Key highlights
Comprehensive Medical Coverage
Covers hospitalization expenses, including room charges, ICU fees, doctor’s fees, and surgical costs, ensuring financial protection during medical emergencies.
Pre and Post-Hospitalization Benefits
Pays for medical expenses incurred before and after hospitalization (typically 30-60 days), covering diagnostic tests, consultations, and follow-up treatments.
Daycare Procedures Coverage
Covers treatments that do not require 24-hour hospitalization, such as chemotherapy, dialysis, and cataract surgery, ensuring broader medical protection.
Cashless Treatment Facility
Provides the option of cashless hospitalization at network hospitals, reducing out-of-pocket expenses and making the treatment process hassle-free.
Tax Benefits Under Section 80D
Premiums paid for the policy are eligible for tax deductions under the Income Tax Act, offering financial relief while ensuring health security.
Optional Add-Ons and Riders
Allows customization with riders such as critical illness cover, OPD cover, maternity benefits, or wellness programs, enhancing the scope of protection.
Exclusion
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Pre-Existing Diseases (Waiting Period)
Pre-existing conditions are covered only after a specific waiting period (typically 2-4 years), preventing immediate claims for known health conditions.
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Cosmetic and Aesthetic Treatments
Expenses related to plastic surgery, Botox, and other cosmetic procedures (unless medically necessary) are not covered under the policy.
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Alternative Treatments
Certain policies do not cover AYUSH (Ayurveda, Yoga, Unani, Siddha, and Homeopathy) treatments unless explicitly mentioned.
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Self-Inflicted Injuries
Medical costs resulting from suicide attempts, substance abuse, or intentionally inflicted injuries are excluded from coverage.
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Unproven or Experimental Treatments
Procedures that lack clinical approval, such as experimental drug trials and unrecognized therapies, are not included in coverage.
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Non-Medical Expenses
Items such as dietary supplements, personal convenience items (like hospital phone charges), and non-prescribed treatments are excluded.
Types of Individual Mediclaim Policy
Basic Individual Mediclaim Policy
A standard policy that covers hospitalization expenses, doctor’s fees, and medical treatments up to a specified sum insured.
Critical Illness Cover
Provides a lump sum benefit upon diagnosis of severe illnesses such as cancer, stroke, or heart attack, offering financial security against major health issues.
Senior Citizen Mediclaim Policy
Tailored for individuals above 60 years, offering specialized coverage for age-related ailments and higher medical risks.
Top-Up and Super Top-Up Policies
Acts as additional coverage that activates once the base policy’s sum insured is exhausted, making healthcare more affordable.
Cashless Mediclaim Policy
Allows policyholders to avail of treatment at network hospitals without paying upfront, as the insurer settles the bill directly with the hospital.
Global Healthcare Policy
Covers medical expenses incurred outside India, ideal for frequent travelers or individuals seeking international medical treatment.
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Why is it Essential?
With healthcare costs increasing rapidly, having a Mediclaim policy ensures you receive quality treatment without financial strain.
In case of hospitalization, the policy covers expensive medical bills, preventing savings depletion and financial burden on loved ones.
With features like cashless hospitalization and pre/post-hospitalization benefits, individuals can focus on recovery instead of medical bills.
Policyholders can seek treatment from top hospitals and specialists without worrying about affordability.
Many financial institutions require health insurance for home loans, and some countries mandate health coverage for visa approval.
Some policies offer annual health check-ups, wellness programs, and discounts for maintaining a healthy lifestyle, promoting long-term well-being.
