Mediclaim Policy in India

List of Banks Providing Mediclaim Policy

Given below are the list of banks providing Mediclaim policy:

National Mediclaim Policy

National Mediclaim policy is an indemnity health insurance that offers coverage ranging from Rs.1 lakh to Rs.10 lakhs to the policyholder. 

1. Sum insured: Rs.1 lakh to Rs.10 lakh 
2. Policy Tenure: One year 
3. Policy Type: Individual 
4. Age limit: 18 years to 65 years 

National Mediclaim Policy Other Plan

It is an indemnity medical insurance plan which is segmented into Plan A, Plan B, and Plan C with the sum assured ranging between Rs.2 lakhs and Rs.5 lakhs per individual. 

1. Sum assured: Rs.2 lakhs to Rs.50 lakhs 
2. Policy Tenure: One year 
3. Policy Type: Individua; 
4. Age Limit: 18 years to 65 years 

New India Janata Mediclaim Plan

New India Janata Mediclaim Plan one year indemnity health insurance plan for those who have less budget. The plan provides sum insured ranging from Rs.50,000 to Rs.75,000. 

1. Sum assured: Rs.50,000 to Rs.75,000 
2. Policy Tenure: One year 

National Parivar Mediclaim Policy Plus

This is a family floater indemnity health insurance plan with sum insured ranging between Rs.1 lakh and Rs.10 lakhs. 

1. Sum assured: Rs.1 lakh to Rs.10 lakhs 
2. Policy Tenure: One year, two years, and three years 
3. Policy Type: Family floater 
4. Age limit: 18 years to 65 years 

Senior Citizen Mediclaim Policy of New India

Senior citizen Mediclaim policy of New India is an indemnity medical insurance policy for the people who are above 60 years of age. The plan provides sum assured options of Rs.1 lakh and Rs.1.5 lakhs. 

1. Sum assured: Rs.1 and Rs.1.5 lakhs 
2. Policy Type: Family floater/ individual 
3. Age limit: 60 years to 80 years 

New India Floater Mediclaim Policy

It is an indemnity medical insurance policy that provides family floater based sum assured options ranging from Rs.2 lakhs to Rs.15 lakhs. 

1. Sum assured: Rs.1 lakh to Rs.15 lakhs 
2. Policy Type: Family floater/ individual 
3. Financially dependent children: Three months to 25 years 

1. Entry age: 18 years to 65 years 

Oriental Bank Mediclaim Policy

Oriental Bank Mediclaim policy is an indemnity family floater health insurance policy that has been designed for the current accountholders of Oriental Bank. 

1. Sum assured: Rs.1 lakh to Rs.5 lakhs 
2. Policy Type: Family floater 

1. Financially dependent children: Three months to 26 years 
2. Entry Age: 18 years to 79 years 

PNB Oriental Royal Mediclaim Policy

Punjab National Bank (PNB) Oriental Royal Mediclaim Policy is an indemnity health insurance policy which has been introduced for the current account holders of the Punjab National Bank and its associated banks. 

1. Sum assured: Rs.2 lakhs to Rs.10 lakhs 

1. Policy Tenure: One year 
2. Policy Type: Family floater/ Individual 
3. Entry Age: 18 years to 79 years 
4. Financially dependent children: 91 days 

Reliance Critical Illness Insurance

This fixed benefit health insurance plan offers financial coverage of ten different critical illnesses. The sum assured ranges from Rs.5 lakhs to Rs.10 lakhs. 

1. Sum insured: Rs.5 lakhs to Rs.10 lakhs 
2. Policy Type: Individual 
3. Entry Age: 18 years to 65 years 

Raheja QBE Comprehensive Plan

It is an indemnity health insurance plan that provides a sum insured which ranges between Rs.3 lakhs and Rs.50 lakhs. 

1. Sum assured: Rs.3 lakhs to Rs.50 lakhs 
2. Policy Type: Family floater/ individual 
3. Financially dependent children: Three months to 25 years 
4. Age limit: 18 years to 65 years 

SBI Arogya Premier Policy

It is an indemnity health insurance policy that provides a medical coverage ranging from Rs.10 lakhs to Rs.30 lakhs. 

1. Sum assured: Rs.10 lakhs to Rs.30 lakhs 
2. Policy term: One, Two, or Three years 
3. Entry age: Three months to 65 years 

Royal Sundaram Lifeline Supreme Health Plan

It is an indemnity health insurance policy which provides sum insured options ranging between Rs.5 lakhs and Rs.50 lakhs. 

1. Sum assured: Rs.5 lakhs to Rs.50 lakhs 
2. Policy Term: One, Two, or Three years 
3. Policy Type: Family floater/ individual 

1. Age limit: 18 years 

TATA AIG MediCare Plan

TATA AIG MediCare Plan is an indemnity health insurance plan that provides sum insured ranging from Rs.3 lakhs to Rs.20 lakhs. 

1. Sum assured: Rs.3 lakhs to Rs.20 lakhs 
2. Policy Tenure: One, two, or three years 

1. Policy Type: Family floater/ Individual 
2. Entry Age: 91 days 

Star Family Health Optima Plan

It is an indemnity health insurance policy that provides medical coverage ranging between Rs.3 lakhs and Rs.25 lakhs on a family floater basis. 

1. Sum assured: Rs.3 lakhs to Rs.25 lakhs 

1. Policy term: One, Two, or Three years 
2. Policy Type: Family floater 
3. Dependent children: 16 days to 25 years 
4. Age limit: 18 years to 65 years 

Universal Sompo Complete Healthcare Plan

It is an indemnity health insurance plan that provides sum insured ranging between Rs.1 lakh to Rs.50 lakhs. 

1. Sum assured: Rs.1 lakh to Rs.50 lakhs 
2. Policy Term: One, two, or three years 
3. Policy Type: Family floater/ individual 
4. Age limit: 18 years to 65 years 

1. Dependent Children: 91 days to 25 years 

United India UNI CritiCare Health Care Plan

It is a fixed benefit critical illness health insurance plan that provides sum assured ranging between Rs.1 lakh and Rs.10 lakhs. 

1. Sum assured: Rs.3 lakhs to Rs.20 lakhs 
2. Age limit: 21 years to 65 years 

What is Covered?

Given below are coverages offered by the Mediclaim policy: 

*Hospitalization Charges 

A Mediclaim policy covers expenses incurred at the time of hospitalization like Operation Theatre (OT) charges, blood, diagnostic procedures, chemotherapy, oxygen, x-ray. Medicines, pacemakers, donor expenses, and radiotherapy. It also incurs the cost of sickness and accidental hospitalization. 

*Fees Charges by Medical Professionals 

The plan offers compensation for fees charged by the hospital professionals like nurse, surgeon, doctor, anesthetist, etc. after hospitalization. 

*Hospital Room Charges 

The insurance company takes care of the charges of intensive care unit or regular ward with cashless hospitalization in any of its network hospital. In case you are admitted in non-network hospital, you can submit the hospital bills to the insurance providers for recompensation of the hospital room charges.

What is Not Covered?

The following things are not covered in a Mediclaim policy: 

1. A Mediclaim policy does not cover pre-existing health issues of the policyholder till the completion of the waiting period. 
2. The plan does not cover certain health ailments for two to four years like joint replacement surgery. 
3. Any sort of medical issues which are diagnosed within 30 days of the commencement date of the policy are not covered in the plan. 
4. The plan does not cover hormonal treatment and birth control. 

1. Dental surgeries done in clinic. 
2. HIV AIDS 
3. Congenital anomaly 
4. Suicide attempt 
5. Drug or alcohol addiction 

1. Complication at the time of ectopic pregnancies and childbirth. 

Eligibility Criteria of a Mediclaim Policy

The following are the eligibility criteria of a Mediclaim policy: 

Documents Required

Given below are the list of the documents which are needed to be submitted to purchase a Mediclaim policy: 

1. Duly filled application form 
2. Age Proof: Passport, Aadhar card, Permanent Account Number (PAN) card, Voter ID card, etc. 

1. Identity Proof: Aadhar card, driving license, passport, PAN card, Voter ID card 
2. Address Proof: Driving license, ration card, utility bills, Aadhar card, passport, Voter ID card. 
3. Two passport size photographs 
4. Medical test reports 

Mediclaim Insurance Claim Process

You can raise claims in two different ways: cashless claim and reimbursement claims. Let us have a look at these one by one. 

1. Cashless Claim Procedure  

In cashless claim procedure, the policyholders can receive cashless treatment in any of its network hospitals. You don’t have to pay for your treatment from your pocket. The following are the steps to apply for cashless claim in Mediclaim policy: 

1. Visit any of the network hospitals mentioned in your Mediclaim policy to receive treatment. 
2. Ask for the pre authorization form from the health insurance desk of the hospital. 

1. Fill out the form by providing all your details. 
2. The network hospital will send your form to the Third-Party Administrator or the policy insurer for the approval process. 
3. The insurance company will go through your documents and will send the approval letter to the insurer. 
4. After sending the approval, the company will fax the network hospital by mentioning coverage amount. 
5. The policyholder can continue their treatment and provide their signatures on all the required documents at the time discharge. 

1. The insurance company will pay your hospital bills after discharge. 

2. Reimbursement Claim Procedure 

In case of reimbursement claims, you have to inform your insurance company about your medical emergency via call or email. Once the treatment is over, ensure to gather all your medical bills and hospitalization documents.  

Now, submit all your medicine bills, hospital bills, and payment bills to your Mediclaim policy company. Enclose the claim form as well as the original discharge form for the review. The insurance officials will go through your documents and will approve your claim. After sending the approval letter, the insurance provider will reimburse your claim. 

Mediclaim Policy & Health Insurance Difference:

The following table explains the key difference between Mediclaim policy and health insurance: 

Benefits of Mediclaim Policy:

Given below are the benefits of Mediclaim policy: 

1. A Mediclaim policy will help in receiving hospital treatment without touching your lifelong savings. 
2. It reduces your financial pressure at the time of medical emergencies. 
3. The cashless hospitalization facility allows to receive cashless treatment at any of the network hospitals. 
4. The plan also covers expenses incurred in hospitals due to critical illnesses or accidents. 

1. It comes with lifelong renewal options. 
2. Mediclaim policies covers ICU and hospital room rent charges. 

GST rate of 18% applicable for all financial services effective July 1, 2017.