Mediclaim Policy: Types and Benefits

A mediclaim policy is a type of health insurance that exclusively covers the medical expenditures incurred by the policyholder during hospitalisation. Notably, such a policy extends medical coverage for hospitalisation expenses only up to the sum insured. Mediclaim insurance, which is offered on an individual and a floater sum insured basis, also provides cashless treatment at the insurance provider’s network hospitals. This proves useful for policyholders and helps them account for the cost of medical emergencies easily.

Check out the article below to know more about the mediclaim policy.

Types of Mediclaim Policies in India

The most common types of mediclaim insurance policies in India are discussed below:

  • Individual Medical Insurance Policy

An individual mediclaim policy provides just the policyholder with health insurance coverage. Typically, such coverage allows only one person to avail of mediclaim benefits in exchange for premiums paid. 

  • Family Floaters Mediclaim Insurance 

A family floater mediclaim insurance plan covers the policyholder as well as their family members, such as parents, spouses, and kids. A single sum insured amount is extended on a floater basis to all family members under the coverage. 

  • Mediclaim Policy for Senior Citizens

Senior citizen mediclaim insurance is designed to account for hospitalisation costs incurred by older adults over the age of 60. Such a health insurance policy cover is tailored to account for all the health-related needs of senior citizens.

Benefits of Availing of a Mediclaim Policy

Having a medical policy serves as a financial safety net at a time when the cost of availing medical treatment is skyrocketing. 

That said, here’s how one can benefit from buying a medical insurance policy:

  • Cost-effective: Mediclaim coverage is a cost-effective approach to obtaining healthcare treatments without depleting your finances.
  • Provides cashless hospitalisation: The insurance coverage makes cashless hospitalisation accessible at all network hospitals of the insurance provider, removing any out-of-pocket expenditure during a medical emergency.
  • Lowers financial burden: By providing monetary aid during a medical emergency, a mediclaim policy lowers the financial load on the policyholder and their family.
  • Individual and Family Floater coverage: Nowadays both individual and family floater insurance plans are available in the market. Thus allowing one to choose a coverage as per requirement.
  • Covers Hospitalisation expenditures: Mediclaim insurance is designed to cover in-patient hospitalisation expenditures such as medicines, OT, doctor’s fees, nursing charges, etc., incurred due to an injury or illness. 
  • Offers lifelong renewability: Depending on the type of policy one opts for, medical insurance may allow the insured the option of lifelong renewability.
  • Accounts for an additional charge: Some mediclaim policies may also extend benefits that cover ICU expenses, hospital room rent, and so on.
  • Accompanies tax benefits: Policyholders are also entitled to claim tax deductions under Section 80D of the Income Tax Act on the policy premium they pay annually.

Factors to Consider While Selecting a Mediclaim Policy

Individuals can easily find and access different types of mediclaim insurance policies in India. However, they must be smart in selecting the same and base their decision on several factors.

To ensure you pick the best health insurance, don’t forget to weigh in these factors:

Individual and Family Floater

Individual plans cover an individual for a specified amount, while family floater plans protect all the family members for a predetermined sum assured. Note that in case of a family floater, the insurance policy is closed when the principal individual dies or achieves the exit age. This means that the younger family members cannot renew the insurance policy. However, an individual insurance plan may allow renewal if the insured reaches the exit age.

Sum Insured

When determining the coverage amount or the sum assured of a mediclaim, several elements like as the rate of inflation, rising healthcare costs, etc. should be taken into consideration. Typically, the cost of hospitalisation and treatment in big cities will be higher than that in rural regions. This is why it is vital to opt for an insurance plan with a higher sum assured. Additionally, if you wish to add your family members to the insurance policy, then you should go for a bigger sum.

Option for co-payment

Many mediclaim plans come with a co-payment option these days. Essentially, co-payments are usually the share of the claim amount the insured needs to bear before the provider covers the remaining amount. Usually, the co-payment could range from 10% to 30%. Make sure to check out if such provisions are included in a plan if you do not wish to go for medical insurance allowing co-payment.


A few medical expenditures are either paid after a given time or aren’t covered by mediclaims at all. Take, for instance, HIV infection and drug or alcohol addiction are not covered by any mediclaim insurance policy. Additionally, certain ailments such as gall bladder surgery, kidney stone surgery, etc, are covered after a designated period. This makes it crucial for intending insurance buyers to review the exclusions closely.

Network Hospitals

The benefit of availing of cashless settlement of the cost of hospitalization at the network hospitals is indeed a huge relief for most policyholders. Fortunately, the best insurance companies have a robust network of hospitals that extend cashless treatment. So make it a point to find out how many network hospitals under the mediclaim are located near you and if they are known to offer quality service or not.

Age of Renewability

Some policies provide individuals with the option of lifetime renewability, which allows them to renew their insurance regardless of their age. This is useful for elderly individuals since it’s challenging to obtain insurance coverage at their age. Examine the renewability option and related clauses when selecting a mediclaim policy.

Pre-existing Condition

After the pre-fixed waiting time, almost all insurance providers cover pre-existing health issues. Hence, when purchasing a mediclaim insurance policy, you should check out the pre-existing waiting time and opt for the one that comes with a minimal waiting period.

Remember these basic pointers when looking for a comprehensive mediclaim policy. Also, make sure to disclose your entire medical history and conditions when availing of a mediclaim to avoid confusion and delays while settling claims or starting treatment.