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.