Mediclaim Policy

Mediclaim Policy

In 2026, the Indian insurance sector has refined the mediclaim policy to be more than just a hospitalisation plan. While often used interchangeably with "health insurance," a mediclaim plan is a specific, cost-effective tool designed to protect you from the immediate financial shock of surgery and inpatient care.

What is a Mediclaim Policy?

A mediclaim policy is a type of insurance that provides financial coverage for medical expenses incurred specifically during Hospitalisation. It operates on an indemnity basis, meaning it reimburses the actual expenses you incur (or pays the hospital directly via a cashless mediclaim policy) up to the predefined sum insured limit. Whether it’s a sudden accident or a planned surgery for an illness, mediclaim insurance ensures you don't have to dip into your life savings to pay the bill.

Benefits of Buying a Mediclaim Policy

• Financial Protection: Handles heavy bills for room rent, ICU, and doctors' fees.
• Cashless Hospitalisation: Access to high-quality treatment at network hospitals without paying upfront.
• Tax Savings: Premiums for a health mediclaim policy are deductible under Section 80D (up to ₹25,000 for self/family and an additional ₹50,000 for senior citizen parents).
• Cost-Effective: Typically offers lower mediclaim premiums than comprehensive health plans, making it ideal for budget-conscious individuals.
• NCB Rewards: Earn a "No Claim Bonus" for every year you don't file a claim, increasing your coverage for free.

Types of Mediclaim Policies Available in India

To find the right mediclaim insurance policy, you should understand the different categories:

• Individual Mediclaim Policy: Covers a single person with a dedicated sum insured.
• Family Floater Mediclaim: A single mediclaim policy for a family where the sum insured is shared among all members (spouse, children, and sometimes parents).
• Senior Citizen Mediclaim: Tailored for those aged 60+, often covering age-related conditions with specific co-payment options.
• Critical Illness Mediclaim: Provides a lump sum payout upon diagnosis of life-threatening diseases like cancer or stroke.
• Group Mediclaim (GMC): Offered by employers to their employees, often with benefits like "Day 1" coverage for pre-existing diseases.

What Does a Mediclaim Policy Cover?

A standard mediclaim health insurance policy in 2026 covers:

• Inpatient Hospitalisation: Room charges, nursing, ICU, and OT expenses.
• Medical Practitioners: Fees for surgeons, anaesthetists, and consultants.
• Daycare Procedures: Treatments requiring less than 24 hours (e.g., dialysis, cataract).
• Pre & Post Hospitalisation: Relevant tests and medicines (usually 30 days before and 60 days after).
• Emergency Ambulance: Cost of transporting the patient to the hospital.

What is Not Covered Under a Mediclaim Policy?

• Cosmetic Surgery: Liposuction, Botox, or plastic surgery (unless for accident recovery).
• Routine Vision/Dental: Standard eye exams or dental cleanings.
• Substance Abuse: Treatment for complications arising from alcohol or drug use.
• Adventure Sports: Injuries from high-risk activities like paragliding (unless specifically added).
• Self-Harm: Intentional injuries or suicide attempts.

Factors to Consider Before Buying a Mediclaim Policy

• Claim Settlement Ratio (CSR): Aim for an insurer with a CSR above 95%.
• Network Hospital List: Ensure your local trusted hospitals offer cashless mediclaim.
• Waiting Period: Check how long you must wait for pre-existing diseases (PED).
• Co-payment Clause: Avoid policies that force you to pay a percentage of every claim.
• Sub-limits: Look for caps on room rent—policies with "No Room Rent Cap" are superior.

How to Choose the Right Mediclaim Policy in India?

When you buy mediclaim online, use these 2026 benchmarks:

• Adequate Sum Insured: For a family of 4, a ₹10 Lakh plan is now considered the "new minimum."
• Restore/Refill Benefit: Choose a mediclaim plan that refills your cover if you exhaust it during the year.
• OPD Coverage: If you visit doctors frequently for consultations, look for a plan with "Out-Patient" benefits.

How to File a Claim Under a Mediclaim Policy?

• Cashless Claim: Present your mediclaim ID card at the hospital’s insurance desk. The hospital coordinates with the TPA (Third Party Administrator) for approval.
• Reimbursement Claim: Pay the bills yourself first. Within 15-30 days of discharge, submit the mediclaim insurance policy documents, discharge summary, and all original bills to the insurer.

Documents Required to Buy a Mediclaim Policy

• Age Proof: Aadhaar Card, Passport, or Birth Certificate.
• Identity Proof: PAN Card or Voter ID.
• Address Proof: Utility bills or Driving Licence.
• Medical Reports: Only required if you have pre-existing conditions or are over 45-50 years old.

How Jio Insurance Broking Helps You Buy the Right Mediclaim Policy

At Jio Insurance Broking, we make it easy to buy mediclaim online through:

• Real-time Comparison: Compare the mediclaim policy premium across 5+ top insurers instantly.
• Simplified Jargon: We break down complex terms like "Deductibles" and "Waiting Periods."
• Claim Concierge: A dedicated team to assist your family during the stressful hospitalisation and claim process.