What is Mediclaim?

Rising medical costs have become a major concern for most families today. Even a short hospital stay or an unexpected surgery can quickly drain years of savings, leaving individuals financially vulnerable during already stressful times. This is where mediclaim plays an important role. It helps you manage unforeseen hospital expenses without worrying about immediate payments. Understanding what is mediclaim, its meaning, and how a mediclaim policy works can make a real difference when emergencies occur, helping you protect both your health and your finances.

Understanding Mediclaim

Before buying health insurance, it’s important to understand what a mediclaim policy is and how it works. Simply put, a mediclaim policy is a type of health insurance that covers hospital expenses arising from illnesses, accidents, or surgeries. It helps you manage medical costs without putting too much strain on your savings.

Mediclaim policies usually offer two ways to settle claims. You can either opt for cashless treatment at network hospitals, where the insurer directly settles the bills, or pay for the treatment upfront and claim reimbursement later by submitting the required documents and bills.

Bajaj General Insurance Limited provides an extensive hospital network, quick claim processing, and reliable assistance during medical emergencies, offering policyholders a smoother and more secure experience when it matters most.

Types of Mediclaim Policies

Choosing the correct type of mediclaim policy depends on your healthcare needs, family structure, and financial priorities. Different policies are designed to meet specific requirements, whether you are an individual seeking personal coverage, a family looking for collective protection, or an employer offering health benefits to staff. Here’s a closer look at the main types of mediclaim policies available in India.

1. Individual Mediclaim Policy

An individual mediclaim policy provides coverage to a single person. The insured individual can claim hospitalisation expenses for illnesses, injuries, or surgeries. However, the policy benefits are limited to that person alone, and no other family member can avail of the coverage under the same plan.

2. Family Floater Mediclaim Policy

A family floater mediclaim policy protects the entire family under a single plan. It usually covers the policyholder, spouse, dependent parents, and children. The total sum insured is shared among all members, making it a cost-effective and convenient way to manage family healthcare expenses.

3. Senior Citizen Mediclaim Policy

This type of policy is specially designed for individuals aged 60 years and above. A senior citizen mediclaim policy provides financial coverage for hospitalisation and treatments related to age-specific health issues. It offers older adults peace of mind by making quality medical care accessible without putting pressure on their finances.

4. Critical Illness Mediclaim Policy

A critical illness mediclaim policy offers a lump sum payout if the insured person is diagnosed with a significant illness such as cancer, heart disease, kidney failure, or stroke. The payout can be used to cover high treatment costs, post-hospitalisation recovery, or lifestyle adjustments needed during recovery.

5. Group Mediclaim Policy

A group mediclaim policy is usually offered by employers to their employees as part of their benefits package. It covers all members of a group under one master policy, ensuring medical protection for the workforce. In some cases, the coverage may also extend to employees’ family members, providing added health security.

What Does a Mediclaim Policy Cover?

A mediclaim policy is designed to cover hospital expenses arising from illness or injury, helping you manage unexpected medical costs with ease. Bajaj General Insurance Limited offers such coverage through its Health Guard Plan, which combines the core benefits of mediclaim with the broader protection of a comprehensive health insurance policy.

The plan typically covers:

1.       Hospitalisation expenses, including surgeries, treatments, diagnostic tests, and organ donor costs.

2.       Room rent for regular wards or ICU stays, with cashless access at network hospitals.

3.       Daycare procedures that do not require a 24-hour hospital stay.

4.       Doctor and surgeon fees incurred during hospitalisation.

5.       Pre- and post-hospitalisation costs, such as medical tests, consultations, and prescribed medicines (usually up to 60 days before and 90 days after hospitalisation).

6.       Modern treatments like oral chemotherapy, radiotherapy, and AYUSH therapies.

7.       Ambulance services for emergency medical transport.

8.       Maternity and newborn care expenses under select plan variants.

9.       Preventive health check-ups, sum insured reinstatement, and cumulative bonus benefits.

What is Not Covered Under a Mediclaim Policy?

1.       Cosmetic or dental procedures, such as implants or prostheses, are not covered unless medically necessary.

2.       Treatments received outside India, except under specific plan options.

3.       Non-allopathic or alternative treatments are not recognised under AYUSH.

4.       Procedures for obesity, gender reassignment, or infertility.

5.       Injuries from adventure sports, war, or self-inflicted harm.

6.       Treatments related to alcohol or substance abuse.

7.       Circumcision is required unless for a medical condition or accidental injury.

Difference Between Mediclaim and Health Insurance

Why You Should Opt for a Mediclaim Policy from Bajaj General Insurance Limited?

When health emergencies strike, having the right Mediclaim plan can ease both emotional and financial stress. Bajaj General Insurance Limited offers simple, reliable, and affordable Mediclaim solutions designed to protect you and your family when it matters most.

1. Wide Hospital Network: Get cashless treatment at over 18,400 hospitals across India for quick, quality care.
2. Easy Claim Process: Enjoy a smooth, transparent process with both cashless and reimbursement claim options.
3. Affordable Plans: Choose flexible Mediclaim plans with premiums that fit your budget.
4. Tax Benefits: Save more with tax deductions under Section 80D of the Income Tax Act.
5. 24x7 Support: Get round-the-clock assistance and quick help whenever you need it.
6. Customisable Cover: Pick the sum insured and benefits that best match your needs.
7. Comprehensive Protection: Covers pre- and post-hospitalisation expenses, along with add-ons like ambulance, organ donor, and daily hospital cash.

Who Should Buy a Mediclaim Policy?

A mediclaim policy is suitable for everyone—young professionals, families, and senior citizens alike.

1. Individuals: Ideal for single persons seeking basic health protection.
2. Families: The family floater variant provides cost-efficient coverage for multiple members.
3. Senior Citizens: Tailored plans cover illnesses common among older adults.
4. Employees: Professionals without corporate health benefits can secure themselves through independent mediclaim plans.

How to Choose the Right Mediclaim Policy?

Choosing the right mediclaim policy requires careful evaluation of several aspects to ensure you get the most suitable and long-term health protection. Here are some key factors to keep in mind before making your decision.

1. Sum Insured: Select a coverage amount that aligns with medical expenses in your city and your family’s needs. Consider factors such as age, health, and any existing medical conditions to ensure adequate protection.
2. Network Hospitals: Check if reputed hospitals near you are part of the insurer’s network. Having access to a vast network of hospitals ensures cashless treatment and timely care during emergencies. Bajaj General Insurance Limited has over 18,400 network hospitals across India, offering policyholders a broad choice and convenience for cashless treatment.
3. Claim Settlement Ratio: The claim settlement ratio reflects an insurer's efficiency and consistency in settling claims. A higher ratio indicates a greater likelihood of receiving fair and timely claim approval.
4. Waiting Period: Understand the waiting period for pre-existing conditions. A shorter waiting period means you can access coverage benefits for such illnesses sooner.
5. Co-Payment Clauses: Examine co-payment terms to know what share of expenses you’ll bear during a claim. Lower or no co-payment reduces your out-of-pocket costs in case of hospitalisation.
6. Renewal Age Limit: Opt for policies offering lifetime renewability so your health coverage continues seamlessly, even in your later years.

How to File a Claim Under a Mediclaim Policy?

Filing a claim with Bajaj General Insurance Limited is a straightforward process designed to ensure quick support when you need it most. You can choose between cashless or reimbursement claim options, depending on where you receive treatment.

Cashless Claim Process

If you’re admitted to a network hospital, Bajaj General Insurance Limited will settle the bill directly with the hospital. Here’s what to do:

1. Visit any network hospital listed under Bajaj General Insurance Limited.
2. Present your mediclaim card and a valid photo ID at the hospital’s insurance desk.
3. Fill in the provided pre-authorisation form, which the hospital will forward to the Health Administration Team (HAT) for approval.
4. Once approved, the insurer will settle the bill directly with the hospital, so you don’t have to pay upfront for covered services.
5. If any additional information or documents are needed, the insurer will inform the hospital promptly.
6. Most cashless claims are processed within one working day, ensuring quick approval.

Reimbursement Claim Process

If you get treated at a non-network hospital, you can file for reimbursement after paying the bills yourself. Follow these steps:

1. Pay the medical bills and collect all original documents—bills, discharge summary, prescriptions, and reports.
2. Download and fill in the claim form available on the Bajaj General Insurance Limited website.
3. Attach the required documents and submit them online or by post to the Health Administration Team (HAT) within the time specified in your policy.
4. The insurer will verify your claim and, once approved, reimburse the eligible amount directly to your bank account (usually via ECS) within 10 working days.

Tax Benefits of Mediclaim Policy

A Mediclaim policy not only offers financial protection during medical emergencies but also provides attractive tax benefits under Section 80D of the Income Tax Act.

1. You can claim a deduction of up to ₹25,000 on premiums paid for yourself, your spouse, and dependent children (if all are below 60 years of age).

2. An additional deduction of up to ₹25,000 is available for premiums paid for your parents. This limit increases to ₹50,000 if either parent is a senior citizen (aged 60 or above).

3. The maximum total deduction you can claim in a financial year is ₹1,00,000 if you are paying premiums for both your family and senior citizen parents under separate Mediclaim policies.

4. To qualify for these deductions, premiums must be paid through non-cash modes such as online payment, cheque, or bank transfer. However, preventive health check-ups can be paid in cash, up to ₹5,000, within the overall limit.

Conclusion

Healthcare costs can rise unexpectedly, and that’s where a Mediclaim policy becomes truly valuable. It ensures you get the care you need without worrying about hospital bills or dipping into your savings.

With Bajaj General Insurance Limited, you can choose a plan that offers wide coverage, cashless treatment across more than 18,400 network hospitals, and easy claim support. Plus, you enjoy tax benefits that make it even more rewarding. A good Mediclaim policy isn’t just about protection—it’s about peace of mind for you and your family.

*Standard T&C Apply

**Tax benefits are subject to change in prevalent tax laws.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

Claims are subject to terms and conditions set forth under the health insurance policy.