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What is Mediclaim Policy? How does Mediclaim Insurance Plan Works?
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What is meant by Mediclaim in health insurance?

A mediclaim policy is an indemnity-based health plan that offers you financial support and assistance in the case of a healthcare contingency. In a medical claim policy, the insured policyholder pays his/her treatment costs for a medical condition. Then, he/she can raise the claim to the company, and later, the insurer will reimburse the insured person until the policy coverage is exhausted. By submitting all his healthcare bills to the company, a person can claim for reimbursement.

What is Mediclaim Policy?

A mediclaim insurance policy is a type of health policy where the insurance company will reimburse your treatment costs once you submit all bills to the company. If you are between 18-65 years, then you can purchase mediclaim policies without any hassle. The premiums of these policies are decided based on your age, sum assured, policy tenure, your existing health conditions, and other miscellaneous factors.

There is a widespread fallacy that mediclaim and normal health insurance policies are the same. Though these two sound similar, still, they are pretty different. A mediclaim policy reimburses your hospital treatment costs, but a health insurance policy either offers your reimbursement or gives you cashless facilities at network hospitals. Mediclaim insurance offers limited coverage, but health insurance offers wider coverage.

What is Mediclaim Policy? How does Mediclaim Insurance Plan Works?

Some Prime Features of Mediclaim Policies

  1. Policy Term
  2. Cashless Facility
  3. Sum Insured is fixed
  4. The coverage is restricted
  5. Tax Benefits


1. Policy Term

Mediclaim policies are usually valid only for a certain period. This period differs from one policy to the other. If the insured person wants he/she can renew this term period at the end of the term. Mediclaim policies are not lifelong, thus, these policies are budget-friendly and cost-effective as compared to a normal health insurance policy.

2. Cashless Facility

Though reimbursement is a pivotal feature of mediclaim policies, still, many policies allow you to enjoy a cashless facility for your health condition. In this scenario, your insurance company directly settles your treatment bills with the hospital. But to avail of the cashless treatment, you need to be admitted to network hospitals (hospitals that are tied up with your insurance company).

3. Sum Insured is fixed

Based on your preference, you can choose a mediclaim policy to cover either yourself or your family. The sum insured amount is fixed and it is between Rs. 5 lakh to 10 lakh, irrespective of the numbers of insured. For a mediclaim policy, your insurance company will not pay out more than this sum assured.

4. The coverage is restricted

Popular mediclaim policies usually cover hospitalization as well as pre-hospitalization costs (up to 30 days) and post-hospitalization costs (up to 60 days).  These policies can also cover other expenses including medications to x-ray costs. Though terms may differ from policy to policy, some policies also offer coverage for less than 24 hours of hospitalization. Mediclaim policies don’t offer coverage for pre-existing ailments, dental or cosmetic surgery, and maternity expenses.

5. Tax Benefits

You are eligible for tax deductions under Section 80D of the Income Tax Act, 1961 against all your paid premiums for the policy. You can claim a sum of up to Rs 25,000 for yourself, your spouse, and your children. Policyholders being able to claim an additional Rs. 25,000 if you are paying the premium for your parents and if they are senior citizen, the amount rises to Rs. 50,000.

Various types of Mediclaim Policies 

Let’s take a look at some common mediclaim policies.  

  • Individual Policy: This type of policy offers benefits to only a single individual. But the benefits can be extended to more members of their family if you choose to.
  • Family Floater: Under this type of mediclaim policy, a master premium is paid so that all family members can stay protected under a single plan against any medical liabilities.
  • Senior Citizen: These policies are carefully designed for senior citizens so that they can get adequate health coverage. This type of plan offers special facilities for testing and diagnosis.
  • Critical Illness: This type of policy plan covers critical diseases like cancer, heart disease, kidney failure, etc. and the insurance company will offer you a lump sum amount if you are diagnosed with these diseases.
  • Mos-Bite Protector: This plan offers coverage for vector-borne diseases like malaria, dengue, Zika virus, etc.
  • Low-Cost: These policies are less expensive. Sometimes, employers also purchase these policies to insure their employees at low premiums.


Things to consider while purchasing a mediclaim policy

To enjoy your mediclaim benefits, you must consider certain parameters while purchasing a policy.

  • Coverage: Always select a sum assured amount that is adequate for you and your family’s healthcare requirements. A higher sum assured implies a higher premium but it also offers wider coverage in the long term.
  • Co-payment: Co-payment clauses indicate the policyholder needs to pay a certain percentage of their medical bills along with the insurance company. Mediclaim policies that come with a co-payment clause are more affordable. 
  • Waiting Period: Most mediclaim policies have a waiting period before which the insured policyholder can’t raise any claim for certain diseases. Insurance companies have a waiting period for pre-existing illnesses, as well as other diseases.
  • Network Hospitals: Policyholders can enjoy the benefits of cashless facilities if they are admitted to network hospitals of their insurance companies. Always select an insurer that has a wide network of hospitals across different locations.
  • Add-Ons: Most mediclaim policies don’t offer any additional or add-on riders
  • Exclusions: Before purchasing a mediclaim policy, always know what things are not covered under your plan. To avoid the pain of rejection and extra expenses, ask your insurer what you are getting against your mediclaim policy.
  • Free-Look Period: This is a period during which the policyholder can return the policy and get refunds from the company.


In India, healthcare inflation is rising between 9% to 15% every year. Mediclaim policies are affordable and mitigate your hospital expenses under emergencies. So, purchase a mediclaim policy to strengthen your health protection and coverage.

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