What is Covered and Not Covered Under Mediclaim Policy


What is Covered and Not Covered Under Mediclaim Policy

Medical advancement and technology have reduced the rate of fatality and increased the rate of recovery in the health care industry. But, the progression in medical sciences is accountable for galloping medical inflation. The costs of hospitalization, treatment, and medicines are burning holes in the pockets. That is why investing in the right mediclaim policy is a wise decision. However, before choosing a medical policy you should check its coverage so that you can make the best out of it. 

Here you can read what is covered (inclusions) and not covered (exclusions) under the medical policy:

Mediclaim Inclusions

With the right medical policy, you do not worry about those medical treatment costs, but it’s good to check what it cover:

  • In-Patient Hospitalization- During medical emergency you can avail in-patient cashless hospitalization facility under mediclaim. You do not need to carry lump sum cash to start the treatment. These expenses include are room charges, nursing expenses, ICU, surgeon’s fee, doctor’s fee, blood, oxygen, and OT changers.
  • Pre and post hospitalization- All pre and posts hospitalization expenses such as diagnosis, treatment, and medicine expenses, doctors’ fees, etc. are also covered in medicalim policy.
  • Annual Health Check Ups- Yearly health check-ups and diagnosis costs are rising day by day. In mediclaim you can get annual health check-up once in a policy year, which is applicable for all the insured members. It includes tests for blood sugar, urine routine, blood groups, kidney function, and ECG check-ups.
  • No Claim Bonus (NCB) - No Claim Bonus (NCB) is a reward that you get for not claiming during your policy tenure. It is the bonus amount that gets accumulated to the sum insured for every claim-free year. It is a double bonus you can avail on your health insurance policy. 
  • Day Care Treatments- It also covers day care treatment, where you do not require admitting in the hospital for 24 hours. Cataract surgery, chemotherapy, dialysis, etc. are included. 
  • Domiciliary Hospitalization- You can also avail domiciliary hospitalization facility, if not in a condition to go to the hospital.  You will get the reimbursement for more than 3 consecutive days.
  • Additional cover- Free ambulance, ICU charges, organ donor cover, second opinion, NCB, and alternative treatments are also covered. 
  • Tax Exemption- Under section 80 D of the Income Tax Act 1961, the premium paid for medicalim policy for self, dependent parents, children, and spouses are exempted from tax. 

Mediclaim Exclusions 

There are the things or diseases that are not covered under medicalim exclusions, take a look:

  • Pre-existing Diseases- Any diagnosis of diseases / undergoing of surgery/occurrence of an event, whose signs or symptoms first occur within 30 days of policy period start date.
  • Self-Inflicted Injury- Expenses attributable to self-inflicted injury such as suicide, attempted suicide, etc.
  • Injuries Due to Consumption of Alcohol- Expenses arising out of or attributable to alcohol or drug use/misuse/abuse.
  • Transmitted Diseases- Medical expenses incurred for the treatment of AIDS and other transmitted diseases.
  • Pregnancy Treatment- Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion, and its consequences.
  • Infertility Treatment- Tests and treatment relating to infertility and in vitro fertilization cannot be claimed.
  • Congenital Diseases- Expenses incurred for the congenital disease also do not cover under health insurance. These are the diseases or disabilities occur due to birth defect.  
  • Permanent Exclusions- War, riot, strike, and nuclear weapons induced hospitalization are considered as permanent exclusions.
  • Cosmetic Surgery- Plastic surgery, cosmetic treatment, and implant are also not covered under insurance policy.

Click here to know about Day Care Treatments Cover


It is a type of insurance coverage that forfeits your medical expenses in case of emergency. You can opt for either cashless facility or reimbursement. You can find ample of options when you browse for mediclaim. But, it is advisable to invest in health insurance policies offered by trusted brand like Care Health Insurance. Its super mediclaim gives you maximum coverage with less exclusion. You can buy it for you or for your family. It is an ideal investment to save your hard-earned money and protect your family. 

Disclaimer: Please read the brochure and prospectus to know more about our health insurance plans cover as conditions may vary.

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