Know Your Mediclaim Policy

'Mediclaim Policy' is a common term in the Indian financial vocabulary. Mediclaim Policy in India is not merely a tax saving deal, but is an indispensable part of an individual's investment portfolio. It refers to a contract between two parties where the insurer indemnifies the insured for expenses incurred on account of hospitalization for a period of 24 hours or more. Typically, while there is a limit on the extent of cover offered by the mediclaim policy, there is no restriction on illnesses or medical conditions that may cause hospitalization.

Mediclaim Policy v/s Health Insurance Policy

Contrary to popular belief, there is a world of difference between a health insurance policy and a mediclaim policy. While each serves its own purpose, it is imperative that you analyze your personal requirements before you opt for a policy that could save you immense financial trouble. Here's how the two basically differ.

1. A Mediclaim Plan exclusively covers expenses that arise from hospitalization of 24 hours or more. It is, simply put, a redeeming policy. A Health Insurance Policy is more comprehensive as it offers financial cover for pre-, during and post-hospitalization expenses, and an array of medical situations, as per the contract. As a financial shield, it includes cover for specific situations like a critical illness or an accident that may lead to loss of livelihood on account of disability, or loss of life.

2. Mediclaim Insurance Plans indemnify the insured for expenses already incurred by way of reimbursement or a 'cashless' benefit.
While there are several kinds of health insurance policies, most plans like personal accident and critical illness policies offer 'benefits' or a lump-sum amount on the occurrence of an event.

3. A mediclaim policy can be claimed as many times as necessary within a year, limited only by the extent of cover offered by the policy.

A health insurance policy usually allows for a single payment, post which another claim in the same financial year cannot be made.

Benefits of a Mediclaim policy

With a lifestyle that leaves little time for fitness, and medical costs that do not match incomes, investing in an insurance policy is a necessity. The Indian market is flooded with players offering an array of insurance plans. Several companies include in their employees' pay-package a Family Mediclaim Policy that serves well during unexpected medical exigencies. Whether you hold a Mediclaim Insurance or are looking to invest in one, know what makes it such a popular investment.

1. As one of the most cost-effective investments, the Mediclaim premium amounts to just about 0.5% - 2% of the total projected costs that may arise out of hospitalization.

2. A Cashless Mediclaim Policy allows you to avail hospital services without having to spend any money. Alternatively, if you are required to make a claim, most Mediclaim policies provide full reimbursement of the expenses incurred.

3. Mediclaim in India is exempt from taxes for annual premium of up to Rs 15,000 per person. While ideally tax benefit should not be the only reason to opt for such a policy, it certainly makes the investment more lucrative.

4. Most mediclaim insurance companies offer cover that extends to the family of the investor, thus ensuring a comprehensive cover for all.

Who can take a Mediclaim Policy?

A Mediclaim policy can cover anyone between the age-group of 5 to 60 years, provided the proposer is more than 18 years of age. Most companies also allow you to continue the insurance cover beyond 60 years, provided you have been covered by the same company, without a break, ever since. There is also a Family Floater Mediclaim Policy – one that allows the sum insured for the proposer to be available to all family members who are covered under the Mediclaim Insurance Policy. Members usually protected under such a policy are:

  • Self
  • Spouse
  • 2 Dependent Children

Parents and parents-in-law are generally not covered by a Mediclaim policy. Children, too, are covered only up to a certain age, as is defined by the company.

Depending on your personal requirements and budget, you can search online for a Mediclaim policy and opt for the best Mediclaim plan in a few clicks. Buying Mediclaim Insurance online is not only the fastest and the easiest way, but it also allows you to compare competitive products and offerings.

What does this Policy Cover?

If you are looking for the best mediclaim policy in India for a family, inquiring into what your policy entails could be helpful in taking an informed decision. While every insurance company has a policy that boasts different features, most come with the following covers and benefits:

1. All expenses directly related to hospitalization, like consultation charges, nurse-service fees, surgeries etc. are covered by a Mediclaim policy. On account of growing competition, some companies may even compensate for pre- and post-hospitalization expenses like local ambulance services obtained.

2. Some procedures, like cataract, that do not require hospitalization, are also covered by a Mediclaim policy.

3. Even the best Mediclaim Insurance plan does not cover illnesses like Cataract, Hernia, Piles and Sinusitis for the first year. However, upon renewal, these illnesses automatically come under its scope.

4. Most Mediclaim Insurance allow Cashless Hospitalization, a benefit that enables the hospital to claim bills from the insurance company directly.

5. The best mediclaim policy for family in India would cover hospitalization charges for you, your spouse and up to 2 dependent children.

6. There is no restriction on the number of claims you make on a Mediclaim Insurance Policy, provided the claims are within the insured amount.

Special Features of this Policy

A Mediclaim Policy offers a few additional benefits. As add-ons, they serve as attractive features for a policyholder.

1. An annual Mediclaim Premium not exceeding Rs 15,000 can be claimed as deductions from Income Tax under Sec 80C.

2. Most companies offer a 'No Claim Bonus' where you are entitled to a discounted premium if you made no insurance claims in the preceding year.

3. A few vendors even offer a 'Loyalty Benefit' that entitles you to benefits if you have taken a policy with the same company for a minimum number of pre-specified years.


While researching to buy the best Mediclaim policy, exclusions make for an important feature to look into. Comparing Mediclaim Insurance online can help you narrow down products that have minimal exclusions and a comprehensive cover in terms of benefits. Just like features, exclusions, too, vary among different products of different companies. Here's a basic outline that is generally applicable:

1. Even the best Mediclaim policy in India comes into effect only after a month of submission of documents. Any hospitalization that occurs during this period is not covered by the Mediclaim policy.

2. Certain medical conditions are not covered by a Mediclaim Insurance Plan. These include:

  • Dental treatment, except in case of an accident
  • Cosmetic and obesity related treatment
  • Plastic Surgery or circumcision, except in cases of injury or illness
  • Debility and General Run Down Conditions
  • Pregnancy
  • Medical condition acquired as a result of war; experimental, natural or domiciliary treatment

To buy the best Mediclaim policy, a number of factors need to be looked into. From players in the market to their varying products, your budget, number of family members to be covered, and personal requirements, the influencing factors are many. An insurance plan, whether it is a cashless mediclaim policy or otherwise, its inclusions and exclusions, and the value it offers in terms of cover provided for the premium invested, can help you in opting for the best mediclaim policy for a family in India.

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