Mediclaim Policy | Health Insurance Policy

What is Mediclaim Policy?

Mediclaim policy is a hospitalization benefit policy offered by both Public & Private sector insurance companies. Mediclaim policy provides financial cover to individuals for any unforeseen medical emergencies, be it an illness or an accident that has led to hospitalization.

Health insurance policy with cashless hospitalization, do not let medical expenses become a burden on your pocket. This policy is taken to defray the hospitalization expenses. The health insurance policy is an annual contract and one needs to pay the premium before the due date so as to continue enjoying its benefits. The premiums rise as you grow older as you are more likely to fall sick.

Why should you buy a Health Insurance Policy?

With ever increasing health care costs have made it necessary for everyone to buy a health insurance policy. When it comes to healthcare, everyone wants the best in class healthcare services. 

However, considering the high going health care expenses, many of us are forced to go for a relatively lower quality of healthcare. But with a mediclaim policy, an individual is able to go for the best available medical healthcare, without having to worry about arranging large sums of money to pay medical bills.

Benefits of Health Insurance Policy

1. Health insurance policy reduces your financial burden. The most crucial feature of a mediclaim policy is that it offers financial coverage against sudden medical expenses.

2. Cashless access to network hospitals. Most of the medical insurance policies provide cashless hospitalization facility wherein no money has to be paid by you.

3. Some medical insurance policies offer coverage beyond hospitalization expenses to cover OPD expenses.

4. The amount paid towards medical insurance premium for self/spouse/children provides tax exemption under Section 80D for a maximum of Rs 25,000. There is an additional benefit of Rs 25,000 on medical insurance premium for parents (Rs 30,000 if parents are senior citizens).

5. Health insurance policy gives peace of mind and sense of security as at the cost of reasonable premium, it gives you an escape from high going medical cost.

Types of Mediclaim Policies

1. Individual Mediclaim Policy

The most basic form of medical insurance is the individual mediclaim policy. It covers the hospitalization expenses for an individual up to the sum assured limit. The insurance premium is dependent on the sum assured value.

2. Family Floater Mediclaim Policy

In Family Floater Mediclaim Policy, the sum assured value floats amongst the family members. The family generally includes self, spouse and two dependent children and in some policies even dependent parents. 

In this policy, the sum assured is not fixed for each family member, but there is an upper limit for the total family cover. It gives the entire family a total cover, which could be utilized by both, the entire family jointly or by one single member alone. 

The premium for this type of policy is based upon the family member who has the highest age. The premium (per person) for family floater policies is less than that for separate insurance cover for each family member.

3. Unit Linked Health Plan

Health insurance companies also introduced Unit Linked Health Plans. These plans combine medical insurance with an investment plan and pay back an amount at the end of the insurance policy term. 

The returns are dependent on the performance of the share market. This type of policies is recommended for the people who have the risk-profile to invest in market-linked products.

Points to consider while buying a Health Insurance Policy

1. Individual Policy or Family Floater - There are two popular policies of health insurance. The first one is basic individual mediclaim that covers a single individual, and the second one is a family floater policy that covers the entire family under one policy. You have to be clear if you want to buy individual policy for each person or a family floater policy. Family floater policies are the preferred option because they provide higher cover at a lower cost.

2. Decide the Sum Insured - It is very important to take adequate cover for your family. The coverage amount of your health insurance policy needs to be decided in accordance with the family health history, age of the members and the class of the hospital you wish to choose. Make sure you opt for sufficient sum insured keeping in mind the cost of healthcare in future.

3. Look for diseases covered under Mediclaim policy - Before buying a mediclaim policy, it is extremely important to see the diseases and sickness it covers. Generally the health insurance companies levy limits on certain specific treatments like cataract, cardiac treatments, dental treatment, plastic surgery, obesity-related treatment etc. It is also important to check the list of permanent exclusions in the health insurance policy.

4. Pre-existing disease - Pre-existing diseases are those which policyholder is suffering from before buying a mediclaim policy. Most health insurance companies in India provide coverage for pre-existing diseases only after a waiting period. A best health insurance policy covers a pre-existing disease as soon as possible.

5. Co-payment/Sub-limit - While buying a medical insurance, it is important to see the clauses like co-pay and sub-limits in the policy. Co-pay is the percentage sharing of the claim amount divided among you and your insurance company while sub-limit refers to the maximum cap that the insurance company reimburses such as the case in room rent cap.

6. Waiting Period - There are instances, where an insured person failed to get the benefit of the mediclaim policy due to the waiting period. Most of the mediclaim policies have a waiting period. Only after completion of this period, the policy becomes fully active and insured person becomes eligible to get the benefit as per the policy terms and conditions.

7. Hospital Network - At the time of emergency one need to reach hospital fast. Therefore, it is also important to check if the mediclaim policy you are buying is compatible with the hospital near you which is also in your budget. Doing so makes it easier for you to avail cashless hospitalization as and when the need arises in future.

8. No-Claim Bonus/Discount - It refers to a feature where insurance companies give a no claim bonus to policyholders if insured have not made any claim in the preceding year. You should look for a mediclaim policy that offers highest no claim bonus/discount.

9. Claim Settlement - Before opting for a mediclaim policy, make sure the claim settlement procedure is quick and easy. The health insurance company has got a high claim settlement ratio.

10. Policy Terms and Conditions - It is very necessary that you read all the terms and conditions of the health insurance policy. This will definitely help in getting in-depth knowledge about the entire policy.

Always treat your health insurance policy purely as an expense. So if you are single, buy an Individual Mediclaim policy and if you have a family, buy a Family Floater policy.

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