Mediclaim

Introduction
 In the absence of any social security systems in this
behalf, the insurance companies had come up with the
medi-claim policies to cater to such medical
emergencies.
 The cost of medical treatment has increased manifold

over a period of time and thus appropriate medical

treatment can be out of the reach of citizens unless the
citizens are covered by such medi-claim policy.
 Introduction
 Mediclaim policy is a hospitalization benefit that is
offered by both public and private sector general
insurance companies in India.
 The Mediclaim insurance policy takes care of expenses

following hospitalization/domiciliary hospitalization of

the insured in respect of the below situations:
a) In case of an accident
b) In case of sudden illness
c) In case of any surgery which required in respect of any
disease which has arisen during your policy period.
 Cont…
 Mediclaim policy is an insurance coverage where in any of your
health related hospitalizations bills can be claimed from the
insurance company.
 There are two different ways to get your bills claimed either by

cashless facility i.e. your bills are directly paid to the hospital or
you can pay your bills in the hospital and get an reimbursement
after submission of the same to the insurance company.
 Mediclaim policy helps employee for take the benefit of medical

treatment.
 Employee’s come under it who pays amount to insurance

company.
 Different types of Coverage
 The policy basically available to persons between the
age of 5 and 80 years (children between the age group
of 3 months to 5 years can be covered if one or both
their parents are also covered concurrently)
 Basic cover
 Pre hospitalization benefits
 Post hospitalization benefits
 Sponsored health checkups
 Discount in premium for family cover
 Types of Policies
 Individual Policy
 Family Policy
 Senior citizen Mediclaim policy
 Individual Mediclaim policy
 This policy is ideal for you if you want to cover just
yourself & medical treatment that only you will need.
 Company will reimburse the medical expenses incurred

while the insured was admitted in the hospital as an in

patient.
 Individual Mediclaim policy also covers surgery,

anesthetist, medical practitioner, consultants, specialist

fees.
 Family Mediclaim policy
It is the enhanced version of Mediclaim policy in
which the sum assured value floats among the family
members i.e. each member of the family is covered
under a single plan and sum assured can be claimed by
any member of the family.
 Family floater policy covers your complete family so

if any medical emergency arise, you have to worry only

about choosing the right hospital not about the
financial costs.
 Senior Citizen Mediclaim policy
  The senior citizen Mediclaim policies are for people
aged between 65 years and 80 years & this policy is
little more expensive then the others.
 It covers:

a) Hospitalization
b) Day care
c) Medical expenses
 Salient Feature of Mediclaim policies
 Mediclaim insurance policy has been devised under the aegis of the
Government of India. The policy provides the following benefits.
 Reimbursement of hospitalization expenses which are reasonably and
necessarily incurred, under the following heads:
 a) Room, boarding expenses as provided by the hospital/nursing
home.
 b) Nursing expenses.
 c) Fees of surgeon, anaesthetist, medical practitioner, consultant and
specialist.
 d) Expenses on account of anaesthesia, blood, oxygen, operation
theatre charges, surgical appliances, medicines and drugs, diagnostic
material, X-ray, dialysis, chemotherapy, radiotherapy, cost of
pacemaker, artificial limbs and cost of organs and similar expenses