Mediclaim Health Insurance

What is Mediclaim?

A mediclaim is a type of insurance that provides you coverage against the rising medical expenses. Alongside hospitalisation expenses, mediclaim plans now encompass ancillary costs such as diagnostics, consultation fees, OPD expenses, pre- and post-hospitalisation charges, and hospital daily cash allowance.

Features of Mediclaim Policy

Below mentioned are a few features of mediclaim insurance you should know about:

• Coverage: Mediclaim policies cover medical expenses incurred due to illness, accidents, or hospitalisation. These policies typically cover expenses such as hospitalisation costs, surgical procedures, diagnostic tests, medication, and ambulance services.

• Cashless Treatment: One of the key features of a Mediclaim policy is the provision for cashless treatment. Insurance companies have tie-ups with network hospitals where policyholders can receive medical treatment without paying upfront. The insurance company settles the bills directly with the hospital, subject to policy terms and conditions.

• Policy Renewal: Mediclaim policies generally have a renewable feature that allows policyholders to renew their coverage annually. Continuous policy renewal ensures uninterrupted coverage and financial protection against unforeseen medical expenses. It is essential to review the terms and conditions of the policy at the time of renewal to ensure it meets your changing healthcare needs.

Types of Plans in Mediclaim Policy

Mediclaim or health insurance plans are typically categorised into two types:

• Individual: This type of plan provides coverage for the policyholder's medical expenses. Factors such as the applicant's age, medical history, chosen sum assured, and other considerations determine the cost and approval of the policy.

• Family Floater: A family floater plan is designed to cover the entire family under a single premium. While the premium for family coverage is higher than individual coverage due to the inclusion of multiple members. However, it is advisable to consider critical illness or specific senior citizen health coverage if there are elderly family members with complex health conditions. 

In addition to these basic types, there are several specialised Mediclaim policies:

• Critical Illness: This insurance category covers life-threatening conditions such as cancer, kidney issues, paralysis, and more. People are advised to choose this insurance as treating these conditions involves significant medical expenses. It can also be added as a rider to existing health insurance policies.

• Senior Citizen: Considering seniors' have higher health risks and specific healthcare needs, these policies are tailored for senior citizens. They come with a feature of comprehensive coverage.

• Group Insurance: Group insurance plans are purchased by employers to provide health benefits to their employees.

What Is the Difference Between Mediclaim and Health Insurance?

While both products aim to cover medical expenses, they differ significantly in scope, flexibility, and coverage depth.

Mediclaim Policy Coverage & Exclusions

Understanding what is "out of bounds" is just as important as knowing what is covered.

Inclusions:

• In-patient hospitalisation (Nursing, ICU, OT charges).
• Doctor’s fees and anaesthetist charges.
• Cost of medicines and drugs used during the stay.
• Daycare procedures (surgeries requiring less than 24 hours of hospitalisation, like cataracts).

Common Exclusions:

• Self-inflicted injuries: Claims arising from suicide attempts.
• Cosmetic Surgery: Procedures like rhinoplasty or Botox unless required due to an accident.
• Congenital Diseases: Internal or external diseases present from birth.
• Drug or Alcohol Abuse: Illnesses resulting from the use of intoxicating substances.

Why Buy a Mediclaim Policy Online?

In the digital age, purchasing a mediclaim policy online is no longer just an alternative; it is the most efficient way to secure your family's future. Niva Bupa offers a seamless digital interface that simplifies the entire process. Here is why you should consider buying your policy through our online platform:

• Convenience and Speed: You can browse, compare, and purchase a policy from the comfort of your home. There is no need to coordinate with agents or visit a physical branch, saving you significant time.
• Complete Transparency: Online platforms provide instant access to the Policy Wordings and Symmetry of Benefits. You can read the fine print, check the list of network hospitals, and understand exclusions without any external pressure.
• Paperless Documentation: The entire journey (from application to issuance) is digital. You can upload digital copies of your KYC documents, and your policy bond is delivered instantly to your email inbox.
• Exclusive Online Discounts: Buying directly from the website often eliminates intermediary costs. This allows us to pass those savings on to you through lower premiums or exclusive digital-only benefits.
• Real-Time Comparisons: You can use our premium calculators to see how different sums insured or add-ons, like the ReAssure benefit, affect your premium in real-time.

Steps to Secure Your Mediclaim Policy Online

Buying the right cover is a straightforward five step process:

1. Visit the Official Website: Navigate to the Niva Bupa homepage and select the health insurance or mediclaim section.
2. Customise Your Plan: Enter your basic details such as age, location, and the number of family members you wish to cover. Select the sum insured that matches your lifestyle.
3. Fill the Proposal Form: Provide accurate personal information and disclose any pre-existing conditions, such as Diabetes or Hypertension, to ensure a smooth claim process later.
4. Instant Premium Payment: Use secure payment gateways to pay your premium via UPI, credit or debit cards, or net banking.
5. Instant Policy Issuance: Once the payment is successful and the proposal is processed, you will receive your policy document via email immediately. You can also access it anytime through our mobile app.

Buying your mediclaim policy online is a proactive step toward protecting your savings from the rising costs of medical inflation. It ensures that during a medical emergency, your only focus remains on recovery, not on financial arrangements.

Things to Consider Before Purchasing the Mediclaim Plan

When buying a mediclaim plan, it is important to consider the following:

• Assess health insurance requirements for yourself and your family, and decide whether you need individual coverage or a family floater plan.

• Determine an appropriate sum that adequately covers your medical needs, avoiding insufficient coverage leading to out-of-pocket expenses and unnecessarily high coverage, increasing premiums.

• Check the network of hospitals covered by the insurance companies you are considering to ensure cashless treatment options.

• Evaluate the insurer's claim process for customer-friendliness, considering factors such as the claims settlement ratio and the efficiency of claims disbursal.

• Confirm that the mediclaim policy covers medical expenses relevant to you, including pre and post-hospitalisation expenses, maternity benefits, OPD coverage, medication costs, consultation fees, and more.

• Verify if the policy offers lifetime renewal and does not impose an age limit, as the need for health insurance increases with age.

• Take note of the waiting periods associated with the policy, both the general waiting period and any specific waiting periods for pre-existing and listed diseases.

Documentation Required

The following documents are typically required for buying a mediclaim policy in India:

• Proof of Age: This can be a birth certificate, passport, Aadhaar card, voter ID card, PAN card, driving license, or 10th or 12th mark sheet.

• Identity Proof: This can be an Aadhaar card, passport, voter ID card, PAN card, driving license, or any other government-issued ID card.

• Address Proof: This can be a utility bill, bank statement, rent agreement, or any other document that shows your current address.

• Passport-size Photographs: Two recent passport-size photographs are required.

• Medical Reports: In some cases, you may be required to provide medical reports. This is usually only required for older applicants or those with pre-existing medical conditions.

• Any other document sought by the insurer: The insurer may also require other documents, such as a marriage certificate or a divorce decree.
   

NOTE: Documents required for buying a mediclaim policy may vary from insurer to insurer. It is always best to check with the insurer directly to find out what documents are required.
 

Mediclaim Policy Claim Procedure

When you need to make a claim with Niva Bupa, the process is designed to be straightforward and transparent, ensuring you can focus on your recovery rather than paperwork. We offer two distinct methods for settling your medical expenses, depending on your choice of healthcare provider: 

• Cashless Claim Process
• Reimbursement Claim Process

Cashless Claim Procedure for Mediclaim Policy

The cashless facility allows you to receive treatment without paying the hospital directly (except for non-medical expenses).

1. Network Hospital: Ensure the hospital is part of the insurer’s network of 10,000+ partner facilities.
2. Intimation: Inform the insurance desk at the hospital and show your health card.
3. Pre-authorisation: The hospital submits a pre-authorisation form to the insurer.
4. Approval: The insurer reviews the request and sends an approval (often within 30 minutes).
5. Settlement: The insurer settles the bill directly with the hospital at the time of discharge.

Reimbursement Claim Procedure for Mediclaim Policy

If you choose a non-network hospital, you must pay the bills first and then seek a refund.

1. Notification: Inform the insurer about the hospitalisation within 24 to 48 hours of admission.
2. Payment: Settle all hospital bills at the time of discharge.
3. Documentation: Collect all original discharge summaries, pharmacy bills, and test reports.
4. Submission: Submit the claim form along with original documents to the insurer within 15 days of discharge.
5. Verification: The insurer verifies the documents and transfers the eligible amount to your bank account.

Reasons for Claim Rejection in Mediclaim Policy

Below are some of the reasons for Claim Rejection in Mediclaim Policy:

• Incorrect or incomplete claims: Claims may be rejected if the claim form or documentation is incorrect or incomplete. Make sure to understand the claim process and submit all required documents.

• Non-disclosure of pre-existing diseases: Claims may be rejected if pre-existing diseases are not disclosed or if a claim is made for a pre-existing disease within the waiting period. Always disclose and familiarise yourself with the waiting periods for your policy.

• Waiting period: Claims may be rejected if they are made for treatment during the waiting period. The waiting period is the time period after the policy is taken out, during which certain treatments are not covered.

• Expired policy: Claims may be rejected if the policy has expired. Make sure to renew your policy on time.

Why Choose Niva Bupa as Your Health Partner?

Choosing the right policy requires a balance between cost and utility. Start by assessing your family's medical history. If you have a history of chronic conditions, look for policies with shorter waiting periods.

Niva Bupa is India's leading health insurance company, offering various plans to cater to individuals and families. With over 10,000 hospitals in their network, they provide cashless claims processing within 30 minutes. The company boasts a dedicated claims team available round-the-clock and excellent customer service. You can purchase Niva Bupa policies online through their website or by getting in touch with our customer care. where you can also avail special discounts on online purchases.

When selecting a health insurance policy, consider the following tips:

• Compare plans from different insurers to find the most suitable one for your requirements.

• Carefully review the terms and conditions of the policy before making a purchase.

• Take your budget and desired coverage level into account.

• Seek recommendations from friends, family, or colleagues.

By following these guidelines, you can ensure that you make an informed decision and choose the right health insurance policy for your specific needs.