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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 10 Factors affecting Mediclaim Policy Premium

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:

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 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.

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 BankBazaar.com.

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

  • 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

  • Ayushman Bharat needs empanelment of more number of hospitals

    After its launch on 23 September 2018, Modi government's flagship scheme Ayushman Bharat - Pradhan Mantri Jan Arogya Yojna (AB-PMJAY) has benefitted around 1.2 lakh people between the period of 23 Septemeber 2018 and 26 October 2018. However, most of the people who were treated under this scheme have been treated is less expensive departments. The top 5 departments are maxillofacial and oral surgery, general medicine, ophthalmology, obstetrics and gynecology, and general surgery. The major concern is around 6,340 government hospitals empanelled under this scheme by default along with only 7,789 private hospitals are treating the patients as of now. This clearly shows the lack of sufficient number of hospitals under this scheme. Even though the private hospitals are in the process of empanelment for better implementation of the scheme the requirement is to impanel at least 3,000 hospitals in tier 2 and tier 3 cities. Since public hospitals are already overloaded there is a requirement of more number of private hospitals specifically in the villages and remote areas.

    19 November 2018

  • Revision of Packages for Private Hospitals on the Cards

    After an elaborate discussion and pondering and contemplation, the Centre has finally agreed to look into the matter of revising package rates offered to private hospitals under the Ayushman Bharat National Health Protection Mission. Within just one year since its roll-out, the Centre has already had to undertake the task of revising the rates offered to private hospitals as they were evidently not pleased with the proposed rates.

    The Central Government committed to undertake this activity and discuss the matter seriously after multiple private hospitals raised their concerns about the low rates proposed under Ayushman Bharat. Almost around 1,500 private hospitals have voiced their concerns about the recently launched Modicare as they feel that the rates set for surgical procedures and treatments are too low. The Indian Government’s flagship programme is supposed to benefit 55 crore Indians if executed in a disciplined fashion.

    According to Union Health Minister, JP Nadda, more than 10,000 private hospitals have already come onboard with Ayushman Bharat National Health Protection Mission. However, according to his statement most of these entities are small-time nursing homes. The Modi Government initiative is all set to get launched in its full force on 25 September 2018.

    7 September 2018

  • Chandigarh’s ‘Do Not Exist’ Group of People Eligible for Ayushman Bharat

    As the nation awaited the much-hyped Ayushman Bharat - or Modicare (popularly known), the city of Chandigarh found out that out of the 71,278 families identified under Socio-Economic Caste Census of 2011, about 31,000 did not exist at all.

    Therefore, to give the Government officials a concrete data as to the number of beneficiaries that fall under the national health scheme, only 23,000 families were selected to avail benefits under Ayushman Bharat National Health Protection Mission. According to Modicare, which is one of the first-ever comprehensive health insurance scheme spread across all the states of India, Rs.5 lakh coverage will be provided to more than 10 crore poor and vulnerable families to give them access to free and improved medical care.

    As identified by the Socio-Economic Caste Census of 2011, the families that are to be covered under Ayushman Bharat will have to be below the poverty line (BPL) and they will have paperless and cashless treatments across the empaneled or network hospitals under the health programme.

    For the existing six union territories, the Indian Government has set up a National Health Fund at the central level. A state health agency (SHA) has been established in Chandigarh which will take care of the financial aspects of the scheme and will offer complete financial support to the beneficiaries. It will also be responsible for carrying out tasks such as registration of beneficiaries, verifying claims, empanelment of hospitals, disbursing claim payouts, monitoring the operations of the hospital, checking fraudulent claims, and so on.

    5 September 2018

  • Irdai aims to simplify health insurance plans for Modicare

    To cover more number of people under the health insurance plans, the Insurance Regulatory and Development Authority of India (Irdai) is pushing for simpler products and greater use of technology. The move is predominantly aimed at making the centre’s Ayushman Bharat National Health Protection Mission (AB-NHPM) more easily accessible by people. The regulators of insurance will work with the health insurance companies under the private-public partnership model for the AB-NHPM. The AB-NHPM is popularly known as Modicare.

    The chairman of the Insurance Regulatory and Development Authority of India (Irdai) Subhash Chandra Khuntia said that the need for the improvement of the penetration of insurance and the coverage has become huge as the life expectancy has increased in the country. He further added that the focus should be to make the process online and enhance the use of technology along with increasing awareness and understanding about the different insurance products. Reportedly, over the last 4 to 5 years, the health insurance industry in India has grown by 16% cumulatively. Out of the total insurance premium in the general insurance, about 27% of the premium comes from the health sector alone. Khuntia said that the health insurance products should be simplified and rationalised in a way so that it becomes easier for the common man to understand and utilise.

    13 August 2018

  • Government of Arunachal Pradesh Expected to Launch New Health Insurance Scheme

    Pema Khandu led Government of Arunachal Pradesh is expected to launch a brand new health insurance scheme. With the establishment of the new Government, it is now believed that the Chief Minister will replace the existing health insurance scheme with a new one, that is more comprehensive in nature.

    The new health scheme will evidently enable people to go cashless and avail medical services without having to pay for the same in cash. The cashless health services will be availed by the citizens of Arunachal Pradesh at hospitals that have been empanelled. Similar to Ayushman Bharat (an initiative of the Modi Government), the CM of Arunachal Pradesh has instituted Chief Minister’s Arogya Arunachal Yojana (CMAAY) in Arunachal Pradesh.

    The CM has also reported to have asked all his officials to work extra hours in order to be able to launch the health insurance scheme by 15 August, 2018.

    After its launch, the health insurance scheme will provide a Rs.5 lakh cover to the families of Arunachal Pradesh. The vision of the scheme, as stated by their CM is to grant medical services of superior quality while still going cashless.

    10 August 2018

  • IRDAI to Decrease the Number of Health Conditions Excluded in Insurance Policies

    The Insurance Regulatory and Development Authority of India (IRDAI) has begun looking into the number of medical conditions that are not covered by health insurance policies. The insurance regulator has set up a 10-member committee to help standardise the guidelines of health insurance policies in the country. The committee will examine the exclusions made and try to enhance the coverage of the policy.

    With an increase in the number of insurance providers, the IRDAI is looking to enhance the uniformity and transparency in the guidelines. This includes standardisation of terminology and standard procedure for critical illnesses.

    8 August 2018

  • Maharashtra MPJAY Subscribers to receive Phone Call from the CM

    From August, 2018 patients from Maharashtra who have enrolled for the Mahatma Jyotiba Phule Jan Arogya Yojana (MPJAY) scheme will be receiving a pre-recorded message from the Chief Minister Devendra Fadnavi.

    The message from the Chief Minister will be a minute long and will contain information about the facilities covered by the scheme and the services expected by the hospitals. MPJAY provides subscribers with free surgery and, since its launch in 2012, has provided services to approximately 3.5 lakh subscribers.

    The aim of the phone call from the Chief Minister is to increase awareness about the cashless health insurance scheme to decrease the amount of misconduct from hospitals associated with scheme. Teh scheme provides those enrolled with food, medication, and hospital accommodation free of charge for individuals who fall below the poverty line.

    7 August 2018

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
  • Apollo Munich Health Insurance
    "Its best insurance for the health"
    0.5 5.0/5 "Blown Away!"
    The claim is easy they approve everything I heard lots of customer using it, the customer support is good they gave me the policy document on time. They gave me Rs. 10 lakhs of medical cover, they have tie up with all the major hospitals like fortis, apollo. They have cash less treatment.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 14, 2018
  • Bajaj Allianz Health Insurance
    "Good Doctor for Health"
    0.5 5.0/5 "Blown Away!"
    My medical policy belongs to Bajaj Allianz, I am working same company hence they gave me best benefits. They do have pre existing disease they got tie up major hospitals, they have helpline of 24/7, the medical value around Rs. 5 lakhs for my entire family.
    Was this review helpful? 0
    , pune
    Reviewed on Dec 14, 2018
  • Future Generali Health Insurance
    "Good and effective policy"
    0.5 5.0/5 "Blown Away!"
    Its a family floater policy. They have given me a coverage amount of Rs. 2 lakhs. The policy has been given by my company. I have gone through the hospital list and many of the hospitals are listed in the cashless treatment facility. My total family has been covered by this policy.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 14, 2018
  • Apollo Munich Health Insurance
    "Good for health "
    0.5 5.0/5 "Blown Away!"
    I have medical policy for the coverage around Rs. 5 lakhs, they do have pre existing disease cover. The process generation is quick, they send the insurance card with the list of hospitals details. I am very fine with Apollo Munich health benefits.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Dec 14, 2018
  • Star Health Health Insurance
    "Its Good"
    0.5 5.0/5 "Blown Away!"
    I have personal health policy with Star Health, the process was smooth, the premium is economical. They have generated the policy without any hassles, I took family policy for Rs. 5 lakhs. They have cash less facility but they don't have pre existing disease cover. They got tie up with many hospitals.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Dec 13, 2018
  • HDFC Ergo Health Insurance
    "Every must need this policy for future"
    0.5 5.0/5 "Blown Away!"
    My health insurance policy was taken with HDFC Ergo. They have provided me a coverage amount of RS. 8 lakhs. I have to pay the premium amount of Rs. 6000 for 4 years till my loan tenure period. When i purchase the loan, they have given this policy. I have not claimed anything from this policy. The hospital list was fine.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Dec 13, 2018
  • HDFC Ergo Health Insurance
    "Best Policy"
    0.5 5.0/5 "Blown Away!"
    I have taken Health insurance from Hdfc ergo insurance . Am satisfied with the premium amount which am making the payment yearly . This policy gives good coverage with cashless hospitalization and pre disease cover . Even they have given network list of hospitals .Overall am satisfied with the service
    Was this review helpful? 2
    , faridabad
    Reviewed on Dec 13, 2018
  • National Insurance Health Insurance
    "Good for emergency purpose"
    0.5 5.0/5 "Blown Away!"
    The medical claim around Rs. 5 lakhs, its for my entire family. I used this policy for my father bypass surgery, it was cash less in Asian heart hospital the taken 6 to 7 days to settle 100% of claim. It covers major and minor disease it was corporate plan.
    Was this review helpful? 0
    , mumbai
    Reviewed on Dec 13, 2018
  • ICICI Lombard Health Insurance
    "Good Policy"
    0.5 5.0/5 "Blown Away!"
    I have a health insurance policy with ICICI LOMBARD from last 2 months, there was no claim experience so far with this insurance policy. I am not aware of the premium amount as my company pays it. I have a coverage value of Rs 1 lac for this insurance.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 13, 2018
  • Star Health Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have been holding my health insurance with Star health & allied insurance from past one year, they have explain me the policy benefit, and they have tie up with many hospital and they have shared me location as well, and the premium amount they have charged me up to 5000 it is nominal and they charge premium on yearly basis.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 12, 2018
  • Apollo Munich Health Insurance
    "Best Policy"
    0.5 5.0/5 "Blown Away!"
    I have taken health insurance from Apollo munich . Am satisfied with the premium amount which am making the payment . This policy covers cashless hospitalization . They have given the network list of hospital . Overall am satisfied with the policy.
    Was this review helpful? 0
    , new delhi
    Reviewed on Dec 12, 2018
  • SBI General Health Insurance
    "Yet to claim the policy"
    0.5 3.0/5 "Satisfactory"
    Total coverage of my medical policy is 2 lakhs. I have purchased a health insurance with SBI General. I make the premium amount of Rs. 9000. Most of the hospitals are covered in all the prime location. I had no claim experience with this policy. Me & my wife are covered in this policy.
    Was this review helpful? 1
    , guwahati
    Reviewed on Dec 12, 2018
  • Apollo Munich Health Insurance
    "Best policy"
    0.5 5.0/5 "Blown Away!"
    I am having a health insurance policy with Apollo Munich from last 3 years, i am not aware of the premium amount as my company pays it. There was no claim experience so far with this insurance policy. This policy has a coverage value of Rs 5 lacs.
    Was this review helpful? 0
    , kolkata
    Reviewed on Dec 11, 2018
  • HDFC Ergo Health Insurance
    "Good health insurance policy"
    0.5 3.0/5 "Satisfactory"
    I have purchased a policy for my family and i bought the policy from HDFC Ergo. I have paid the premium amount of Rs. 13650 yearly once. I have received a coverage amount upto Rs. 3 lakhs. This policy covers for me and my wife. The hospital list was fine. I had no claim experience with HDFC Ergo.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 11, 2018
  • Star Health Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my health insurance with Star health insurance,there premium they charge is nominal only i use to pay my premium amount on monthly bases and it use to get auto debited with my bank account and they have explain me all policy which is cover in this policy clearly, till now i did not face any issue with this insurance.
    Was this review helpful? 1
    , indore
    Reviewed on Dec 11, 2018
  • Reliance General Health Insurance
    "Better Policy for health"
    0.5 3.0/5 "Satisfactory"
    I don't know about the features of my health policy which provided provided by company, total mediclaim value of Rs. 3 lakhs, it covers for 4 persons. I have received the medical cover, but I didn't interact with the customer support of Reliance. They have not done the medical test. The premium is low for one year.
    Was this review helpful? 1
    , hyderabad
    Reviewed on Dec 11, 2018
  • Royal Sundaram Health Insurance
    "No claim experience with Royal Sundaram"
    0.5 5.0/5 "Blown Away!"
    1 year back i have purchased the health insurance policy with Royal Sundaram and last month i have renewed the policy. They have given me a coverage value of 5 lakhs and they are providing the cashless treatment facility. I have received the no claim bonus.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 11, 2018
  • ICICI Lombard Health Insurance
    "Best health insurance policy"
    0.5 5.0/5 "Blown Away!"
    I'm holding the health insurance policy with ICICI Lombard and i have selected this company because of the services. I can get the cashless treatment facility. I have purchased this policy for myself and my wife. They have given me a coverage amount of Rs. 3 lakhs. I have been paying the premium amount of Rs. 6000 approximately.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 11, 2018
  • National Insurance Health Insurance
    "Its Good"
    0.5 4.0/5 "Great!"
    I have the mediclaim policy with National Insurance for the cover of Rs. 3 lakhs they have major and minor hospitals tie up, they gave me list of hospitals, policy duration is good. There is no pre existing or critical illness cover. They have cover for major diseases, the premium is low with best benefits.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 11, 2018
  • ICICI Lombard Health Insurance
    "Economical policy"
    0.5 4.0/5 "Great!"
    I have a health insurance policy with ICICI Lombard. It is a individual policy. The medical coverage is for ten lakhs and the premium is also economical for me. It is of 510 on a monthly basis. There are cashless facility too. Fortunately I have used it till date.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Dec 11, 2018
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