Mediclaim Policy
A Mediclaim Policy offers financial coverage for healthcare expenses incurred during hospitalization due to a medical emergency, whether caused by illness or an accident. It protects individuals and their covered family members by covering expenses such as hospital room/ICU charges, diagnostic tests, medications, and other related costs.
Key Benefits
- Provides the convenience of cashless hospitalization.
- Available for both individuals and families.
- Reduces financial stress by covering medical expenses.
- Eliminates out-of-pocket costs for hospitalization.
- Ensures insurance companies manage hospital-related expenses.
- Easily accessible through online health insurance platforms.
- Offers tax benefits.
- Enables access to affordable healthcare services.
Coverages
- In-Patient Hospitalization
- Room Rent and ICU charges
- Nursing care
- Medicines and drugs
- Consumables
- Fees for medical practitioners (surgeons, anesthetists, consultants, etc.)
- Coverage for blood, oxygen, anesthesia, diagnostic and pathological tests, operation theatre charges, chemotherapy, dialysis, pacemakers, artificial limbs, etc.
- Registration, service charges, and surcharges
- Pre-Hospitalization Medical Expenses
- Post-Hospitalization Medical Expenses
- Day Care Procedures
- Domiciliary Treatment
- Organ Donor Expenses
- Accidental Dental Treatment
- Ayush Benefits (Alternative treatments)
- Daily Allowance
- Emergency Ambulance Services
Policy Exclusions
- Pre-Existing Diseases: Excluded for four years from the start of the first medical policy.
- Waiting Period: Initial 30-day waiting period for newly diagnosed conditions (accidents are exceptions).
- Specific Diseases Waiting Period: Exclusions of one or two years for certain conditions as outlined in the policy.
- Non-Medical Items: Costs for spectacles, contact lenses, or hearing aids are not covered.
- Recovery Period: Excludes coverage for convalescence, general debility, congenital diseases/defects, or sterility.
- Risky Activities: Claims due to participation in hazardous sports or activities are excluded.
- HIV/AIDS: Claims arising from or related to HIV/AIDS are excluded.
- War/Terrorism/Nuclear Risks: Excludes claims related to war, acts of terrorism, or nuclear incidents.
- Non-Medical Expenses: Excludes personal comfort or convenience services.
- Lifestyle Treatments: No coverage for obesity treatment, hormone replacement therapy, sex changes, or weight management programs.
- Genetic/Stem Cell Treatments: Excludes genetic disorders, stem cell implantation, and surgery.
- Alternative Therapies: No coverage for naturopathy, acupressure, acupuncture, magnetic, or experimental therapies.
- Illegal Activities: Claims arising from criminal acts, self-inflicted injuries, or suicide attempts.
- Substance Abuse: Excludes claims related to intoxicants, hallucinogens, smoking cessation, or substance abuse treatments.
- Pregnancy/Maternity: Excludes pregnancy-related claims (except ectopic pregnancy), voluntary termination, or complications due to assisted reproductive procedures.
- Fertility and Sterility Treatments: Excludes fertility treatments, surrogacy services, or complications from contraceptive procedures.
Claim Process
In the event of a medical need, you can use your insurance card through two methods:
1. Cashless Treatment
- Steps:
- Present your health card at the hospital.
- For planned treatments: Obtain prior approval in advance.
- For emergencies: Approval must be secured within 24 hours of admission.
2. Reimbursement Treatment
- Required Documents:
- A duly completed claim form.
- The final hospital bill with a detailed cost breakup and proof of payment.
- Supporting medical documents, including original medical bills, prescriptions, and discharge summary.
- Detailed bills for miscellaneous charges with a prescription from the treating doctor.