5 "Blown Away!"
      I have taken this policy for the first time. I have not claimed the policy so far. I have paid around for Rs.8500 as premium. It family based health insurance policy. I can claim upto 5 lakhs. Cashless treatment is available. There is no pre-existing offer is available. I have taken this policy last month. Most of the hospitals are covered in this policy.
      Was this review helpful? 0
      , gurgaon
      Reviewed on Jun 14, 2018
    • review Health Insurance
      "Good policy"
      0.5 4.0/5 "Great!"
      It is a health insurance policy from HDFC. Accidental benefits are there. If i admit in a hospital, i can claim for that also. I took this policy for my whole family. I'm paying Rs. 4500 for every year. I can claim upto 3 lakhs in a year. If i renew the policy without any claim, they will offer some bonus points. I never claimed this policy so far. Cashless treatment is available.
      Was this review helpful? 0
      , chennai
      Reviewed on Jun 13, 2018
    • Royal Sundaram Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      I got the health insurance policy from the ROYAL SUNDARAM GENERAL INSURANCE company and i have got it around 5 years. This policy covers 4members in my family and it has the medical coverage amount of Rs,3,00,000 . I pay the premium amount of Rs,8,000 to renew the policy every year.
      Was this review helpful? 0
      , bangalore
      Reviewed on Jun 13, 2018
    • United India Health Insurance
      "Good policy to use"
      0.5 5.0/5 "Blown Away!"
      Got the health insurance policy from the UNITED INDIA INSURANCE company and I having this policy from past 5 years. The customer support and the response is good with the United India and this policy covers 4 members in the family. This policy has the medical coverage up to Rs,3,00,000 and I pay the premium amount of Rs,10,900 to renew this policy.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jun 13, 2018
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