Monday, July 26, 2021


What is Mediclaim? How Does it Work? Who is it for?

June 15, 2021 by  
Filed under Business, Health, Opinion, Weekly Columns

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(ThyBlackMan.com) Medical emergencies seldom announce their arrival and almost always catch you off-guard. In the absence of health insurance or a mediclaim policy, you are at the risk of bearing the medical expenses on your own.

However, this is not the most practical option due to rising healthcare costs in India. That is the reason you need to invest in a mediclaim and do it now. Let us understand its importance and benefits in detail.

What is a Mediclaim Policy?

A mediclaim policy is an insurance cover that protects you against hospitalization bills. It provides you with financial protection in case you need to be hospitalized due to an illness or an injury. As with other forms of insurance, Mediclaim also comes with a wide range of benefits that can be exercised by paying an annual premium. This type of insurance comes for a certain period of time and needs to be renewed to continue enjoying the benefits.

Simply put, it is a type of health insurance that either reimburses you for the medical expenses arising out of hospitalization or allows you to get cashless treatment at one of the network hospitals. Additionally, the premium paid towards this policy is eligible for tax exemption u/s 80D of the Income Tax Act[1].

mediclaim 2021

How Does A Mediclaim Policy Work?

Here is how you can avail the benefits of the Mediclaim policy:

  • Cashless Benefits:

When you choose a cashless mediclaim policy, you can get cashless treatment only in one of the network hospitals mentioned in your insurance plan. Therefore, you need to check the document carefully to ensure that your preferred hospital is listed in the network of hospitals before choosing it for your treatment. This will help you mitigate the risk of claim rejection later.

It is important to note that you will not be able to claim the cashless benefits of your mediclaim policy in any other hospital than the one listed in your policy document. So, before you file for a claim, make sure that the medical expenses have been incurred in the hospital that is part of your insurance company’s hospital network.

  • Reimbursement Benefits

If you find that you were treated in a hospital outside of the hospital network, it does not entirely disqualify you from claiming the cost of hospitalization. You may still be able to get the reimbursement benefit if the hospital is a recognized one.

You need to be consistent with your premium payments and keep the policy active before applying for a claim. Be sure to strictly follow all the terms and conditions listed in the policy document to avoid any claim rejections.

Once you initiate the claim settlement for your hospitalization, the insurance provider will assess your case and approve your request for cashless benefit. This process is known as authorization. It can take up to 72 hours for your insurer to validate and approve your claim.

Any pre-planned hospitalizations due to health concerns or pre-existing medical conditions require pre-authorization before hospitalization. However, you do not need prior authorization for emergency hospitalizations.

Who Should Buy Mediclaim Policy?

Thanks to the rising prices of medical bills and hospitalization, healthcare costs can quickly put a huge dent in your savings if you do not invest in a mediclaim policy at the right time. It becomes even more challenging when the expenses stem from an unforeseen situation, such as critical illnesses or accidents.

But with a Mediclaim policy in your financial portfolio, you will be able to overcome the financial risks and ensure that you get access to quality medical care when you need it the most.

Not only do these policies safeguard your finances, but they also offer you tax saving benefits at a reasonable premium. Therefore, it is safe to say that mediclaim policies are a smart investment that everyone should make. If you are able to afford the premium payments consistently, then it is advisable to get the policy as early as possible.

However, before investing in mediclaim plans, experts advise prospective buyers to assess their needs and budget first. You should also use online tools provided by reputed insurance providers, such as Care Insurance, to compare policies to make an informed buying decision. Besides, you can also explore their blog section to find insights on different insurance topics and gain a better understanding about your purchase!

Staff Writer; Derrick Love


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