Key things about mediclaim policy that you should know

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Good health is looked upon as a luxury in the post-pandemic world. Healthcare expenses have hit the skies and its affordability has become a struggle and matter of concern for many. Mediclaim policies provide much-needed relief in such circumstances. It offers financial assistance against hospitalisation charges of the insured. Besides, the final settlement in this policy doesn’t involve the insured as the insurance company and the hospital authority deal with it themselves. It is, thus, a cost-effective means of securing health insurance and provides a variety of options right from individual policies, family floater plans, senior citizens plans, critical illness policies to group Mediclaim plans.

Since mediclaim is a rather popular insurance product, it becomes critical to understand the nuances of this policy for better usage. Let’s take a quick look at key things you should know about mediclaim policy before buying one.

Indemnified coverage 

Basis the policy document, your mediclaim policy will ensure hospitalisation expenses up to a certain amount (up to the sum insured or fixed sum as per the treatment sub-limit clause). Any medical cost of a planned, sudden or pre-decided decease is generally covered under mediclaim policies. It offers optional benefits such as non-deductible, room rent modification, pregnancy, and cataract coverage under strict guidelines.

However, one must be admitted to a hospital ward for more than 24 hours for treatment or surgery due to an illness or accident to be eligible to claim money under mediclaim policies. Moreover, pre and/or post hospitalisation costs are excluded from this policy. No critical illness cover is included in such policies either. Generally, insurance companies offer riders which can be attached with the basic policy.

Cashless payment 

If you get admitted to a network hospital, mediclaim policies let you avail of cashless treatment without having to worry about reimbursements and collecting bills for proof. The insurance company will directly settle invoices with the network hospital.

Meanwhile, in a non-network hospital, the insured can avail medical treatment and submit relevant bills to claim reimbursement of those expenses as well.

Payable premium 

The payable premium is influenced by several factors like total sum insured, how many people are covered under the policy, the city they live in, their age, health conditions and policy tenure. Consider health insurance of a 30-year old with a sum assured of Rs 5 lakh. If you go for a mediclaim policy, the premium rate varies between Rs 4,900 and Rs 5,500. Notably, these rates don’t include GST and other variable charges.

It’s generally not possible to change the mediclaim policy or the tenure in the middle of the year. Hence, it may not be a flexible policy, so to say.

Tax benefits 

Mediclaim policies offer tax benefits for payments made towards insurance premiums under Section 80D of the Income Tax Act. The deduction is up to Rs 25,000 for those less than 60 years of age and Rs 50,000 for senior citizens.

What is imperative here? To thoroughly understand the various terms and conditions mentioned in the policy document for end-to-end knowledge of coverage, waiting period, exclusions, and other aspects before buying it.