Planning To Buy A Mediclaim Policy Here Is What You Need To Know

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03 Jan 2023

Read about 6 Questions mediclaim policy that every health insurance seeker should know. Check out the health insurance policy from Kotak General Insurance.

Amidst growing medical costs, spending hard-earned money on hospital bills can easily push you back financially by a few months, if not years. While most people know that health insurance is nothing less than a basic necessity today, when it comes to buying one, there are many questions in people’s minds. Let's deal 6 questions that you must be aware of as a health insurance seeker-

1. What is a mediclaim policy?

A mediclaim policy is a kind of health insurance plan that provides financial aid to manage the expenses incurred in medical emergencies. By regularly paying the required premiums, one can get coverage for the hospitalisation/ medical treatment expenses caused due to accidents or illnesses.

2. What are the different types of mediclaim policies?

There are different types of mediclaim policies that you can choose from-

• Individual mediclaim policy

If you want a plan that covers only one person then an individual mediclaim policy can be the right one. It covers the medical expenses of only the policyholder.

• Family floater mediclaim policy

A family floater mediclaim plan as the name suggests covers the whole of the family including spouse, children, and parents under one policy. Anyone can benefit from the plan as and when needed.

• Senior citizen mediclaim policy

If you want to cover your old parents, a senior citizen mediclaim policy can do the needful. These plans are specifically designed keeping in mind the increasing healthcare needs of people above 60 years of age.

• Group mediclaim policy

A group mediclaim policy is purchased by a company for its employees. All the members of the group are covered under a single policy.

• Critical illness mediclaim policy

Critical illnesses like cardiovascular disease, kidney problems, cancer, etc. are covered under the critical illness mediclaim policy. It can be quite expensive to treat these diseases and the lump sum payout, offered by such disease-specific health insurance plans, can be very beneficial.

3. What are the inclusions of a mediclaim policy?

Most mediclaim policies cover the following expenses-

• Hospitalisation cost

• Pre and post-hospitalisation cost

• Cost of hospital room rent

• Day care expenses

• Doctor's fees.

4. What is excluded from a mediclaim policy?

The following health conditions are commonly excluded from a mediclaim plan-

• Pre-existing diseases

• Dental problems

• Sexually Transmitted Diseases

• Cosmetic surgery

• Maternity expenses.

5. Are mediclaim policies and health insurance plans the same?

Confused if a mediclaim policy and a health plan are the same? Well, the answer is No. While health insurance offers comprehensive coverage, a mediclaim plan usually covers selected medical expenses. Also, a health insurance plan often has a higher sum insured than a mediclaim plan.

6. How to file a mediclaim policy claim?

A mediclaim policy provides 2 kinds of claim settlements: reimbursement of the bills and cashless hospitalisation at network hospitals. The process includes-

• Reimbursement claim

Get treatment in your preferred hospital and inform your insurance provider about the same. You’ll have to pay the bills upfront, and post-discharge you can raise a claim by submitting the required bills and paperwork. Post verification, the insurance provider will transfer the admissible charges.

• Cashless hospitalisation

For cashless hospitalisation, you need to inform your insurance company about the treatment and get admitted to one of the network hospitals of the company. The insurance provider will settle bills directly with the hospital and you would have to pay only for the uncovered expenses.


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Team Kotak GIC

The content of this blog has been created and carefully reviewed by the esteemed team at Kotak General Insurance, with the sole purpose of providing valuable guidance and sharing insights on the importance of general insurance. Our objective is to assist users in making informed decisions when purchasing or renewing insurance policies for their cars, bikes, and health. Our expertly curated information aims to empower our readers with the knowledge they need to protect their valuable assets and financial interests.