What is a Mediclaim? This is one of the most common questions that comes to everyone’s mind when someone is planning to buy health insurance. Individuals often get confused between health insurance and mediclaim.
In this particular blog, we will clear the confusion and explain the mediclaim meaning and how it works.
What is a Mediclaim?
A mediclaim is a type of health insurance policy that covers hospitalisation expenses for illnesses or accidents. Your insurer will reimburse your medical costs after processing your claim during the time of any medical emergencies. It can be both a cashless which is a direct settlement, or a reimbursement of bills.
What Does a Mediclaim Cover?
These are some common inclusions under a mediclaim policy in India:
- Hospitalisation: It covers costs during an inpatient stay, such as room rent, nursing, and surgical expenses.
- Medical Treatments: Includes costs for diagnostic tests, chemotherapy, medicines, and radiotherapy.
- Pre-and Post-Hospitalisation: Covers expenses incurred before and after hospital admission, like follow-up tests and doctor visits.
- Ambulance Charges: Some mediclaim plans include a certain portion of ambulance fees.
Additionally, there are some exclusions under a mediclaim plan, such as voluntary cosmetic procedures and non-hospitalisation costs. Some non-hospitalisation costs include routine outpatient consultations or preventive care.
Types of Mediclaim Policy
Now that you have understood the mediclaim meaning and its inclusions and exclusions. Let us discuss the types of mediclaim policies that are available in India. These are as follows:
- Individual Mediclaim
It provides dedicated financial coverage for the medical expenses of an individual only. The entire sum amount is available exclusively for the policyholder, and you cannot share it with other family members.
- Family Floater
A family floater mediclaim policy is a single health insurance plan that provides medical coverage for the entire family under a single coverage amount. Instead of purchasing individual policies, you can buy this as a cost-effective approach to manage your treatment expenses.
- Senior Citizen
Mediclaim for senior citizens offers financial coverage for medical expenses, like hospitalisations, hospitalisations, and other age-related health needs. Key features of these policies are coverage for daycare procedures, critical illness pre-and post-hospitalisation, and health check-ups.
- Critical Illness
These mediclaim policies provide a certain coverage amount for the extensive treatment of life-threatening conditions, such as cancer, stroke, or heart attack. Unlike standard health insurance, which reimburses actual hospitalisation expenses, these policies provide coverage for the entire treatment process.
Medical insurance for Everyday Protection
Medical insurance covers more than just hospital beds—it handles diagnostic tests, chemotherapy sessions, ambulance rides, and even AYUSH treatments like Ayurveda when Western medicine falls short. When a family member faces sudden hospitalization for dengue fever or gallstones, Medical insurance steps in to reimburse room charges, ICU stays, nursing fees, and post-discharge medications that easily total ₹2-5 lakhs. Unlike basic plans that cap room rent or exclude daycare procedures, comprehensive Medical insurance ensures treatment quality doesn’t suffer due to budget constraints during medical crises.
Health insurance for family to Save Costs
Health insurance for family through floater policies beats individual plans by covering spouse, kids, and parents under one shared sum insured—typically saving 35-45% vs separate premiums while simplifying renewals and claims. Health insurance for family handles everything from children’s accidents and maternity costs to parental joint replacements and cardiac care, with cashless access at network hospitals nationwide. Families appreciate how one mediclaim card serves everyone during overlapping emergencies, plus no-claim bonuses boost coverage limits 20-50% yearly without extra premiums.
How does a Mediclaim work?
Here we will show you how mediclaim works to provide you coverage during any kind of unforeseen medical emergencies:
- Purchase a Policy
You need to choose a health insurance policy that fits your health needs. After that, fill out the necessary forms and pay the premium to the insurer.
- Pay Premiums
To keep the policy active, you must continue to pay your premiums regularly, either on a monthly or annual basis. You have to pay the premium continuously to keep it active for the specific policy tenure.
- Go to the Hospital
If there is any case of medical emergency and you have been hospitalised, show the hospital your mediclaim card. They will contact your insurer and will start the claim process immediately.
- Choose a Claim Option
If you are at a network hospital, you can opt for a cashless facility. The insurance company will directly settle the bill with the hospital. However, if you are in a non-network hospital, you will need to pay the bill first. After completing the payment, you need to submit all the documents to your insurer for reimbursement.
- Receive Payment
Your insurer will process your claim, and upon approval, the company will directly pay the bill to the hospital. Moreover, if you have filed for reimbursement, then they will transfer the reimbursed amount to your personal account.
Final Words
Understanding the mediclaim meaning is sometimes challenging, as it complements the term health insurance. It is an essential component that protects your savings from being depleted by unforeseen medical emergencies. A mediclaim offers various benefits like cashless treatment and comprehensive hospitalisation coverage.
