Surveys have revealed that India is said to record among the top per capita, out of pocket, health expenditures. The reason is because there is noticed low insurance penetration. People in large numbers still are unaware of the different available ways to manage their financial emergencies arising from illnesses or accidents.

Mediclaim Policy: Know the different types and how to claim it

One such insurance policy that helps people to manage their healthcare expenses is ‘Mediclaim’ policy. It takes care of critical illnesses or accident issues that require hospitalization and undergoing advanced treatment procedures. Hence, it becomes important to select the best mediclaim policies available in the market. 

Covering medical issues

Availing such an insurance policy allows you to get reimbursed for the medical expenses incurred. It also covers you for treatment, nursing and lodging costs till the specified coverage amount chosen in the policy. Mediclaim is a good investment to protect your finances. 

Types of Mediclaims plans offered

• Family floater policy: The entire family gets insured for a specific fixed amount insured assured. Coverage is provided to dependent children, spouse, self and in some cases to dependent parents. A single member or all the family members may use the sum insured assured. 
• Individual Mediclaim policy: A single person gets insured in this policy for a specified amount. It provides mediclaim along with other hospitalization benefits, but limited to a single person. The insured person is free to claim the whole sum insured assured. 
• Critical illness policy: If a person is diagnosed with some critical illness that is provided coverage under this policy, then he/she is paid a lump sum amount on the sum insured assured. The policyholder will be able to plan the treatment accordingly. Hospitalization expenses will be covered under general mediclaim policy. However, critical illness policy will be desired to cover various types of illnesses that might affect your lifestyle and work. Such policies generally offer higher claimable amount unlike other available policies. Some of the illnesses covered under this policy are:
  • Kidney failure
  • Cancer
  • Aorta graft surgery
  • Heart attack
  • Stroke
  • Paralysis
  • Coronary artery bypass surgery
  • Major organ transplant
  • Primary pulmonary arterial hypertension
  • Multiple sclerosis
• Senior citizen policy: This policy is beneficial for elderly individuals. If you are nearing your retirement age or are planning to retire soon, then you will be entirely dependent on your savings or pension amount for a living. If an emergency situation takes place, then you are likely to face financial crisis. Such unfortunate situations can be avoided by availing this policy. 
• Group Mediclaim policy: It is generally taken by companies to provide coverage for their employees. It allows them to avail hospitalization expense reimbursement or cashless hospitalization. 

Types of claims made

These days, making claims on mediclaim policy is quite easy, hassle-free, convenient and time saving. Claims on Mediclaim policy can be done in two possible ways. 

• Reimbursement Mediclaims: Cashless claims may not be possible for several reasons. In such a case, choose reimbursement claims. After treatment is completed and amount is settled, send the insurance provider documents like doctors’ reports, claim form along with related prescriptions. The provider will scrutinize thoroughly the submitted documents to verify its authenticity and correctness. Following documents are the ones that are to be submitted while making the claims:
  • Duly filled up claim form
  • Receipts & bills
  • Investigation report
  • Authorized doctor signed form or medical certificate
  • Prescription provided by the hospital or pharmacy
  • Patient’s discharge summary
  • For accident related cases, there will be required FIR or Medico Legal Certificate
• Cashless Mediclaims: In case, you plan to choose cashless hospitalization treatment, then discuss with the insurance provider before getting admitted. Hospitalization expenses will be collected directly from the insurance provider or their third party administrator. Submit claim form with doctor’s report to seek provider approval to avail cashless hospitalization treatment. On approval of request, insurance company or third party administrator will settle directly the bills with the hospital. The policyholder will not be disturbed in any manner. But this facility is offered only if the policy covers critical injuries or illness. 

Steps to file claims

• Put all essential medical receipts, bills and reports in order. Identify documents containing required information like cost price, patient’s name, etc. 
• Request insurance provider to provide claim form. You can also download the same from their official website. Go through the instructions given carefully and thoroughly. As the policyholder, sign the form and get it stamped with the official seal of the hospital. Attach relevant policy and medical documents with the form. 
• Submit filled up claim form including original and photocopies of relevant documents. Review carefully all the documents and make sure none is missing at the time of submission. 
• Once the documents are submitted, inform about the same to the concerned officials at the insurance company by sending them a copy. 

You can always rely on a reputed insurance company like Care Insurance to get your Mediclaim policy and enjoy its benefits.