What is a mediclaim?
Mediclaim Insurance is a hospitalisation benefit policy offered by both Public & Private sector General insurance companies and Stand Alone Health Insurance Companies. The policy takes care of medical expenses following Hospitalisation/Domiciliary Hospitalisation of the insured. When it is taken by an individual either for self, family or dependant parents, they assume a certain expense that can be caused due to any unforeseen medical requirements. It helps them meet these expenses due to sickness or injury in the event of hospitalisation. Mediclaim is thus a contract between a health insurer and a proposer where the former agrees to provide the latter with facilities that it offers based on the defined premium amount that the latter pays.
The proposer can be any individual or a corporate offering to insure their employees under Group medical cover. Unlike the retail individual policies, in group medical cover offered to corporate is based on the requirement and covers proposed by them for their employees.
Different types of mediclaim policies in India
1. Individual
2. Family floater covering an entire family under one sum Insured
3. Senior citizen plan
4. Critical illness
5. Diseases specific and surgery
6. Group medical cover from corporates/employers
7. Personal Accident Cover.
How do you choose the best medical insurance cover?
It is always advisable to check the following facts before deciding the cover and insurer.
Cashless facility and efficiency and fast re imbursement of medical bills
Cashless hospital network across the country
Fast reimbursement records
Family cover option (spouse, children, parents)
Claim settlement record
Complaint redressal records
Action taken by the regulator against insurer
Caps and sub limits on expenses
Pre existing disease cover – This can range from 2 to 4 years
Renewal bonuses and discounts
Additional features like maternity hospitalization cover and enhancement of sum insured during policy period etc.
What is not covered under medical insurance plans?
1. Pre-existing diseases are generally excluded but at the same time some of them are also covered after certain waiting period which can range from 2 years to 4 years.
2. Equipment like hearing aids, lenses, cosmetic dental surgery, sinus treatments
3. Diseases like AIDS, venereal disease, hernia (Will be covered after waiting period)
4. Suicides, ailments due to drugs or alcohol
It is very important the proposer reads and understands the brochure/prospectus in order to understand the complete policy details. Some insurance companies can include certain covers which may not be available with others. All doubts and clarifications about the preferred policy should be completely understood before they are taken.
What are waiting periods applicable under medical Insurance?
Generally the waiting period will be 30 days starting with the policy inception date during which the policy will not cover any hospitalisation. But this is not applicable to for hospitalization due to accidents.
About health cover portability
IRDA ,vide , circular dated October 1, 2011 has notified that any policyholder can transfer his or her medical insurance from existing Insurer to a different insurer without having to compromise on the renewal bonuses or discounts, benefits enjoyed in the previous plan. In order to do this, it is advisable to discuss the same with new insurance company where you wish to transfer your policy.
Tax Exemption
Deduction for Medical Insurance: Sec 80 D provides for tax deduction from the total taxable income for the payment of medical insurance premium paid by an individual.
Self and Family Rs 25000
Self and Family + Parents ( 25000+25000) Rs 50000
Self and Family + senior citizen Parents ( 25000+30000) Rs 55000
Self (senior citizen) and Family + senior citizen Parents ( 30000+30000) Rs 60000
Posted: November 2017