The costs of medical treatments have increased considerably. Though modern medicine has found treatments for the most critical of illnesses, affording the treatments has become difficult for an average middle class man. As such, when a medical emergency strikes, you face both physiological and financial loss. Though the physiological loss cannot be mitigated, you can definitely make provisions for the financial loss that you suffer.

Mediclaim insurance policies are available in the market which covers the cost of your medical treatments if you face any medical emergency. As such, mediclaim plans prove to be a blessing for a common man and helps in saving his financial outflow on medical treatments. Mediclaim plans also allow you to avail quality healthcare since the cost of such healthcare is met by the policy. So, a mediclaim policy can be defined as a health insurance plan which covers the cost of medical treatments and other medical expenses in case of medical emergencies.

Features and benefits of mediclaim insurance plans

Here are some common features and benefits which you can find in mediclaim insurance policies –

  • Mediclaim insurance plans come in different variants. You can find a policy which covers the actual cost of hospitalisation as well as a policy which pays you a lump sum benefit on claim
  • Mediclaim policies which cover the actual medical costs that you incur are called indemnity mediclaim plans
  • Mediclaim plans which pay a fixed amount in case of a claim are called fixed benefit health insurance plans
  • Mediclaim policies allow you lifelong renewals thereby ensuring that you remain covered even in your older ages
  • You can buy a mediclaim policy for yourself as well as for your family members. Mediclaim plans which cover your family are called family floater health insurance plans
  • The coverage under mediclaim policies is usually allowed for one year. However, you can buy a long term health insurance plan by paying the aggregate premium at once
  • There are different types of premium discounts allowed under mediclaim policies which help you lower the cost of coverage 
  • If you don’t make a claim in your mediclaim insurance policy in a policy year, you are awarded with a no claim bonus. This bonus can either increase the coverage amount free of cost or grant you discounts on the renewal premiums
  • The premiums that you pay to buy a mediclaim insurance policy are allowed as a deductible expense from your income. Premiums paid up to INR 25,000 for a policy covering yourself and your family can be claimed as a deduction under Section 80D. If you are a senior citizen, the limit increases to INR 50,000. Moreover, if you buy a policy covering your dependent parents, you can claim an additional deduction of up to INR 50,000 if your parents are senior citizens. If your parents are not senior citizens, the deduction would be limited to INR 25,000

Types of mediclaim insurance plans

As mentioned earlier, mediclaim insurance policies can be offered in different variants. These variants are as follows –

1. Indemnity oriented mediclaim insurance plans

Indemnity oriented policies cover the actual cost of hospitalisation. These policies are further sub-divided into the following variants –

  • Individual mediclaim insurance plans

    Individual health insurance plans are those which cover a single individual under a single sum insured.

  • Family floater mediclaim insurance plan

    Under family floater policies, the whole family is covered under a single sum insured. Family means self, spouse, dependent children and dependent parents.

  • Senior citizen health insurance plans

    Senior citizen mediclaim policies are those which cover individuals who are senior citizens, i.e. aged 60 years and above

  • Top-up health insurance plans

    Top-up mediclaim policies have a sum insured and a deductible limit. If your claim exceeds the deductible limit that you have chosen under the policy, the excess amount of claim would be paid by the top-up plan.

  • Super top-up health insurance plans

    Under super top-up mediclaim insurance policies, the total claim made in a year is considered rather than every instance of claim. A super top-up plan works like a top-up plan and has a sum insured and a deductible. However, under top-up plans, every claim is matched with the deductible and is paid if it exceeds the deductible. However, under super top-up plans, the total claims made in a year are added together and then compared against the deductible. If the total claims exceed the deductible, the claim is paid.

  • Disease specific mediclaim policies

    These policies are designed to cover specific illnesses or diseases. The policy, therefore, pays a claim in case the insured suffers from the covered illness. For instance, there are diabetes specific health insurance plans which cover diabetics and the medical illnesses that they might suffer. Then there are cardiac care plans or dengue plans which cover the corresponding illnesses.

2. Fixed benefit health insurance plans

As mentioned earlier, under these plans a fixed benefit is paid on claim irrespective of the actual medical costs that you incur. The different types of fixed benefit mediclaim policies are as follows –

  • Critical illness policies

    Critical illness policies are specialised mediclaim insurance plans which cover a set of specific critical illnesses. If the insured is diagnosed with any of the covered illness, the sum insured is paid in lump sum.

  • Hospital cash policies
  • Hospital cash policies are mediclaim policies which cover hospitalisation for 24 hours or more. If the insured is hospitalised for 24 hours or more, the plan would pay a fixed daily benefit for each day of hospitalisation.

  • Personal accident policies

    Under personal accident policies, accidental death and disability are covered. If the insured suffers from accidental death or permanent disability, a lump sum benefit is paid.

How mediclaim policies work?

While fixed benefit mediclaim insurance plans cover specific events, an indemnity oriented mediclaim policy provides coverage for a variety of expenses that you might incur when you are hospitalised. If you are hospitalised and incur the covered expenses, the mediclaim policy would pay the medical expenses which are incurred. Though the actual coverage benefits of mediclaim policies depend on the policy that you buy, some common coverage benefits under are mentioned below. –

  1. Inpatient hospitalisation

    If you are hospitalised for 24 hours or more, the expenses incurred on your hospitalisation would be covered. These expenses include room rent, ICU room rent, doctor’s fee, surgeon’s fee, treatment costs, cost of blood, oxygen, medicines, etc.

  2. Pre-hospitalisation

    The expenses incurred before you are actually hospitalised are called pre-hospitalisation expenses. These expenses are also covered under mediclaim insurance policies for a specified number of days.

  3. Post hospitalisation

    The expenses which are incurred after you are discharged from the hospital are called post-hospitalisation expenses. These expenses are incurred for reviewing and monitoring your recovery and are covered for a specified number of days.

  4. Day care treatments

    Treatments which do not require 24 hour hospitalisation due to advanced medical techniques are called day care treatments. Mediclaim insurance plans either cover a specific list or all day care treatments up to the selected sum insured.

  5. Ambulance expenses

    The expenses incurred on hiring an ambulance to take you to the hospital are covered under mediclaim policies up to a specific extent.

  6. Organ donor treatments

    If you are undergoing an organ transplant surgery, the cost of harvesting the organ from the donor would be covered under this head.

  7. Domiciliary treatments

    Treatments which are taken at your home are covered under mediclaim policies only under special instances. These instances are when you are in no condition to be shifted to a hospital or when there is no empty hospital bed for admission.

  8. AYUSH treatments

    AYUSH treatments cover treatments taken through non –allopathic means like Ayurveda, Unani, Siddha and Homeopathy. These treatments are covered under many mediclaim policies.

  9. Maternity treatments

    Maternity treatments are covered under some mediclaim policies and they cover the cost of childbirth and also the pre-natal and postnatal care for the mother.

  10. Free health check-ups

    Almost all mediclaim insurance plans allow you the facility to avail free preventive health check-ups once after a specified number of policy years.

What is not covered under mediclaim insurance plans?

Though mediclaim insurance policies provide a good scope of coverage, there are some instances which are not covered under the plan. These instances are called plan exclusions and some common exclusions include the following –

  • Pre-existing illnesses are not covered initially. These illnesses include those which you already suffer from at the time of buying the policy. These illnesses and their related complications are covered after a specific waiting period which can range from 2 to 4 policy years.
  • Illnesses occurring within the first 30-90 days of buying the policy are excluded
  • Suicides are not covered
  • Congenital diseases and hereditary ailments are excluded from the scope of coverage
  • Unproven and experimental treatments are not covered
  • Illnesses or injuries suffered due to war, riots, civil unrest, nuclear contamination and other related perils would not be covered
  • Cosmetic treatments and weight management treatments are not covered under mediclaim insurance policies
  • Dental treatments and OPD expenses are not covered unless otherwise stated

Top #6 Best mediclaim policies in India

There are more than a hundred mediclaim policies available in the market. Among those plans, here is a list of some of the best policies which not only provide a good scope of coverage, they are charge affordable premiums –

  1. National Mediclaim Policy 

    This is a popular mediclaim plan offered by National Insurance. The plan is offered on an individual sum insured basis and can be taken for family members too. The sum insured is increased by 5% every year when there is no claim. Free health check-ups are allowed after four policy years and there is a premium discount for buying the policy for your family members.

    Eligibility parameters of National Mediclaim Policy 

    Entry age 

    18 years to 65 years

    Renewability age 

    Lifelong 

    Sum insured 

    INR 50,000 to INR 5 lakhs

    Networked hospitals 

    Major hospitals in India through the company’s TPA (Third Party Administrators)

  2. Manipal Cigna ProHealth Protect Policy 

    This mediclaim policy allows you to avail coverage of up to INR 50 lakhs. You can even avail coverage internationally and the policy would cover the cost of treatments. The sum insured can be restored multiple times during the same policy year if it gets exhausted. The no claim bonus allows the sum insured to increase to 200% if you don’t make claims.

    Eligibility parameters of Manipal Cigna ProHealth Protect Policy

    Entry age 

    Adults – 18 years onwards

    Children – 91 days to 23 years

    Renewability age 

    Lifelong 

    Sum insured 

    INR 2.5 lakhs to INR 50 lakhs

    Networked hospitals 

    Major hospitals in India through the company’s TPA (Third Party Administrators)

  3. Religare Care Plan

    A comprehensive mediclaim policy, Care provides you with a range of inbuilt as well as optional coverage features. Free health check-ups are provided in every policy year and the sum insured gets automatically refilled if it is exhausted. You can also avail free second opinion in case of major illnesses and get coverage for AYUSH treatments.

    Eligibility parameters of Religare Care Plan

    Entry age 

    Adults – 18 years onwards

    Children – 91 days onwards

    Renewability age 

    Lifelong 

    Sum insured 

    INR 4 lakhs to INR 6 crores

    Networked hospitals 

    7400+

  4. Universal Sompo Complete Health Care Insurance Plan 

    As the name suggests, this is a comprehensive health insurance plan which provides a range of coverage benefits. Accidental dental treatments are covered under the policy along with OPD expenses. Maternity costs and new born baby cover is also promised under the policy making is suitable if you are planning a family in future. There are optional coverage benefits too through which you can enhance your coverage.

    Eligibility parameters of Universal Sompo Complete Healthcare Insurance

    Entry age 

    Adults – 18 years to 70 years

    Children – 91 days to 25 years

    Renewability age 

    Lifelong 

    Sum insured 

    INR 1 lakh to INR 10 lakhs

    Networked hospitals 

    4000+

  5. Star Health Family Health Optima Insurance Plan 

    Star Health’s Family Health Optima is also an inclusive mediclaim policy which offers you an affordable family floater cover. The policy allows free health check-ups every policy year. The sum insured can be completely restored thrice during a policy period. Unique coverage benefits include coverage for assisted reproductive treatments, new born baby cover, emergency medical evacuation and repatriation, etc.

    Eligibility parameters of Star Health Family Health Optima Insurance Plan 

    Entry age 

    Adults – 18 years to 65 years

    Children – 16 days onwards

    Renewability age 

    Lifelong 

    Sum insured 

    INR 1 lakh to INR 25 lakhs

    Networked hospitals 

    9800+

  6. HDFC Ergo Health Optima Restore Plan

    Optima Restore is a very popular mediclaim policy available in the market. The policy restores your sum insured if it is ever exhausted in a policy year. Moreover, the sum insured increases by 50% after each claim-free year making the sum insured double in just two consecutive claim-free years. You can also earn premium discounts if you walk and take a specified number of steps in a policy year through the plan’s Stay Active benefit.

    Eligibility parameters of HDFC Ergo Health Optima Restore Plan 

    Entry age 

    Adults – 18 years to 65 years

    Children – 91 days onwards

    Renewability age 

    Lifelong 

    Sum insured 

    INR 3 lakhs to INR 50 lakhs

    Networked hospitals 

    10,000+

A mediclaim insurance policy is very important in today’s age because of the expensive medical costs. The policy proves to be a blessing in medical emergencies and should not be missed. You should compare the coverage benefits of mediclaim plans and then choose the best policy which provides all the coverage benefits that you need.


FAQ’s

Co-pay means co-payment and it is applicable in times of claims. If the policy has a co-pay ratio, it means that the specified percentage of claim would be paid by you and the mediclaim policy would, then, pay the rest.


Yes, mediclaim insurance policies allow porting between different plans. You can switch to another plan at the time of renewal through porting. The request for porting should be given at least 45 days before renewal of the policy and porting is free of cost. When you port, the existing policy’s coverage duration is taken into account and the pre-existing waiting period is reduced.


Yes, you can make any number of claims on your mediclaim policy in the same policy year. You would get coverage for the claims provided that the policy’s sum insured is sufficient enough to pay the claim.


Yes, every mediclaim plan has a waiting period for maternity cover. Maternity related expenses would be covered only after the waiting period is over which, usually, ranges from 1 year to 4 years.

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