As medical expenses rise and health-related uncertainties increase, safeguarding your financial protection is just as important as protecting your health. A Mediclaim policy is the foundation of financial protection. But what is it, and how does it differ from Health Insurance? This article will define it, examine its purpose and protections, as well as develop a plan to find the right Mediclaim policy for you.
Mediclaim vs. Health Insurance: Is There a Difference?
Though used interchangeably, there is a difference. A Mediclaim policy is typically viewed as a type of Health Insurance plan that pays for hospitalization expenses specifically from either medical condition or injury. It is usually viewed as a base-level indemnity plan. Health Insurance is a broad term for many products, which includes Mediclaim, as well as more comprehensive products that provide coverage for outpatient expenses (OPD), critical illness, personal accident, and wellness benefits. Mediclaim is a product or plan within the broader Health Insurance marketplace.
Key Benefits of a Mediclaim Policy
The biggest advantage of a Mediclaim policy is the financial protection it provides. Here are its main advantages:
Cashless Treatment: The most significant advantage. The hospital bills will be settled directly with the network hospital by your insurer so you do not have to spend large amounts of money out-of-pocket at a time when you are likely under pressure and stress.
Hospitalization Benefit: The great value of a typical Mediclaim Policy is that it covers room rent, doctor’s fees, surgical costs, medicine, and the cost of diagnostic tests during hospitalization.
Pre & Post-Hospitalization Expenses: Mediclaim policies will also cover medical expenses for a designated time-period prior to hospitalization (for diagnostics) and after discharge (for medicines and follow-up check-ups).
Day-Care Procedure: Day-care procedures will be procedures such as chemotherapy or dialysis with the patient being hospitalized (or admitted) for less than 24 hours.
Tax Benefits: Premium paid toward a Mediclaim policy is tax-deductible under section 80D of the Income Tax Act. The tax deduction is up to ₹25,000 on the premiums paid for self and family, and up to ₹50,000 for senior citizens.
What Does a Typical Mediclaim Cover?
Before buying any plan, it is important to understand what is covered. A standard Mediclaim covers:
- In-patient Admission to Hospital (at least 24 hours)
- ICU Room Charges
- Doctor/Surgeon Fee
- Medications and Medical Consumables
- Diagnostic Tests (X-ray, Blood Test etc.)
- Operation Theatre Charges
- Ambulance Charges (limited to a certain amount)
How to Select the Right Mediclaim Policy in India
With so many insurers with a variety of Mediclaim and Health Insurance plans it can be challenging to choose the right option. You can use the following checklist:
Identify Needs: Your needs should be based on your age, family, health profile and city. A young individual has different needs than a family with elderly parents.
Adequate Sum Insured: This is the maximum amount you can claim from the insurer. Don’t underinsure. Due to medical inflation, and the average cost of a single day of hospitalization being ₹20,000, I would recommend a cover of a minimum ₹5-10 lakhs. Also, choose a plan which will allow you to restore the sum insured if it is exhausted.
Check Network Hospitals: Check how many network hospitals you have access to in your city, and if it is a suitable quality of hospital for cashless treatment.
Understand the Sub-Limits: Read the policy wording for any sub-limits on covers, especially room rent. If your room rent is capped, then all other expenses covered may be capped proportional to the room limit as well. Try to avoid or minimize any policies with sub-limits.
Consider Waiting Periods: Almost all policies will have a waiting period for pre-existing diseases (typically 2-4 years) and certain treatments. Compare the waiting periods against other insurers.
Conclusion
A Mediclaim policy isn’t an expense, it’s a proactive measure for your family’s health and financial wellness. It allows you to make best-in-class medical decisions based on health needs rather than costs. Understanding your needs, reviewing the fine print, and selecting a plan from an established insurance company allows you to establish a strong Health Insurance foundation that prepares you for anything that may come your way. You don’t have to wait for an illness to see its value – act today and secure your Mediclaim Policy.
