मेडिक्लेम पॉलिसी क्या है?

What is Mediclaim Policy? – मेडिक्लेम पॉलिसी क्या है?


Medical inflation has made healthcare services costlier. If you are read to be admitted to the hospital due to a medical emergency, then the hospital bill can end your Lifetime Savings at any time.

What is Mediclaim Policy? - मेडिक्लेम पॉलिसी क्या है?

Buying a Mediclaim policy is the best way to pay for costly medical treatment without draining your savings.

Despite the rising cost of healthcare, many of us ignore it and do not cover our family and ourselves with a Mediclaim policy.

Let us understand what is Mediclaim Policy and its features, benefits and coverage through this article.


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What is Mediclaim Policy? What is Mediclaim Policy?

A Mediclaim Policy is a type of health insurance policy where the insurance company reimburses the expenses incurred by the insured person for their treatment in case of a medical emergency.

If you have purchased a Mediclaim policy, you can request for reimbursement by submitting the bill to the insurance company.

Moreover, if you have opted for the cashless treatment option, you need not worry about paying the hospital bills. The insurance company will manage the bill directly with the hospital. However, to avail the cashless facility, you must seek treatment from one of the network hospitals of the insurance company.

One of the important features of a Mediclaim policy is that it is valid for a limited period only, and you have to renew the policy at the end of every year to continue receiving the benefits of the policy.

These policies also provide tax benefits to the insurance holder.

Benefits of Mediclaim Policy

मेडिक्लेम पॉलिसी के लाभ-Benefits of Mediclaim Policy


Whatch A Web-Stories : मेडिक्लेम पॉलिसी के लाभ-Benefits of Mediclaim Policy

This policy provides protection whenever you or your family faces a medical emergency. You can read about the important benefits of this below.

Cashless Admission: Provides cashless hospitalization in case of medical emergency.

Enhanced Coverage: Covers all medical expenses like pre and post hospitalization expenses, OPD expenses , diagnostic expenses, doctor’s fees, treatment and medicines, etc.

Lifelong renewability: Once you have taken this policy, you can continue to take advantage of it for a lifetime on break-free renewals.

AYUSH BENEFITS: AYUSH (Ayurveda, Unani , Siddha and Homeopathy) is also covered under the policy. If you want to go for treatment other than allopathic then you can opt for it in your policy. 

Direct Claim Settlement: In this policy you can get direct claim settlement service without involving any third party. Your claims will be settled on time.

Low Premium: You can get Mediclaim policies at low rates. Affordable premiums reduce your financial burden so that you keep your money linked for your and your family’s future.

Easy EMIs: Now you can avail Mediclaim on easy EMIs as well. This will not put a burden on your pocket and you and your family’s health will also be good.

Answers to important questions related to Mediclaim policy are as follows:-

1. Are Mediclaim and Health Insurance Rider same type of policy?


Mediclaim health insurance policy is meant to cover hospitalization expenses whereas health insurance rider is meant to provide a specified amount for the diseases that are already mentioned in the form.

2. What is the difference between Mediclaim policy of general or health insurance companies and health rider policy of life insurance companies?

There are mainly following differences between health insurance mediclaim and health rider:-

Mediclaim health rider
If within 1 year of taking the policy, the expenses incurred on admission to the hospital to the policy holder are given up to the fixed limit of Sum Assured . In the health rider, if any one of the pre-finalized diseases occurs, then the pre-decided amount is paid as per the disease in proportion to the whole or Sum Assured.
The medical policy sold by general insurance companies and health insurance companies is known as Mediclaim policy. Medical related policies sold by life insurance companies are called health rider policies.
The tenure of Health Insurance Mediclaim Policy is 1 year. The tenure of the health rider is equal to the term of the life insurance policy.
Mediclaim is a separate independent policy. Health riders are taken along with the life insurance policy. It cannot be taken in isolation.
For Mediclaim policy, it is mandatory for the policy holder to be admitted in the hospital for at least 24 hours (excluding day care treatment). The rider is paid on survival for a period of 28 days from the date of diagnosis of the disease.
Mediclaim policy has to be renewed every year. Health insurance rider is a long term policy.
No Claim Bonus is available in health insurance policy or mediclaim policy. No claim bonus is not available in the health rider policy.
Cashless claim settlement facility is available in Mediclaim Policy. Cashless facility is not available in the rider.
Agent gets less commission. Agent gets more commission.
In Mediclaim Policy, the claim is received according to the expenses incurred in the treatment. The maximum amount in the rider remains up to a fixed limit. There is no relation with the expenditure.
In health insurance policies, the facility of remaining sum assured after discharge from the hospital is available till the end of the tenure of the policy. Under the rider, the entire amount gets together on the disease.
Mediclaim Policy can be obtained till the age of 45 without any medical examination. Medical examination is mandatory for the medical rider.

3. Which Mediclaim Policy to take? Health insurance company or life insurance company.


Both the policies are of different types and their objectives are also different.

According to your need and keeping in view the financial capacity , both types of policies should be taken. But if one has to choose then Mediclaim Policy of Health Insurance Company is the best.

4. Can maternity expenses be claimed by Mediclaim policy while pregnant?


This facility is not available in Individual Policy but in Group Mediclaim Policy such expenses can be claimed.

5. Which and how much exemption is available through Income Tax in Mediclaim and Health Insurance?

Under Section 80D of the Income Tax Act , 1961,a rebate of ₹ 25 thousand per year in taxable income on the premium paid for the Mediclaim Policy of each policy holder and his family. Meets with

The deduction limit for premiums paid for senior citizens is Rs 50,000.

6. Is medical examination mandatory for Mediclaim policy?

Medical examination is mandatory if the age of new and first time Mediclaim policy taker of general or health insurance companies is more than 45 years. People below this age can get the policy without medical examination.

Medical examination is not required at the time of renewal of the policy.

If the policy breaks midway, then the same old process has to be done for the new policy. In case of break, the earlier premium or No Claim Bonus is not considered.

Therefore, the Mediclaim Policy should be renewed on time.

7. What is the minimum and maximum tenure of Mediclaim policy?

The tenure of Mediclaim Policy of health insurance companies is usually 1 year and in some companies it is even 4 years.
Mediclaim rider of life insurance has the same tenure as the base policy.

8. How many claims can be made in Mediclaim policy in 1 year?

There is no limit on this. Claims can be made till the balance of Sum Assured remains.

9. Does the Mediclaim Policy recognize the treatments done by Ayurvedic, Unani, Homeopathy?


But some health insurance companies have decided to use 10% to 20% of the Sum Assured for this type of treatment.

10. What is the minimum or maximum sum assured limit of Mediclaim policy?

The Sum-Assured limit of many companies ranges from a maximum of ₹5 lakh to ₹10 lakh.

Some companies do not have a fixed maximum limit. They offer Sum-Assured ranging from ₹50 lakh to ₹1 crore.

11. If more than one Mediclaim policy is taken, will the claim be received from each company?


If the insurance-holder has more than one policy of different health insurance companies, then all those companies together pay the amount of Mediclaim. Each company will not independently pay a separate claim.

If you have a Mediclaim policy from a general or health insurance company and a medical rider from a life insurance company, then both the policies can help.

12. Is there any waiting period after taking a new Mediclaim policy?

Yes yes it happens.

Generally: The waiting period is 30 days. During this time it is not given when the claim comes. But this rule does not apply if he has to be admitted to the hospital due to an accident.

13. Is the cost of medical tests covered under Mediclaim policy?

If the patient is admitted to the hospital for the disease due to which the investigation is done, then his expenses can be claimed.

14. What is meant by pre-existing illness?

If there is or was any disease before taking the Mediclaim Policy, then it is called Pre-Existing Illness . They cannot be protected under Mediclaim Policy.

Health insurance policies have a waiting period of 3 or 4 years for pre-existing illnesses.

Can regularly taken medicines like to control diabetes, for any external treatment or tonics be claimed for all expenses?

Can’t claim.

If the policy holder lives in Delhi due to his job and his family lives in some other city, then can he take a family floater policy for all?

Family Floter Policy can be availed at any place in your country.

15. What is the meaning of family under Mediclaim?

You yourself, wife, children and your parents.

If one has to be admitted to a hospital abroad, can his expenses be recovered under the Mediclaim policy?

The protection of Mediclaim Policy is only on getting admitted in the hospital available in the country.

If the policy holder dies during treatment after being admitted to the hospital, then to whom the claim is given?

If there is a cashless claim settlement , then all the hospital expenses are deposited directly into the hospital account, otherwise the nominee is given.

16. What happens if the Mediclaim Policy is not renewed in time?

If the renewal of the policy is not done then it gets closed. Can be renewed within 7 days after due date.

17. Are pre and post hospitalization expenses reimbursed by the Mediclaim policy?

Are pre and post hospitalization expenses reimbursed by the Mediclaim policy?

Generally, the cost of treatment up to 30 days before admission in the hospital and up to 60 days after discharge from the hospital is included in the Mediclaim policy.

18. Claim intimation has to be given even if there is no cashless claim settlement?

It is necessary to give intimation to the insurance company within 7 days of hospitalization .

19. What is the time limit for submission of claim form?

It is necessary to submit the claim form within 30 days of discharge from the hospital. It is necessary to give a proper reason for the delay.

20. What is Pre-Authorisation?

Pre- authorization is the written permission sought by the TPA to get the treatment done in the hospital by the policy holder for cashless settlement in Mediclaim policy .
It is convenient for everyone to get treated in this way.

21. Can TPA deny pre-authorization and cashless facility?

If the policy holder has not attached all the documents? or pre-existing disease or policyholder has hidden his disease or given wrong information then TPA can deny.

22. What is day care procedure?

Due to the advancement of medical equipment , many diseases are treated in less than 24 hours and it is possible to discharge the patient despite the operation, this is called day care procedure. Its cost is reimbursed in Mediclaim.

23. What is the difference between network hospitals and non network hospitals?

The process of connecting different hospitals all over India is called network and these are called network hospitals. The hospitals which do not come under this network are called non-network hospitals.

Mediclaim policyholder is treated by cashless hospitalization in network hospitals.

If the policy holder gets treatment in non-network hospitals, then initially he will have to bear all the hospital expenses and later he can get the expenses back from the insurance company under Mediclaim Policy by filling the claim form.

24. Where to submit the claim form in Mediclaim Health Insurance?

If settlement is done through TPA then the form has to be submitted to TPA and intimated to health insurance company and if there is no TPA then it has to be submitted directly to health insurance company.

25. Can NRIs take Mediclaim policy in India?

NRIs can definitely take a policy in India, but they will have to be admitted to a hospital in India for treatment.

26. Some children are handicapped or mentally retarded since birth, can they get Mediclaim policy?

Can take

The facility of a policy called Candle Care is available for such children but it is mandatory to take it during pregnancy only.

27. From whom to buy Mediclaim Policy?

Mediclaim policy can be purchased through an agent of the health insurance company and through an insurance broker. Some companies give Mediclaim Policy directly to the customer.

28. When does the premium get reduced while taking Mediclaim Policy?

Taking a direct policy from the health insurance company results in huge savings in the premium as there is no agent or broker commission.

29. Where will the information about health insurance companies, brokers, banks selling insurance be available?

All the information is available on the IRDA site. With the help of numbers and toll free numbers from their website, you can locate the nearest office.

30. Which are the institutes to make a career in Health Insurance?

The best institute to study health insurance is – Insurance Academy, Pune.

Website – https://niapune.org.in/

31. Like a life insurance policy, can a medical health insurance policy be revived after a period of time after it has lapsed?


Because Mediclaim health insurance policy is only for 1 year, it is a pure insurance policy. Hence it cannot be started again once it is closed.

Therefore, it is essential to pay the renewal premium for the Mediclaim health insurance policy on time.

32. If the company’s Corporate Mediclaim Policy provides medical protection to the entire family, then is it not a waste of money to take an Individual Mediclaim Policy again?

Corporate Medical Policy (Mediclaim Policy) is useful only till the time you are associated with that company. Along with this , there is a limitation of Sum Assured If for some reason you leave the company or the company leaves you, then this protection goes out of hand.

Therefore, it is wise to take an Individual Mediclaim Policy for the protection of the family.

There is no limit on the number of claims that can be registered during a policy year. You can keep making claims until the sum insured of the policy is exhauster.
Health insurance companies have their guidelines, and usually, the timely filing limit ranges from 30 days to 1 year from the day of service. You can find timely filing limits under the claims section in the provider manual. The insurers are not responsible for late claims.

35.How do I make an unlimited claim?

You are required to notify The Unlimited’s Customer Care Call Centre on 0861 99 0000 within 30 (thirty) days from the date of the Accident and/or Death. You can obtain claim forms from The Unlimited by calling us on 0861 99 0000.


Do not take health insurance just to get tax exemption, but accept it as an essential facility of your life.

Through this article, how can Mediclaim Health Insurance Policy be planned according to age? Tried to give detailed information about it.

You are requested to plan for Mediclaim insurance policy by understanding health insurance and health care very well.


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