All you need to know about Mediclaim

What is Mediclaim?

Mediclaim Policy is a type of Health Insurance Policy, whereby the Insurance company agrees to cover your hospitalization costs with their terms and conditions upon payment of an amount called a Premium.

The Insurance Company pays for the treatment cost be it due to an accident, or illness including daycare treatments. With the number of lifestyle diseases increasing day by day, the cost of medical treatment is increasing at a high pace. By having a Mediclaim policy, we are assured of financial assistance during hospitalization.  Mediclaim Policy, Mediclaim Insurance, or Mediclaim all mean the same.

Key Features of Mediclaim Policy

  1. Hospitalization Cover – The basic part of the Mediclaim Policy is that it covers your Hospitalisation Costs such as Out-Patient expenses, doctor’s fees, operation charges, medicine costs, diagnostics costs, etc.
  2. Lifelong Cover – Generally Insurance companies offer Life-Long Cover unless specified for limited Renewability. The lifelong cover is taken care of by paying a renewal premium.
  3. Reduces Financial Burden – As it offers financial assistance during hospitalization, it helps in reducing your money outflow.
  4. Low Cost – Mediclaim comes at a very reasonable cost. The lower the age, the lower the premium.
  5. Tax Benefits – The Premium paid for Mediclaim Policy can be claimed as a deduction under Section 80D of the Income Tax Act, 1961.
  6. Cashless & Reimbursement – The settlement of a claim is in 2 Modes. If the Insurance Company directly pays to Hospital, then it is called Cashless. A cashless facility is available in Network Hospital of specific insurance companies. If no such facility is available then you need to pay the hospital, then take reimbursement from the Insurance Company later. It is really important to track your claim status in case you apply for reimbursement.
  7. Individual or Floater – Mediclaim Cover is available for individuals as well as floaters i.e., family as a whole.

Types of Mediclaim Policies

  1. Individual Mediclaim Policy – This type of Policy offers Insurance Coverage on Individual Basic, basically speaking an Individual enjoys the benefit under this.
  2. Family Floater Mediclaim Policy – This type of Policy offers Insurance Coverage to the whole family including spouses, children, parents, etc. depending on policy to policy. A single sum insured is available for a family as a whole.
  3. Senior Citizen Mediclaim Policy – This is a specific type of Mediclaim policy designed for senior citizens. As chances of Hospitalization increases with an increase in age, the premium for this policy is generally high.

What is Covered in Mediclaim Policy?

  1. Hospital Stay – Admission to the hospital gives rise to occupancy of bed & room. Mediclaim covers charges for bed & room based on Policy terms & conditions.
  2. Hospital Charges – Expenses such as OT Charges, diagnostic procedures, medicines, oxygen cylinders, etc are covered.
  3. Consultant & Doctor Fees – Mediclaim Policy covers fees of doctors, consultants & specialists.
  4. Day Care Treatment – Generally Mediclaim Policy pays for Hospitalisation over and above 24 hours, but certain Day Care Procedures are also covered.
  5. Pre & Post Hospitalisation – Mediclaim Policy covers expenses that are incurred before & after hospitalization, but the period of pre-hospitalization and post-hospitalization is dependent on policy to policy.
  6. Annual Check-ups – General health check-up is covered under Mediclaim policies. The limit for the same and conditions are mentioned in the policy.
  7. Domiciliary Hospitalization – Under certain conditions prescribed in the Insurance, domiciliary treatment is also covered.

What is NOT Covered in Mediclaim Policy?

If something is not covered in a Mediclaim policy, it is listed as Exclusions. Generally following are not covered:

  1. Cosmetic Surgery – Plastic surgery, implants, cosmetic corrections, etc which are like beautification are not covered.
  2. Infertility Treatment – Tests and treatments about infertility, in vitro fertilization, etc are generally excluded.
  3. Pregnancy – Treatment for pregnancy, child labor, abortion, etc is generally excluded.
  4. Sexually Transmitted Diseases – Treatment for Sexually Transmitted Diseases such as HIV, HPV, AIDS, etc are not covered.
  5. Dental Treatment – Dental treatments other than those caused due to accidents are not covered.
  6. Injuries due to abuse of Alcohol Consumption – Treatment arising due to or about abuse or misuse of alcohol is excluded.
  7. Permanent Exclusions – Hospitalisation due to riots, wars, and nuclear warfare are excluded from Mediclaim insurance.
  8. Self-Inducted Injuries – Treatment for self-caused injuries such as suicides, attempted suicide, and sports activities like bungee jumping are not covered.
  9. Congenital AnomaliesAlso known as birth defects and could be caused by single-gene defects, chromosomal disorders, multifactorial inheritance, environmental teratogens, and micronutrient deficiencies.

The above list is not exhaustive. Also, some policies may cover some of the above-mentioned exclusions. So, it is always recommended to go through the policy wording documents before making any decision.

Important Terms used in Mediclaim Policies

  1. Waiting Period – It is the time after which benefits under the policy can be availed. The tenure of the waiting period depends on policy to policy. Generally speaking, Mediclaim insurance becomes effective after 30 days of purchase i.e., first 30 days no hospitalization benefit is available. However, hospitalization due to an accident is covered immediately without any waiting period.
  2. Pre-existing Diseases (PED) – Pre-existing illnesses or PED are those illnesses that the buyer of the policy is already diagnosed with within 48 months before the effective date of the policy. In simple words, a pre-existing disease meaning is any disease that you are diagnosed with within 2 years before taking up a policy. PEDs are generally covered after a certain waiting period as per the policy.
  3. Cumulative Bonus – Bonus is the increase in your existing sum insured accrued on account of no claims under the policy without paying any additional premium. Companies offer extra cover every year for those who have no claims during the year as a reward.
  4. Grace Period – It is the time given to the insured to renew his Mediclaim policy even after expiry. It is given to pay the premium to keep the policy valid and retain continued benefits. Generally, the Grace period is 15/30 Days.
  5. Portability – It is the benefit by which one can shift from a product of one company to another company without losing the benefits of their current insurance. The process of portability is generally started 45 days before the expiry of the current Mediclaim.
  6. Co-payment – It is the agreed percentage of the admissible claim amount which is to be borne by the Insured. For example Co-payment of 20% means, If the Claim amount is 110 and the admissible claim amount is 100, then 20% of 100 i.e., 20 needs to be borne by the Insured himself.
  7. Free Look Period – The free look period is the time given to the insured from the date of receipt of policy documents to review the terms and conditions and return the same if not acceptable. Generally, it is 15/30 Days.



This article highlights the basic information about the Mediclaim policy. There are many other coverages, exclusions, benefits & add-ons under the Mediclaim insurance policy which are mentioned in the policy wording. So, It is really important to read and understand the policy terms and conditions before buying. Please feel free to connect in case you want to buy, port, or claim under the Mediclaim policy.