Mediclaim Policy

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.

A health insurance plan, also known as medical insurance, is a critical financial support that helps individuals and families protect their savings. When you are planning to buy a mediclaim policy, you should consider following reasons:

• Convenient and Time-saving: You can compare and purchase policies with just a few clicks.
• Paperless: No need to submit physical documents.
• Competitive Prices: You can compare prices from different insurers.

To buy a mediclaim policy online, you can:

• Visit the website of an insurance company.
• Select the policy that best suits your needs.
• Provide your personal and financial information.
• Pay the premium.
• Download your policy document.

Buying the best mediclaim policy online is a quick and easy way to protect yourself and your family from financial hardship in a medical emergency.

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.

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.

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.

Your mediclaim insurance claim procedure can be cashless or reimbursement-base and this can be done via network hospitals.

Network hospitals refer to medical facilities that have entered into an agreement or partnership with an insurance provider or a healthcare network. These hospitals are part of a preferred network and offer services to insured individuals at pre-negotiated rates. By choosing network hospitals, patients can avail of cashless treatments, reduced out-of-pocket expenses, and seamless coordination between the insurance provider and the healthcare facility.

Network Hospitals:

For cashless claims, it is essential to follow these steps:

• Select a network hospital and inform the insurer at least 72 hours before treatment. In case of sudden admission, inform the insurer within 48 hours of admission.
• Provide your health insurance card, policy document, and photo ID to the hospital.
• The hospital will send your pre-authorisation form to the insurance company.
• Once approved, you can proceed with cashless treatment at the hospital.

Non-Network Hospitals or Reimbursement Claims:

If you choose a non-network hospital or prefer reimbursement, the process is as follows:

• Inform the insurer about your hospital admission, preferably within 48 hours.
• Retain all bills, medical reports, payment receipts, prescriptions, discharge certificate, and other relevant documents during your discharge.
• Upload soft copies of these documents, along with the claim form, on the insurer's website for online processing.
• Alternatively, you can visit the insurer's office, fill out the claim form, and submit the physical documents.
• The insurer will process and verify your claim, after which reimbursement will be disbursed.

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.

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 licence, or 10th or 12th mark sheet.
• Identity Proof: This can be an Aadhaar card, passport, voter ID card, PAN card, driving licence, 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.

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.