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Mediclaim Policy

  • 15500+ Cashless Healthcare Provider
  • Pre & Post Hospitalization
  • Annual Health Checkup
  • 92.3%* Claim Settlement Ratio
  • Tax Benefit u/s 80D






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Mediclaim Policy

India is grappling with several health problems. It has turned into the diabetes capital of the world. Around one million new cases of cancer register, every year, and the rising rate of non-communicable diseases (NCDs) causes 61% of deaths in the country. No doubt, medical advancement bringing new hopes to the health care sector. But, at the same time, it is giving rise to medical inflation. The costs of diagnosis, medication, treatment, and hospitalization are burning holes in the pockets and become unaffordable for the common mass. Either one has to sell the assets or lend money whenever there is a medical emergency. It results in financial distress for the entire family. So, to combat such a medical crisis, we offer the best mediclaim policy that covers your risks and provides you financial support whenever you need it.

What is Mediclaim Policy

You cannot predict health uncertainties, but you can stay prepared. Mediclaim policy helps you to stand strong during a medical emergency. It is a medical insurance plan that covers your medical expenses up to the sum insured and helps to avail the best possible treatment for yourself or your loved ones. Under the mediclaim policy, you can cover self, spouse, children, and dependent parents and opt for either a cashless hospitalization facility or reimbursement to settle the claim. It is the best mediclaim policy for investment that avails you class healthcare services without worrying about money. So, your farsighted approach, pragmatic planning, and mediclaim health insurance cover help you to stay in the pinkest of your health without financial stress.

Key Features of Mediclaim Policy

Mediclaim Policy is a comprehensive medical insurance policy that provides financial assistance during hospitalization. With mediclaim, you do not need to arrange cash for your treatment at any of our network hospitals. We take responsibility for all your medical hassles so that you can focus on your recovery. Let's take a close look at its key features:

  • Cover for in-patient hospitalization
  • Coverage for medical expenses during pre and post hospitalization
  • Claim settlement either by a cashless facility or by reimbursement up to the sum insured
  • Minimum 24 hours hospitalization is required to get the claim
  • It also has a list of specific exclusions
  • Lifelong renewability is easily available
  • No upper age limit for enrolment
  • In a family mediclaim, you can pay a lump sum premium instead of paying for individual policies.

Calculate your Mediclaim Premium now!

Benefits of Mediclaim Policy

It is your savior whenever you or your family faces a medical emergency. It provides you financial help without depletion of your savings. Read below the vital benefits of having the best medical policy for the family:

  • Mediclaim policy provides a cashless hospitalization facility during a medical emergency.
  • It will cover various out-of-pocket medical expenditures.
  • Mediclaim policy has additional add-ons such as daily allowance and OPD care you can select according to your needs for complete protection.
  • It offers coverage for your pre and post hospitalization medical expenses such as OPD expenses, diagnosis, doctor's fee, medication, therapies, etc.
  • One has the lifelong renewability option with additional benefits, such as coverage for alternative treatments, day care procedures, annual health check-ups, etc.
  • You can choose the advanced treatment facility on a cashless basis at any in-network hospitals in nearby locations.
  • You become eligible for income tax benefits under Section 80D of the Income Tax Act, and can claim a deduction up to Rs.75, 000 for the premium paid for a family floater policy.

What Does a Mediclaim Policy Cover?

Due to the uncertainties of life and the constant rise in health care costs, mediclaim nowadays is important for families and individuals. Read below what a mediclaim policy covers.

  • Cashless Hospitalization: During an emergency, you get cashless hospitalization in any of the network hospitals nearby to your location without getting stressed for arranging cash for the treatment.
  • In-Patient Hospitalization: If the in-patient hospitalization is for more than 24 hours, then mediclaim policy covers your hospitalization expenses. These expenses include your room charges, nursing expenses, ICU, surgeon's fee, doctor's fee, blood, oxygen, and OT (operation theatre changers).
  • Day Care Treatments: If you have to undergo any surgery or treatment or therapy that requires hospitalization for a day, then from room rent to medicine bills, we bear your day care treatment expenses, up to the sum insured. We cover more than 540-day care treatments.
  • Pre and post hospitalization: Mediclaim policy covers your pre and post hospitalization expenses that include diagnosis, treatment, and medicine expenses, along with doctor's fees. Treatment costs such as dialysis, daycare treatments, and surgeries are also covered.
  • ICU Charges: We value every life and know the importance of the right healthcare services. If you are admitted to ICU, we will cover the charges.
  • Ambulance cover: Mediclaim policy provides reimbursement against the expenses that you incur on an ambulance during a medical emergency.
  • Domiciliary Hospitalization: If recommended by a medical practitioner or there is no vacant bed in the hospital, you can avail of the domiciliary hospitalization facility. You will get the reimbursement if the hospitalization exceeds more than 3 consecutive days.
  • Annual Health Check-Ups: Under mediclaim policy, you will get an annual health check-up facility at our emplaned healthcare services providers. It includes complete blood sugar, urine routine, kidney function, ECG check-ups, etc.
  • Recharge of Sum Insured: If your coverage amount gets exhausted, you get an automatic recharge of sum insured. You can use this amount for the treatment of any other insured family member or yourself.
  • Other Benefits: Organ donor cover, second opinion, NCB, and alternative treatments are other good benefits.
  • Tax Exemption: Under section 80 D of the Income Tax Act 1961, the premium paid for mediclaim policy for self, dependent parents, children, and spouses qualify for tax deductions. Thus, you can have saved a good amount of money and enjoy the tax benefit.

What is Not Covered under a Mediclaim policy?

The medical conditions that are not covered under medical insurance plan are called exclusions. You can read below the *exclusions under our mediclaim policy.

  • Any diagnosis, treatment, or surgery for illnesses occurring within 30 days of Policy Period Start date
  • Medical expenses related to treatment of congenital disease
  • Medical expenses incurred due to IVF or infertility treatment
  • Treatment arising from/ or traceable to pregnancy and childbirth, miscarriage, abortion and its consequences
  • Hospitalization due to war, riot, strike or nuclear weapons
  • Medical expenses due to alcohol or drug abuse
  • Expenses arising due to self-inflicted injuries and suicide/suicide attempts
  • Pre-existing diseases for a period of 4 years since the inception of the policy

Note: Please read the policy documents carefully to know the exclusions at the time of buying a policy

Documents Required for Mediclaim

You need only a few documents to buy online mediclaim policy that includes:

  • Proposal form
  • Pre-existing medical condition reports(if any)

How to Choose the Best Mediclaim Insurance Policy?

A mediclaim policy will protect you at any time if at all, you have to face a medical emergency or any planned medical treatment for you or your loved ones. Choose a policy wisely so that you can avail of its maximum benefits.

You may find many mediclaim policy options online, but to finalize what is best can be challenging, and several aspects need your attention. You will then be able to take a better decision as to what is suitable for your family.

  • Type of Plan: You can opt for an individual cover or a family floater plan and get a customized health cover that will shield your finances from the impact of expensive health care procedures.
  • Sum Insured: Carefully select the sum insured after thoroughly assessing your estimated medical expenses and the rate at which medical costs are rising in India to get the best mediclaim policy.
  • Benefits: Opt for a plan that gives maximum coverage, including treatment, ambulance, medication, and hospitalization expenses. Know the different additional benefits, such as international second opinion, OPD cover and more to enhance the coverage of your mediclaim policy.
  • Premium: The coverage you would get should not make you spend on high premium costs. Check and compare the premium using the online mediclaim premium calculator available on our official website to pick the most affordable policy.
  • Lifelong Renewability: Always check the eligibility criteria and pick a plan with lifelong renewability. Health risks increase as we become older. It is essential to ensure that your mediclaim policy has the lifelong renewability feature to help you get continued coverage even in old age.
  • Exclusions: Check the exclusions of online mediclaim policy to ensure timely claim settlement without rejection.
  • Waiting Period: Before you say yes to a mediclaim or a health insurance policy, check the waiting period clause in the policy document. There is an initial waiting period, a waiting period for pre-existing diseases, and a waiting period for specified ailments/treatments.
  • Network Hospitals: Check out the complete list of network hospitals empanelled with us to ensure you have easy access to medical care. Identify the hospitals located in proximity, where you will be comfortable getting the cashless medical treatment.
  • Claims: A high claim settlement ratio is one indicator of how easily you will get a claim. It is essential for you to understand this factor and make an informed decision. CHI had a claim settlement ratio of 92.3% in FY 2019-20.

Mediclaim Insurance Policy Claim Process

When opting for a mediclaim insurance policy, one of the vital things you should never skip is checking the claims procedure. It will keep away from confusion when coping with a medical emergency.

A policyholder has two options to get the coverage under a mediclaim policy – one is filing a claim for reimbursement of expenses. The second is selecting the cashless treatment facility at a network hospital. Both these procedures are easy, as discussed below.

Reimbursement Claim

In this process, you will need to bear the hospital expenses first from your pocket. However, these expenses will be reimbursed by us, as per the policy terms and conditions. Here are the steps to file the claim:

  • Notify us about the hospitalization within the specified time.
  • Fill the reimbursement claim form with the required information.
  • Submit the form to us along with the mandatory documents.
  • Our claim management team may raise a query if required.
  • The claim management team will send an approval after verification of the documents.
  • After approval, we will reimburse your hospitalization expenses, subject to policy T&C.

Cashless Claim Facility

The cashless treatment facility saves much of your valuable time when you have other things to look into when a medical emergency occurs. You need not make any direct payment, as we will pay your medical bills directly to the hospital, subject to the policy terms and conditions. We have over 8,350 network hospitals empanelled with us in our network where you can get the cashless facility. The steps to avail this facility are mentioned below:

  • Visit any of our network hospitals for medical treatment.
  • Approach the hospital insurance/TPA desk.
  • Submit the duly filled pre-authorization form and share Photo ID and proof of patient.
  • The hospital will send the documents to us.
  • Our claim management team will verify the documents. It may raise a query if required.
  • The network hospital will receive an approval letter from our claim management team.

The policyholders should notify us within 24 hours of emergency hospitalization and 48 hours prior to planned hospitalization.

FAQ on Mediclaim Policy


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Most Frequently Asked Questions

Popular Questions

Q. What is the Meaning of Mediclaim Premium?

Mediclaim premium means the amount of money that you as an insured have to pay to Care within a stipulated time, against the policy coverage. We ensure that our premiums are affordable and do not burden your pocket. However, the premium amount is subjected to age, pre-existing disease, income, and the number of family members need to cover in a mediclaim policy.

Q. Is it Possible to Modify the Sum Insured in the Mediclaim Policy?

Yes, you can modify the sum insured in the mediclaim policy that shall be permissible only at the time of renewal of the Policy. However, it can affect your premium amount.

Q. Can I Add and Remove Family Members in My Current Mediclaim Policy for the Family?

No, you cannot add and remove family members in your current mediclaim policy for the family. You can do it only at the time of policy renewal. However, you can buy a separate medical insurance policy for your family members.

Q. Can I Change My Date of Birth, if it Gets Written Incorrectly in the Mediclaim Policy Document?

The acceptance of change in DOB is solely Care's discretion, and it may affect your premium. Therefore, providing the right birth of date and other details at the time of purchasing the mediclaim policy is advisable.

Q. What does Lifelong Renewability Mean?

With our health insurance plans you can enjoy lifelong renewability. It ensures that your Mediclaim policy can be renewed for life without any age restriction. Once you have received the insurance policy you have the right to renew it for lifelong. You do not need to buy a health insurance policy again and again after its expiry.

Q. How do I switch to Care Health Insurance when I have another on-going mediclaim policy?

Switching from one insurance provider to another is called portability. Now you can port to Care Health Insurance in simple steps:

  • Portability is possible before 45 days before the renewal date
  • Fill the online portability form
  • Fill the proposal form with complete details
  • Make online payment via secure payment modes

Q. What should I do if my mediclaim policy expires?

You can renew your mediclaim policy as per the following steps:

  • Log into our website
  • Provide basic details about your policy
  • Make the payment of the premium
  • Get the instant renewal of the policy

Q. How do you Claim the Benefits of My Mediclaim Policy?

For Cashless Mediclaim Facility:

  • Get the policy claim form from the insurance help-desk of the network hospital and fill all the required details.
  • Collate all the medical bills, diagnosis and doctor's prescription
  • Submit all the required documents along with policy claim to us
  • Once your documents will be verified by us you will receive an approval letter from our claim management team
  • If required, the query might be raised from the claim management team
  • After approval, your hospitalization expenses will be borne by us directly to the respective hospital

For Mediclaim Reimbursement:

  • Fill health insurance claim reimbursement form and attach all the required documents along with the form
  • Submit the form and the required documents to us
  • Claim management team may raise the query
  • Once they cross-check and verify the documents you will get an approval letter from the claim management team
  • After approval, your hospitalization expenses will reimburse up to the sum insured

Q. Is there a Mediclaim Policy for Pregnancy?

Yes, you can buy Joy mediclaim policy for pregnancy. It is the right combination of hospitalization and maternity insurance. We offer cashless treatment at network hospitals, a hundred percent sum insured, waiting period as low as nine months, and other benefits.

Q. What does the best mediclaim policy cover?

The best mediclaim health insurance policy covers in-patient hospitalization, pre and post hospitalization expenses, medication, treatment, therapies, daycare treatments, domiciliary hospitalization, alternative treatments, ICU charges, room rent, ambulance cover, etc.

Q. What is not covered under a mediclaim policy?

Mediclaim insurance policy also has some exclusions that include any diagnosis of diseases / undergoing of surgery/occurrence of the event, whose signs or symptoms first occur within 30 days of Policy Period Start date. Expenses attributable to self-inflicted injury, costs arising out of or attributable to alcohol or drug use/misuse/abuse, medical expenses incurred for treatment of AIDS, treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion, and its consequences. Also, congenital disease, tests and treatment relating to infertility and in vitro fertilization and war, riot, strike, nuclear weapons induced hospitalization. For more details, read policy terms and conditions.

Q. What is the age criterion to buy a mediclaim policy?

The minimum entry age to buy a mediclaim policy is 91 days, and the maximum entry age is no age bar with lifelong renewability.

Q. Does mediclaim cover accidents?

Yes, mediclaim cover accidents as well. However, you need to buy it as an optional benefit. Under which you will get an additional sum insured for accidental hospitalization.

Q. What is a cashless mediclaim policy?

Under cashless mediclaim policy, you can avail of cashless hospitalization facility at the network hospitals. You do not need to arrange cash for the treatment. We will pay your maximum medical bills as per policy terms and conditions.

Q. Which mediclaim policy covers dental treatment?

Amongst our various mediclaim policies, Operation mediclaim covers dental treatment subject to policy terms and conditions.

Q. What is a floater mediclaim policy plan?

A floater mediclaim policy is a plan that covers the entire family. You need to pay a single annual premium, and the sum assured covers all insured family members that can be used for multiple hospitalizations.

Q. How to port a mediclaim policy?

You can port the policy only at the stage of policy renewal. Intimation for porting is required 45 days before renewal. Inform your last insurer in writing for a porting mentioning the name of the new insurer. Fill up our portability form with existing insurance details and submit the relevant documents and make payment.

Looking for Health Insurance Portability

Q. How Many Types of Mediclaim Policies available in India?

There are several types of mediclaim policies available in India. However, at Care Health Insurance, we offer four mediclaim insurance policies- Cancer Mediclaim, Heart Mediclaim, Critical Illness Mediclaim, and Operation Mediclaim. These are comprehensive and customized medicalim policies cater to your unique health care needs and help you get the best treatment.

Disclaimer : Information above is just for reference. Kindly read T & C of policy thoroughly, Do refer IRDAI guidelines for tax exemption conditions.

*Claim settlement ratio is for FY 19-20 and *number of claims settled as on June 30, 2020

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