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What is Mediclaim?

Mediclaim Insurance is a hospitalisation benefit policy offered by public sector general insurance companies. The policy takes care of medical expenses following Hospitalisation/Domiciliary Hospitalisation of the insured in respect of the following situations:
•       In case of sudden illness,
•       In case of an accident
•       In case of any surgery which is required in respect of any disease which has arisen during the policy period.

What are the policies available for health?
Mediclaim (in India for individual and group) and Overseas Mediclaim Policy (in abroad)

What is the age limit for Mediclaim Policy?
The insurance is available to persons between age of 5 and 80 years. Children between the age of 3 months and 5 years can be covered provided one or both parents are covered concurrently.

Does Mediclaim cover treatment in hospital only?
Though the main purpose of the policy is to provide reimbursement in respect of treatment taken in the hospital/nursing home, the policy also provides reimbursement in respect of domiciliary hospitalisation. However for a claim to be processed under domiciliary hospitalisation the following conditions should be satisfied:
•          Medical treatment should be for more than 3 days.
•         The treatment should be such for an illness/disease/injury which in the normal course would require treatment and care in the hospital/nursing home but actually taken whilst confined at home due to any of the following circumstances:
1.      Condition of the patient is such that he/she cannot be moved to the hospital/nursing home or
2.      The patient cannot be moved to hospital/nursing home for lack of accomodation there in.

Can my whole family be covered under a single Mediclaim policy?

Yes. In fact a family package discount of 10% is also available

To whom is the claim paid if nominee is dead?

The insurance company will insist upon a succession certificate from a court of law for disbursing the claim amount. In the alternative the insurers can deposit the claim amount in the court for disbursement to next legal heirs of the deceased.

Who can avail Group Mediclaim Policy?

It is available to any homogeneous group/association/ institution/corporate body provided it has a central administration and subject to minimum of 100 persons to be covered.

What is the benefit of group Mediclaim policy?

Group discount on premium is allowed depending upon the total number of insured persons.

Are all the systems of medicine covered under Mediclaim Protection?

No, Presently it is available only for allopathy, ayurvedic and unani systems of medicine.

Does Mediclaim policy covers benefits if one suffers illness/disease or contract injury through accident either in India or outside India?

Yes, Mediclaim protection is available for illness/disease contracted anywhere in the World provided the treatment is availed in India.

What happens if the illness/disease/injury is of such a nature that it is covered under Domiciliary Hospitalisation but requires employing of a qualified nurse to attend to the patient?

Domiciliary Hospitalisation benefits cover the expenses on employment of qualified nurses, who are employed on the recommendation of the attending Medical Practitioner and who holds a certificate of recognized Nursing Council.

Who is a Medical Practitioner?

A Medical Practitioner is one who is engaged in the medical profession, who holds a degree/diploma of a recognized institution and is registered by the Medical Council of the respective state in India. It will include a physician, specialist and surgeon.

What happens when I have to undergo a treatment like dialysis when I am discharged on the same day?

When treatment such as Dialysis, Chemotherapy, Radiotherapy etc is taken in the Hospital/Nursing Home and the insured person-patient is discharged on the same day, the treatment will be considered to be taken under Hospitalisation Benefit Scheme.

What about undergoing an operation of the eye by Laser Capulsotomy?

Operation of the eye by Laser Capulsotomy shall be covered under Hospitalisation benefits of Mediclaim Policy.

Whether my spouse or any of my family members can avail of your protection even if he/she is covered by another Mediclaim Policy?

If the spouse or any other member of the family is already covered under another Mediclaim Policy, no coverage will be allowed for them.

Who is to be bear the cost of medical check-up when your operating office refer me to a physician in respect of diabetes, hypertension or any other pre-existing disease?

You as the proposer will have to bear the fees of the doctor in such circumstances

How do you define continuous treatment?

A treatment will be deemed to be continuous if the concerned illness relapses within 45 days from the date of last consultation with the doctor/hospital/nursing home. Any occurrence after a lapse of 45 days will be considered as new illness.

When is the claim payable under Mediclaim?

The claim is payable, when treatment is from a registered hospital or nursing home.However, in case of non registered hospital or nursing home the treatment can be covered under the policy subject to hospital/nursing home conforming to the following guidelines:
•          The hospital/nursing home should have 15 inpatient beds
•          It should have qualified nursing staff round the clock
•          Qualified doctors round the clock
•          Fully equipped operation theatre

How will the payment of claim be made ?

All claims will be payable in Indian currency. All medical treatments for the purpose of Mediclaim protection will have to be taken in India only.

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