Mediclaim Policy

What is mediclaim policy?

Mediclaim policy is a type of health insurance policy that provides financial coverage for medical expenses incurred due to illness or injury. It is designed to help individuals and families cope with the high costs of medical treatment and hospitalization, by providing financial protection against unexpected medical emergencies.

Under a mediclaim policy, the insurance company agrees to pay for the medical expenses incurred by the policyholder up to a certain limit. The policy may cover expenses such as hospitalization, doctor’s consultation fees, diagnostic tests, medication, surgery, and other related costs.

The coverage and premium of a mediclaim policy can vary depending on factors such as the age and health status of the policyholder, the sum insured, and the type of policy chosen. Some policies may also offer additional benefits such as cashless hospitalization, maternity benefits, and coverage for pre-existing conditions.

It’s important to carefully review the terms and conditions of a mediclaim policy before purchasing it, to ensure that it provides adequate coverage for your needs and budget.

How mediclaim policy useful

Mediclaim policy is useful in several ways:

  1. Financial protection: Medical expenses can be very expensive, especially in case of major illnesses or accidents. A mediclaim policy provides financial protection against these expenses, helping you avoid the burden of unexpected medical bills.
  2. Access to quality healthcare: With a mediclaim policy, you can access quality healthcare services without worrying about the cost. This allows you to focus on getting the medical treatment you need, without having to worry about how you will pay for it.
  3. Peace of mind: Having a mediclaim policy can give you peace of mind, knowing that you and your family are financially protected in case of a medical emergency. 
  4. Tax benefits: Premiums paid for a mediclaim policy are eligible for tax benefits under section 80D of the Income Tax Act. This can help you save on your income tax liability.

Overall, a mediclaim policy is a useful tool for managing the financial risks associated with medical emergencies. By providing financial protection against unexpected medical expenses, it can help you and your family cope with the financial impact of illness or injury.

How to claim mediclaim policy

The process for making a claim under a mediclaim policy can vary depending on the insurance company and the type of policy. However, here are some general steps that you can follow to make a claim:

  1. Inform the insurance company: The first step is to inform your insurance company as soon as possible after the medical emergency occurs. You can do this by calling their customer service number or by submitting a claim form online.
  2. Submit necessary documents: The insurance company will require you to submit some documents to support your claim, such as hospital bills, doctor’s prescriptions, diagnostic reports, and discharge summary. Make sure to collect all the necessary documents and submit them to the insurance company within the specified time frame.
  3. Get pre-authorization: If your policy includes cashless hospitalization, you will need to get pre-authorization from the insurance company before getting admitted to the hospital. This involves submitting the hospital’s estimated expenses to the insurance company for approval.
  4. Pay the deductible: If your policy has a deductible, you will need to pay that amount before the insurance company covers the rest of the expenses.
  5. Follow up with the insurance company: After submitting your claim, you may need to follow up with the insurance company to check the status of your claim and provide any additional information they require.

It’s important to review the terms and conditions of your mediclaim policy carefully and understand the claim process before making a claim. This can help you avoid any delays or complications in the claim process.


Here are some additional tips that can help you with the mediclaim claim process:

  1. Keep records of all medical expenses: Keep track of all the medical expenses incurred during the treatment, including bills, receipts, and prescriptions. This will help you to submit accurate information and support your claim.
  2. Inform the insurance company about pre-existing conditions: If you have any pre-existing medical conditions, make sure to inform your insurance company when purchasing the policy. Failure to do so can result in your claim being rejected or reduced.
  3. Be aware of the claim settlement process: Make sure to read the claim settlement process of your mediclaim policy before purchasing it. Some policies may have a specific time limit for submitting the claim, and it is important to follow these deadlines to avoid rejection of your claim.
  4. Keep copies of all documents: Always keep a copy of all the documents you submit to the insurance company. This will help you in case there are any discrepancies or disputes with the claim settlement process.
  5. Be honest: Always provide accurate information when submitting a claim. Any false information can lead to rejection of your claim, and the insurance company may even cancel your policy.

By following these tips and being well-informed about the claim process, you can ensure a smooth and hassle-free experience when making a mediclaim claim.

is mediclaim same as health insurance

Mediclaim and health insurance are similar in that they both provide financial protection against medical expenses. However, there are some differences between the two.

Mediclaim is a type of health insurance policy that covers hospitalization expenses for a specific period and up to a certain limit. It provides coverage for medical expenses incurred due to illnesses or injuries that require hospitalization, surgery, or other medical procedures. The coverage is limited to the actual expenses incurred during hospitalization, and the policyholder is required to pay a certain portion of the expenses, known as a deductible.

On the other hand, health insurance is a broader term that refers to a range of insurance policies that provide coverage for medical expenses, including hospitalization, outpatient care, diagnostic tests, 

and prescription drugs. Health insurance policies can provide coverage for a wider range of medical expenses and can be customized based on the policyholder’s needs and preferences.

So, while mediclaim is a type of health insurance policy that provides coverage for hospitalization expenses, health insurance is a broader term that can cover a wider range of medical expenses beyond hospitalization.

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