Mediclaim is a type of medical insurance that covers expenses during medical emergencies. In India, mediclaim policy coverage ranges between Rs 1.5 lakh and Rs 2 crore. In the face of the COVID-19 pandemic, we learned to be prepared for a medical emergency at all times. It is wise to remain insured and protect yourself from financial burdens during such crises.
While mediclaim covers only expenses incurred during hospitalisation, health insurance covers pre and post-hospitalisation expenses such as OPD and daycare charges. However, some mediclaim plans may offer coverage for medical bills paid around the time of an emergency. This feature is a recent addition.
Meanwhile, let us learn 8 factors to consider before buying a medical insurance policy.
The cost of hospitalisation, similar to the cost of living, usually follows an upward curve. The healthcare sector is affected by several national and international events leading to rising inflation and recession. The 2020 pandemic was a horrific reminder of how uncertain life is and how anything can happen at any time. Considering all these factors, a medical insurance policy with a higher sum insured is better. Especially for those living in metropolitan cities, a higher coverage amount is essential to meet the rising healthcare costs.
If you have a family to take care of then you must consider all your family members when buying health insurance. Cover your whole family with a family health insurance policy. However, remember, every policy comes with a set age limit for your children and parents. They cover children within a particular age group, say, between 18 and 25 years. Broader the range, the more beneficial the policy is. Your child would need an individual plan if they do not fit in the age bracket. For long-term benefits, you may also check for clauses related to the marital status of your children.
The entry age limit decides whether the policy covers your parents. For example, if your parent is 55 years old but the upper limit is 43 years, the policy will not insure them.
Insurers offer the cashless facility upon admission to preferred hospitals only. These hospitals are called the insurer’s network hospitals. Before buying a medical insurance policy, you must go through the list of network hospitals and see if the list includes hospitals close to your place of residence. Consider factors such as good quality treatment, facilities, easy access, and specific treatment options for pre-existing diseases. The longer the list of network hospitals, the better.
This clause needs the policyholder to pay a part of the medical expenses while the insurer pays the remaining. Usually, the policyholder is expected to pay 10% to 30% of the claimable amount depending on the policy terms and conditions. The smaller the co-payment, the better the medical insurance policy is. The policy can be easily cited as the best policy if the co-payment amount is set at zero. The burden of co-payment increases with healthcare costs and the severity of the emergency.
There are certain situations and conditions that are not covered by insurance. These are called exclusions. Every policy has its list of exclusions. For example, some policies do not cover emergencies due to suicide attempts or drug abuse. Also, some policies cover emergencies due to pre-existing illnesses such as renal failure only after a waiting period. In some cases, certain pre-planned procedures or surgeries are eligible for coverage after a set waiting period is completed. Therefore, be clear about policy exclusions before purchasing the medical insurance policy.
Every insurance company, while selling a mediclaim policy, takes the record of the health status of the individuals to be included under the plan. In the case of a pre-existing disease, the insurer assesses the risk of a possible medical emergency. Based on the assessment, it fixes a waiting period for which the policy does not cover the hospitalisation related to that particular illness. While buying a policy, you should compare the waiting periods for pre-existing diseases of you and your family. The best would be the one with the shortest waiting period. In case of multiple pre-existing conditions, you should prioritise them and decide so that you can make the best of the policy.
It is the age limit up to which you can renew your medical insurance. However, beyond that, you must buy a new policy. Mediclaim with lifetime renewability is the best, especially for senior citizens. The option has the benefit of no waiting period for certain diseases.
Types of Claim Procedure
There are two types of claim procedures—cashless claim and post-hospitalisation reimbursement. Under cashless claims, the insurance company settles the hospital bill directly with the hospital. Once a patient gets admission for an emergency health issue, a concerned family member familiar with active mediclaim must notify the insurer within 24 hours. You can do it through the insurance desk at the hospital. The desk processes requests for pre-approval using the mediclaim ID given to the insured. The hospital receives approval within six hours, and the patient does not have to pay any bills. During the discharge, the insurance desk sends all the required documents and requests final approval. The insurer verifies them and approves the claim. The patient can go home.
Meanwhile, under the reimbursement claim, the patient clears the hospital bills and claims the expense after discharge. The insured person must fill up a reimbursement form and enclose original hospitalisation bills and reports. The insurer verifies all the submitted documents, approves the claim, and pays the insured.
In both cases, the medical insurance provider approves the bills for the insured amount or less. The coronavirus pandemic has promoted the use of a cashless claim initially to avoid contact payments. However, due to the ease of transaction, people are inclined toward the cashless claim.
To Sum Up
Several insurance companies offer different types of mediclaim policies. It is your responsibility to compare them and make a wise choice. Always choose a policy that meets your needs and is well within your budget.
Disclaimer: The above information is for illustrative purposes only. For more details, please refer to policy wordings and prospectus before concluding the sales.