Health Insurance

Best Mediclaim Policy Online in India

by SMCIB on Tuesday, 10 January 2023

Best Mediclaim Policy Online in India

You may be healthy today, but can you guarantee the same tomorrow? Even with the best habits and lifestyles, there is always a chance of getting sick. So, it is important to plan for these possibilities and make sure you have adequate resources and support to get through difficult times.

And, this is why a mediclaim policy is a must-have for everyone. Having a mediclaim policy is similar to wearing a life jacket while sailing on a stormy sea - you might not need it, but in case you do, it can be a lifesaver.

While there are a plethora of mediclaim policies, you may wonder which one is the best. The answer to this is simple. The "best" policy is the one that caters to your unique needs, offers an easy claim settlement process, is backed by a reliable insurance provider, and can be purchased at an affordable price. In short, its features and benefits should come to your rescue in your hour of need.

Let's take a closer look at what a mediclaim policy is, along with some of the top mediclaim policies in India.

What Is A Mediclaim Policy?

It is basically a term that was used to describe health insurance in the past. Essentially, both mediclaim policies and health insurance policies work the same. Your insurance company will cover your medical expenses in exchange for the premium you pay. You can make a claim in the following ways, depending on the product:

  1. Cashless Claims - To qualify for cashless claims, you must be treated in a network hospital listed with your insurance company. Insurers will then settle the medical bills directly with the hospital.

  2. Reimbursement Claims - You can get treated at any hospital of your choice and pay the bills yourself. The insurer will then approve the same and reimburse the amount.
     

What Is Covered Under A Mediclaim Policy?

The scope of coverage of mediclaim varies across products and insurers. Some of the common expenses covered by a mediclaim policy include -

  1. Hospitalisation Costs

    Expenses you incur during hospitalisation such as room rent, ICU charges, fees of the doctor and nurses, cost of surgery or treatment, cost of medicines, etc come under hospitalisation expenses. To qualify for coverage, you need to be hospitalised for a minimum of 24 hours. However, there is a notable exception to this rule, which we will discuss later in this article.

  2. Pre-Hospitalisation Costs

    Expenses incurred prior to hospitalisation such as costs of consultations, diagnostic/radiological tests, lab reports, etc. are pre-hospitalisation costs. Most mediclaim policies cover pre-hospitalisation expenses for 30 to 90 days.

  3. Post-Hospitalisation Costs

    Expenses you incur after you are discharged from the hospital such as follow-up visits to your doctor or the hospital, diagnostic/radiological tests, rehabilitation, physiotherapy sessions, etc are called post-hospitalisation expenses. Most mediclaim policies cover post-hospitalisation costs for 60 to 180 days.

  4. Domiciliary Costs

    You can choose to get treated at home in case there is an unavailability of hospital beds or a serious illness or injury prevents you from being moved to the hospital. This is called domiciliary treatment which is covered by a mediclaim policy as well.

  5. Daycare Treatment Costs

    Some surgeries or treatments can be completed in a few hours (less than 24 hours) such as cataracts, dialysis, chemotherapy, etc. in a hospital or a daycare centre under general or local anaesthesia. The costs associated with such treatments/surgeries are covered by a mediclaim policy.

  6. Organ Donor Costs

    During organ transplant surgery, the organ donor will incur expenses associated with hospitalisation. Some mediclaim policies cover the expenses of the organ donor such as organ screening, surgery, pre-hospitalisation costs, post-hospitalisation costs, etc. However, in the absence of such coverage, these expenses may have to be borne by the organ recipient.

  7. Optional Overs/Add-Ons

    Add-ons are optional covers that can be added to your base policy at a certain extra cost and they don't require any additional paperwork.

    Some of the add-ons include -

    Critical Illness Add-On - If you are diagnosed with a critical illness listed in the policy document, you will receive a fixed sum of money. It assists you to cover the expenses incurred during treatment and recovery. In case you have quit your job for treatment, this amount will serve as an income replacement to take care of your and your family’s everyday expenses.

    Hospital Cash Add-On - This add-on provides you with a daily cash allowance (depending on the policy T&Cs) during hospitalisation.

Note: Besides these, there might be many other add-ons available with a mediclaim policy. Ensure you read the policy wordings to know the list of add-ons available with your policy.

What Is Not Covered In A Mediclaim Policy?

Now, let's move on to exclusions. Exclusions are situations/treatments/surgeries that the mediclaim policy will not cover. Ensure you are aware of the exclusions of the policy.

Exclusions can be either temporary or permanent.

  1. Temporary exclusions

    These are also known as ‘waiting periods’. A waiting period is a span of time during which the insurer will not cover certain treatments.

    Initial Waiting Period: Insurers will not cover any treatments during the initial 30 days of policy purchase - except for accidents.

    Specified Disease/Treatment Waiting Period: Insurers may apply a waiting period of 2-4 years for some specific medical conditions, like hernia, haemorrhoids, chronic kidney disease, etc. This is called the specified disease/treatment waiting period.

    Pre-Existing Disease Waiting Perio: The IRDAI defines a pre-existing disease (PED) as any medical condition that was diagnosed or treated in the 4 years prior to policy purchase. All insurers impose a waiting period of 2-4 years for such PEDs.

  2. Permanent Exclusions

    The IRDAI has established a set of exclusions that must be followed by every insurer. These are known as Standard Permanent Exclusions. Here are the top standard permanent exclusions to be aware of:

    Investigation And Evaluation: Hospital admission for the purpose of observation and monitoring only.

    Rest Cure, Rehabilitation And Respite Care: Any costs associated with admission to a facility specifically for bed rest - without any active treatment.

    Obesity/Weight Control: Obesity or weight control treatments or surgeries.

    Change Of Gender Treatment: Treatments that involve changing the body's characteristics to those of the opposite gender.

    Cosmetic Or Plastic Surgery: A surgery or treatment that alters the appearance or body features of a person.

    Profession In Hazardous Or Adventure Sport: The costs associated with treating injuries sustained while working as a professional in adventure activities such as river rafting, mountaineering, scuba diving, horse racing, etc.

    Breach Of Law: Costs associated with treating a person who has committed or attempted to commit a crime.

    Excluded Providers: Receiving treatment from a medical practitioner or hospital that is excluded in the mediclaim policy.

    Unproven Treatments: Treatments, surgeries, or medical procedures that are not proven to provide results.

    Drugs And Narcotics: Treatments carried out for alcoholism, drug abuse, or addiction in general.

    General Exclusions: Expenses such as administrative fees, registration fees, etc.

Note: Other exclusions can also apply besides those listed above. Make sure you go over the brochure and policy wording before making a decision.

Aside from the standard permanent exclusions, insurers may also apply a variety of exclusions to their mediclaim policies. These are known as additional permanent exclusions. Insurance companies may permanently exclude certain diseases or serious medical conditions from coverage - if they consider these conditions too risky to cover. Note, however, that insurers are only permitted to exclude coverage for the list of illnesses specified by IRDAI.

 

Financial Conditions In Mediclaim Policies You Should Know

 

Here are a few financial conditions that may limit the coverage -

  1. Room Rent Limit

    It is the maximum amount that your insurer will pay for per-day hospital room charges. If you choose a room with a rent that is more than what you are eligible for, insurers won’t only deduct the difference in room charges, but also proportionately deduct all associated medical expenses. Make sure you look for a policy with no or least room rent capping. Thus, you'll be able to get the most out of your policy.

  2. Sub-Limit On Treatments/Surgeries

    Insurers may impose sub-limits on surgeries for frequent or major lifestyle diseases to keep claims under control. Some insurers may apply a financial limit on cardiac treatments, or the payments may be standardised for high-frequency surgeries, like cataracts and hysterectomies. Choose a policy without a sub-limit or the lowest possible sub-limit, so you can use the policy to the fullest.

  3. Copayment

    Copay is a specific percentage of the approved claim amount that you’ll have to pay from your end before the insurer steps in to pay the remaining amount. To minimise your out-of-pocket expenses, make sure you choose a mediclaim policy without the copay clause, or with a less copay percentage.

    Now, let’s look at some of the leading mediclaim policies available today.
     

Which Are The Best Mediclaim Policies Online In India?

Perhaps you are searching for the best mediclaim policy available. But the truth is that there is no ‘best’ mediclaim policy as such. Different policies offer different levels of coverage, and no two individuals have the same needs. What may work well for one person may not be suitable for another. Therefore, it is important to assess your own medical needs and select the policy that caters to them - because that's what makes it the best.

Here’s a comparison of some of the top mediclaim policies available today.

  Aditya Birla - Activ Fit (Preferred) HDFC Ergo - Optima Secure ICICI Lombard - Complete Health Insurance (Health Shield)
Room Rent Limit No limit No limit No limit
Pre-hospitalization Expenses Expenses are covered up to the sum insured for 90 days Expenses are covered up to the sum insured for 60 days Expenses are covered up to the sum insured for 30 days
Post-hospitalization Expenses Expenses are covered up to the sum insured for 180 days Expenses are covered up to the sum insured for 180 days Expenses are covered up to the sum insured for 60 days
Day Care Treatment Expenses All treatments are covered All treatments are covered All treatments are covered
Organ Donor Expenses Harvesting expenses covered up to the sum insured Inpatient expenses are covered up to the Sum Insured Harvesting expenses covered up to a maximum of Rs. 10 lakhs
Modern Treatment Expenses Expenses covered up to the sum insured Expenses covered up to the sum insured Expenses covered up to the sum insured
Domiciliary Treatment Expenses Expenses covered up to the sum insured Expenses covered up to the sum insured Expenses covered up to the sum insured
Refill/ reload of sum insured Available Available Available
No Claim Bonus

Available

You get 10% increase, for every claim free year, up to a maximum of 100% of sum insured

Available

You get 50% increase, for every claim free year, up to a maximum of 100% of sum insured)

Available

You get 10% increase, for every claim free year, up to a maximum of 50% of sum insured)

Super No Claim Bonus

Available

You get a 50% increase every year, maximum up to 100%

Not available

Available

You get a 50% of increase every year, maximum up to 100%

PED Waiting Period 48 Months 36 Months 24 Months
Specific disease Waiting Period 24 Months 24 Months 24 Months (3 Months for Hypertension, Diabetes and Cardiac conditions)
Annual premium ₹ 22,046 ₹ 25,828 ₹ 16,540

Please Note: Premiums are taken on 10.01.2023 for a family of 3 - 30-year-old male, 30-year-old female, and 1-year-old son for a sum insured of Rs 10 lakhs. And, the premium is inclusive of taxes.
 

Wrapping up!

So, we’ve reached the end. We hope this article provides you with a brief overview of a mediclaim policy, its inclusions and exclusions, and the leading mediclaim policies available in the Indian market. With this knowledge, you can now make an informed decision and choose the right policy that fits your healthcare needs and budget.

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