Health Insurance / Mediclaim

Types of Health Insurance

Hospitalisation plans:

In this case, all the expenses related to the hospitalization period are paid by the insurance company, provided the insured gets admitted to hospital for not less than 24 hours. The maximum amount to be reimbursed is the specific sum insured against the policy. Other add on can be purchased like pre and post hospitalization care, at home care etc.

Hospital Daily Cash Benefits

In this plan, insurance company takes the liability of paying a definite amount per day during hospitalization period up to the certain maximum number of days.

Critical Illness Plans

Few diseases are high severity and low frequency but can cause a high amount of financial requirement for the treatment like cancer, heart attack etc. Under these plans, a lump sum amount is to be payable by the insurance provider on the event of diagnosis of certain critical diseases.

All the above policies can be taken either for the individual or for the group of the people. In case the policy is taken for a group of people like family it is called as floater policy in which all the members are covered in the single policy and the sum insured will be available for the treatment of any one or all of the members as per the event.

Mediclaim Policies

Mediclaim policies undertakes to reimburse for the expenses incurred during your hospitalization or domiciliary care provided the submission and verification of necessary documents is complete.

Features:

• Premiums – that are payable on Mediclaim policies differ between insurers but are based on certain criteria like age of the proposer, geographical area of treatment, sum insured, term of plan, etc.
• Family cover – Mediclaim cover can be extended for the entire family with the payment of extra premium.
• Overseas Mediclaim Policies – Overseas Mediclaim policies cover the insured in India and overseas, subject to certain predetermined conditions.
• Claims – Claims are administered by Third Party Administrators (TPAs) these days, but a few insurers deal with claims in-house.
• Types – Mediclaim policies are available in various range and types, depending on the requirement of those to be insured. There are individual policies, group policies, senior citizen policies, critical illness policies and special maternity policies etc.
• Tax benefits – Under Section 80D are available up to Rs.15,000 on Mediclaim premiums for yourself, spouse and dependent children and an additional exemption of Rs.15,000/20,000 for including parents/senior citizen parents.

Types of Mediclaim policies in India:

• Individual Mediclaim
• Family Floater
• Group Mediclaim
• Overseas Mediclaim
• Low-cost Mediclaim - is for the underprivileged masses.
• Senior Citizen Mediclaim
• Critical Illness Mediclaim

Any Mediclaim Policy covers the following expenses:-

• Hospital charges
• Day-care treatment
• Pre and post-hospitalization expenses
• Hospital accommodation charges
• Medical professional’s fees
• Investigation charges.

General Exclusions:

• All pre-existing diseases, medical conditions and injuries.
• All diseases that arise within the first 30 days of the policy commencement date.
• Injuries or medical conditions caused by war, hostile foreign invasion or attack, war-like operations, etc.
• Plastic surgery (not arising out of accident), cosmetic or aesthetic treatments of any kind.
• Cost of spectacles, hearing aids, contact lenses, etc.
• Dental treatment and surgery – unless it arises due to an accident and requires hospitalization.
• Intentional self-injury and attempted suicide.
• Alcohol / drug abuse.
• STDs like HIV / AIDS, human T cell lymph tropic virus type III (HTLB III), lymphadenopathy associated virus (LAV) or their variations.
• Pregnancy and childbirth related cases.
• Naturopathy related treatments.