What is Covered and Not Covered Under Mediclaim Policy

• Written by Ritika Malik

  Reviewed by Munmi Sharma

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Medical advancement and technology have reduced the rate of fatality and increased the rate of recovery in the health care industry. But, the progression in medical sciences is accountable for galloping medical inflation. The costs of hospitalization, treatment, and medicines are burning holes in the pockets. That is why investing in the right mediclaim policy is a wise decision. However, before choosing a medical policy you should check its coverage so that you can make the best out of it. In this blog we'll be discussing about what is mediclaim insurance, what all are included and excluded in the mediclaim insurance. Let's start!

What is Medical Insurance Coverage?

Medical insurance coverage is a financial protection to the insured and their family in case of a medical emergency, where a defined sum insured is offered towards the incurred expenses. The policy provides coverage for expenses like hospitalisation, diagnostic tests, medications, surgeries, and precautionary care. Policyholders can enjoy several other benefits depending on their plan and coverage, such as maternity coverage, wellness programs, mental health support, etc. 

Benefits of Medical Insurance Coverage 

Medical insurance coverage offers several benefits, such as:

• Ensures peace of mind: Offers financial security by eliminating out-of-pocket expenses.
• Quality care: It provides access to quality network hospitals, ensuring timely care through cashless benefits. 
• Tax benefit: Premiums paid towards medical insurance are eligible for tax benefits under Section 80D.

Medical Insurance Coverage - Inclusions

With the right medical policy, you do not worry about those medical treatment costs, but it’s good to check what it cover:

• In-Patient Hospitalisation- During medical emergency you can avail in-patient cashless hospitalisation facility under mediclaim. These expenses include are room charges, nursing expenses, ICU, surgeon’s fee, doctor’s fee, blood, oxygen, and OT changers.
• Pre and post hospitalisation- All pre and posts hospitalisation expenses such as diagnosis, treatment, and medicine expenses, doctors’ consultation fees, etc. are also covered in medicalim policy.
• Annual Health Check Ups- In mediclaim you can get annual health check-up once in a policy year, which is applicable for all the insured members. It includes tests for blood sugar, urine routine, blood groups, kidney function, and ECG check-ups.
• No Claim Bonus (NCB) - No Claim Bonus (NCB) is a reward for not claiming the policy during your policy tenure. It is the bonus amount that gets accumulated to the sum insured for every claim-free year.  
• Day Care Treatments- It also covers day care treatment, where you do not require admitting in the hospital for 24 hours. Cataract surgery, chemotherapy, dialysis, etc. are some of the example.  
• Domiciliary Hospitalisation- You can also avail domiciliary hospitalisation facility, if not in a condition to go to the hospital.  You will get the reimbursement for more than 3 consecutive days.
• Additional cover- Some insurers offer additional coverage in exchange for an additional premium. These add-ons help boosing the basic coverage. 
• Tax Exemption- Under section 80 D of the Income Tax Act 1961, the premium paid for medicalim policy for self, dependent parents, children, and spouses are exempted from tax. 

Medical Insurance Coverage - Exclusions 

There are the things or diseases that are not covered under medicalim exclusions, take a look:

• Self-Inflicted Injury- Expenses attributable to self-inflicted injury such as suicide, attempted suicide, etc.
• Injuries Due to Consumption of Alcohol- Expenses arising out of or attributable to alcohol or drug use/misuse/abuse.
• Transmitted Diseases- Medical expenses incurred for the treatment of AIDS and other transmitted diseases.
• Pregnancy Treatment- Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion, and its consequences.
• Infertility Treatment- Tests and treatment relating to infertility and in vitro fertilization cannot be claimed.
• Congenital Diseases- Expenses incurred for the congenital disease also do not cover under health insurance. These are the diseases or disabilities occur due to birth defect.  
• Permanent Exclusions- War, riot, strike, and nuclear weapons induced hospitalization are considered as permanent exclusions.
• Cosmetic Surgery- Plastic surgery, cosmetic treatment, and implant are also not covered under insurance policy.

Why Should You Know the Inclusions and Exclusions?

Comprehending your medical insurance's inclusions and exclusions is vital to guarantee financial protection during a medical crisis. Inclusions determine the treatments or services covered in the policy, including diagnostic testing, procedures or surgeries, hospitalisation, etc. On the other hand, exclusions underline what is not covered, such as pre-existing conditions in some instances or cosmetic surgeries. 

Understanding this information will assist you in dodging unwelcoming shocks during a filing claim process. For instance, imagine you presume that your policy covers maternity costs and alternative treatment, only to discover these are not. In such situations, transparency allows you to plan your expenses better and make better decisions during crucial situations. 

In addition, awareness of the policy terms helps you pick the proper coverage to fulfil your requirements. It confirms that you are neither underinsured nor overpaying for irrelevant benefits. By comprehensively checking the inclusions and exclusions, you can stop claim rejections and protect your peace of mind in difficult times.

>>Read More: Comprehensive Guide to Day Care Treatment, Coverage and Advantages

Nutshell

It is a type of insurance coverage that forfeits your medical expenses in case of emergency. You can opt for either cashless facility or reimbursement. You can find ample of options when you browse for mediclaim. But, it is advisable to invest in health insurance policies offered by trusted brands. You can consider our medicalim policy that gives you maximum coverage with multiple sum insured options. For policy related information kindly connect with our experts or visit Care Health Insurance website. 

Disclaimer: Please read the brochure and prospectus to know more about our health insurance plans cover as conditions may vary.