All you want to know about Mediclaim Policy

By
Hemant Beniwal
53

All you want to know about Mediclaim Policy
There is a saying that ” an apple a day, keeps the doctor Away…” but this does not apply in today ‘s world . First of all, not everyone can afford to have an apple a day and even if people who can afford, eat impure apples, get sick and then meet doctors. End of the day, we meet doctors more regularly even more than we meet our near dear ones. Do some calculations on your own and find out, how much money you spend on monthly basis just to visit doctor, buying medicine and getting the RECOMMENDED test done. Don’t take into account any hospitalization cost you incurred, else you may well have a high BP.

Read – Best medical insurance for parents

India Vs USA

Bottom line, The medical expenses are increasing day by day, there is no escape to this. You will be astonished to know that in US, 15% US GDP is all spent on medical cost. 15 % of US GDP means, close to double of India GDP which is over Rs. 5,60,000 Crore. In US 15.3% population is not insured by health cover & another 35% of the population is under insured but in India 88% of the population is not covered by health insurance. Medical expense are now on the rise in India as well. In today ‘s fast moving and fast earning life, we spent our half working life in 5 star hotels and half in 5 star hospitals. There lies a huge risk with everyone about medical cost hitting ones finances in such a bad way, that at times, it is beyond repairable. We meet many people who sell even their house/gold or withdrawing from retirement savings just to cover the medical cost. In such a scenario, one has to cover themselves from such a risk and get a good Medical cover in the form Mediclaim  policy.

Check – Health insurance portability

What Mediclaim Policy covers

Mediclaim policy covers against hospitalization cost one incur, provide one is admitted for more than 24 hours. It covers various cost during hospitalization including that of medication, surgery, room cost, ambulance etc. It also covers the cost you incur on medication, test, doctor’s fees etc. 30 days and 60 days post hospitalization provided the cost is incurred for the same cause for which one is hospitalized.

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Who provide Mediclaim policies

Mediclaim Policy is typically offered by General Insurance Companies & health insurance cos. both in public domain.  There are many life insurance  companies that also offers such similar products but it is better to take policy from specialist.

Read: The rising strength of Indian Middle Class

Type of Mediclaim Policies

Predominantly there are two types of medical policy available. The most common way of taking such policy is where, you buy a specific coverage called sum assured for each of the family members for which you want the cover(Individual Plan). The other way of taking the policy is that you buy a sum assured not specific to any particular person in the family but for the whole family, this is known as Floater Policy(Family Plan).

For example, a family of four, husband, wife and 2 kids. One may take Rs. 1 Lac cover for each of the person and if  any one meets with casualty and is hospitalized, the insurer will pay up to the limit specific to the person. But if you have taken a floater policy, you buy a float cover, let say of up to Rs. 3 lacs for the entire family. Now if anyone in the family, meets with casualty, the cover is up to Rs 3 lacs. But if one has fully used that float, then for that year, insurance company will not pay anything if either the same person or someone else family incurs hospitalization cost.

Special policies for senior citizens are also available. Consult a Certified Financial Planner  near you before taking the policy because it’s important to first judge your requirement & then select best suitable policy.

Also Read: How much medical insurance I need

Claim settlement process

There is a myth that taking claim from insurance companies is to difficult. Yes, it is, if you are not aware of methodology and at times, many people file claim for something which they are not covered for or not informing insurer at the time of hospitalization(in case of cashless claims). The system is such that most of the insurance company has a TPA (Third Party Administrator), TPA is an outsourcing agency of Insurance companies that services claims. Once the policy is taken, insurance company issues card to the Policy holder with name of TPA on it. Policy holder have freedom to select it from list of TPAs with insurance company. In case, one meets with casualty, he/she has to produce the same card in hospital. Earlier, there was a system of reimbursement of expense where in you first spend the money from your pocket and then apply for claim. Now, TPA offers CASHLESS arrangements with many hospitals. if you get admitted such hospitals, the TPA would directly make payment for which you are entitled and hence there is no problem of you arranging Cash immediately.

Tax Benefits on Medicalim Policies

Mediclaim Policy offers tax benefit as well under section 80(D) when premium is paid by any mode other than cash. A person who is 30% tax slab can income tax upto Rs 12360 by paying Rs 40000 as premium. Check Table:

Users of financial products make costly mistakes, either they buy costly life insurance policy or they ignore cheap Mediclaim Policy and then incur huge cost. Choice is yours.

Read More Articles on Insurance.

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ईएलएसएस

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53 COMMENTS

  1. Hi, the article was very informative. Stresses the importance & the need to have a proper, suitable health insurance cover. Can you please add more details about on what grounds the claims are denied, too? I guess, this will be more helpful for the insured to be informed about this as some unpleasant surprises could be avoided. Thanks for the article, again.

    • @ Syed

      We know this is one of the concerns people have, we will soon come up with such article.

      Keep visiting TFL.

  3. I am extremely thankful for your suggestions and guidelines.
    I wish I had met you earlier, and increased the returns.

    Keep up the good work.
    Regards
    Deepak Sharma

  4. can you guide me for a good medcilaim policy as there are many in the market and i am confused.

    please guide me for a proper policy

    and also for a good insurance term policy
    i took bajaj allainaz and i got robbed it was a nightmare

    • Hi FT

      We don’t advice products here – as product depends on specific needs of individual. A product that is good for you can turn fatal for others.

      Search for a CFP near you.

      Keep visiting TFL.

    • Hi Birbal

      As such there is no benefit of taking 2 mediclaim policies but if you are buying second policy as top up policy- you can increase your sum assured with lesser premium.

    • Hi Fareed

      As such there is no comparative data but if your documents are completed you can expect a fast disbursal. People have good experience with apollo & bajaj.

  8. My age is 25 Years & I want to purchase mediclaim policy. Which is the best mediclaim policy – I can give premium upto Rs 4000 per year.

    • Hi Rajendra

      Medical Insurance or Life Insurance is never taken this way that I can afford this much of premium so what should be my sum assured or which policy should I buy. It’s always other way round that you first check what exactly is your need, how much should be the sum assured & then you ask someone for premium. Normally if someone realizes that premium is not affordable means either he has not calculated his needs rightly or he is not managing his income rightly. If I assume that you want to have individual mediclaim policy with Rs 3 Lakh sum assured. My Suggestion will be go for Apollo Munich easy health insurance policy – its premium is competitive, claim settlement ratio is good & best part is you can renew it for life. Premium for this will be around Rs 3600.

  9. Hemant Ji Please Help

    Presently I am at the age of 46 male. Since 44, I own a mediclaim policy of “The new India Assurance company Ltd”. I had been insured till 31/03/2010 under that policy. I forgot to renew the same before 31/03/2010 and when I contacted the branch manager on 01/04/2010 he refused to renew the same and said there is no grace period. In the document of the same insurance company I have seen the content mentioning that the company has right to reject the renewal at any point of time. Presently I am free from any ailment but I feel in due course of time in my later age I may need medical assistance as usual for that I wish to purchase a medical insurance policy and keep on renewing the same till my death. Please advise me a medical insurance policy that:

    1. Can not refuse renewal of the policy after some years when I will have entered in 50s. Because if I purchase a policy from some company at the age of 46 than to which company I will go to at my latter age.

    2. Offer lowest premium with highest sum assured.

    3. The offering company is most reputed for their claim settlements.

    4. The offering company is reputed for there honesty.

    • Hi Vipin,

      It is quite unfortunate to learn what happened with your mediclaim policy as the new India Assurance company Ltd is the only PSU general insurance company that does now allow a grace period. The two companies that offer guaranteed renewal for life are Apollo Munich and Max Bupa. Of course these are not the most economical on premium but certainly, Apollo Munich does match all points that you have raised including renewal, comparatively lower premium & good claim settlement. Honesty is a very subjective thing & can’t be determined as such. In case any adverse medical condition develops at a later date, you becomes a bad risk for the company, they will certainly load your premium but they will never refuse your right to renew. My suggestion is go for Apollo Munich their claim settlement ratio & other processes are good. Max Bupa is new in Market & even premiums are on higher side.

    • Every mediclaim policy provides tax benefit. There are few Health Insurance products from life insurance cos that matches your second requirement like ICICI Pru health saver. But actually these are very expensive & complex products – I will suggest go for simple vanilla floater mediclaim policies.

    • Hi Rohit,

      Choice of policy depends on once requirement but I found Apollo Munich scoring good on few criteria.

  12. Hemant ji

    Can you guide me which is the best mediclaim policy currently in India in terms of claim settlement ratio . Further myself (37 yrs) , my wife (36yrs) & 01 child(3 yrs) to be insured for life . which insurance company – Govt / private can be applied keeping in view for long term – 40 yrs ( should be reliable & covers maximum benefits & have good track record)

    • Hi Aditya,

      Nothing is best in this world – if it is best today may have chance to be worst tomorrow. So best should not be the criteria of choosing any financial product.

      You can check Apollo Munich.

  13. Hello Hemant,

    I have taken Oriental Health’s family floater plan, which includes my parents. My father, at 63, is a senior citizen. I am paying a premium of INR 28000. However, my CA has told that only INR 20000 (INR 15000 for me plus additional INR 5000 since my father is a senior citizen) is available for tax benefit. Is that so? Wouldn’t the amount eligible for exemption INR 30000 in this case – INR 15000 for my immediate family and another 15000 for my parents? Kindly clarify.

    • Hi Sumeet,

      Yes you can take this benefit – maximum benefit that can be taken is Rs 40000.(20000*2)

      • HEMANT PLZ TELL ME IF HE IS PAYING 28,000 PREMIUM . HOW CAN HE AVAIL BENEFIT OF SAY RS. 35,000 OR 40,0000?

  14. Hi Hemant

    I am quite new to the blog and was going around through the archives and found many good info. i got convinced of the need of a medical insurance and term insurance (though an NRI of 38 yrs) and is finding out the best for me. appreciate to know your view on ICICI lombard vs Appolo munich fpr the medical insurance and Kotak e preffered vs Aegon Religare life insurance.

    Thanks in advance and all the best to the best services you to continue

    Shinu

    • Hi Shinu,

      It’s good that you got convinced that there is importance of insurance in once life. As you mentioned you are an NRI my suggestion will be that you should buy it in country where you are residing. But for other readers I have found that Apollo Munich policy features are better & also serving better in comparison to ICICI Lombard. No coming to your life insurance question – yes you should buy a term plan from India. If we compare the cost of Kotak e-preferred to Aegon Religare – it’s almost same but if we talk about claim settlement Kotak wins the bout.

  15. Hi this is jegan mohan and my age is 35 and my brother is 33 we would like to take a individual poolicy but we are cofused whether to take health insurance or medical insurance , we are planing to take from Reliance please advise us.Waiting for your reply.

  16. Hemant ji,
    Pl suggest me can i will taken LIC’s Jeevan Arogya policy?
    If no why if yes why pl give me the details.
    Kiran

  17. In medical policies, one has to take care that if your policy is new, you might face problem in getting your claim approved as they will check whether your disease is pre existing or not, and you might not get the claim if your documents proof the disease was pre existing!!!

  18. I have a Mediclaim policy with National Insurance Company which offers cover for individual family members. I have taken different amounts for different members of the family and has been steadily increasing. This policy has some sub limits such as 50% for Medicines for one illness, and other minor break up for Doctor fees, amblance, room rent etc. There are no separate sub limit for Pre and Post hospitalisation expenses.

    I also have a Family floater for Rs. 5 Lakhs from Star Health and Allied Insurance Co. In this policy the restriction is a maximum of Rs. 5000 for post hospitalisation.

    If I have to make a claim, what is the procedure. Assuming I make use of the Family Floater for Hospitalisation benefits (since there are no sub limits for medicines), can I use the National Ins. Co., Mediclaim policy for post hospitalisation benefits for which there are no sub limits (in case the expenses breach Rs. 5000/- limit as stipulated by Star Health.

    How do I do the paper work since the TPA for National Insurance does a shabby work and irresponsible. Kindly guide me.

    Regards
    Srinivasan

  19. Hi,

    Im having corporate insurance policy from my company.
    My baby was born on Aug6th and since then hospitalized till yesterday. 29th Sep 2011
    Expenses incurred were 5.09lacs.
    My policy year was from
    Sep1st 2010 to Aug31st 2011 — with IFFCO TOKIA (TPA – MEDIASSIT)
    Sep1st2011 to Aug31st2012 — with UNITED INDIA INSURANCE (TPA – MEDIASSIST)

    I have already availed for cashless facility with IFFCO Tokia thro MEDIASSIT but as the expenses more than double of my insured sum, I still need to reimburse for the 3.5lacs or the expenses from Sep1st to till discharge on 29th Sep2011 from UnitedIndiaInsurance??

    In that case could you please let me know the process for the same.
    But my TPA is saying its not possible to reimburse, but i have read online that its possible, so now they want references to such documentation. Could you please point me to some of such

    Thanks
    kumar

  20. I am looking for an insurance agent who can help me with all my general insurance needs (medical, accident & disability, home, car & 2 wheeler).
    National Insurance Co agents preferred.

  21. I am 29 years old doctor and residing at Arunachal Pradesh.I want to cover myself and my parents for health insurance.As you have suggested that Apollo munich for the health insurance,I am confused if I will be able to make a claim since we will be availing the local hospitals in the area for the health care.Could you please suggest me which health policy should I opt for.ICICI lombard,jeevan Arogya,national Insurance or any other which would be available in the north east India?

    • Hi Kaling,
      Best way for you will reaching the finest hospital in your area & asking their preference. (but remember their preference can change in future)

  22. Hey Hemant,
    What amount of medical cover would you suggest for a family of 3 – husband 35 yrs, wife 32 yrs, child 1 yr. Family annual income Rs. 4.5 lakhs.

    Please advise.

    Regards, Nishi

    • Hi Nishi,

      There is no specific criteria but you can evaluate the coverage amount on the basis of city you are living in as the cost of treatment in bigger cities will be higher. For e.g. in a metro city for your family size any cover less than Rs 5 lakh may not be adequate. Take a view of the cost of medical treatment in your preferred hospital and take a decision accordingly.

    • Hi Joy,

      You will have to submit documents related to the medical treatment with both the companies. Once the documents are submitted the companies will decide on the claim amount. The information on procedure and list of document to be submitted you can get by informing the TPA/Company.

  24. nobody talks of exclusion. whenever u buy see for excluded procedure as well. agent will never tell u. even there website will not be having exclusion list

  25. Sir/Madam,

    I am aged 48 years and my wife is 42 years and daughter is 18 years. I would like to know which policy is the best for me ????

    • Hi Saravanan,

      You can look towards a family floater covering three members. Apollo Munich, Max Bhupa, Religare Health are some companies you can consider. Which product you should buy will rest on which one matches your requirement. You can analyze them and consider the most viable one.

  27. hello,
    I have mediclaim from new India assurance for me & my wife. My wife meet with accident which required operation. Opposite party which caused this accident paid part of my medical expenses and have taken a written note on stamp paper regarding this payment. Now my question is what part of this medical expense can i claim? can I claim the entire medical expense or the part that I have paid?

    • Hi Vinayak,

      Any health insurance will reimburse expenses related to Hospitalization only. So you can claim from the insurance company what you paid to hospital for your wife treatment. The company will look into the claim with respect to their limitations, if any, in the policy and then will reimburse the amount as per their policy terms and conditions.

  28. sir i was covered under group mediclaim of national insurance company more then 19 years, ie till 2012 under family floater scheme of 4.0 lacs from 2008. I increased this amount after 50 years of age . will it cover chronic disease . I have already claimed under 4.0 lac coverage for the same chronic disease when i was under corporate. Now I have covered under individual policies of 5.0 laks each

  29. I for all time emailed this website post page to all my associates, as if like to read it after that my links will too.

  30. Great. Sir plz tell me what are those expenses that could be in policy cover. And if I will consult my home physician. That cost and pathological test could be in policy or not.

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