How to Choose the Best Mediclaim Policy in India?

The only way to prepare yourself against medical emergencies is by investing in the best Mediclaim policy in India. It will take care of your medical bills by paying for your hospitalization arising out of sickness or injury. It will also pay for expensive treatments, such as surgery. The payments are either made through cashless treatment or reimbursement mode that the insurance company offers.

The best mediclaim policy in India is designed in such a way that you get access to good quality medical care without worrying about medical bills and treatment costs. However, you need to submit bills and proofs to be eligible for reimbursement. Alternatively, you can also choose cashless hospitalization, where your insurer will pay directly to the concerned provider after your treatment.

Simply put, a Mediclaim policy will provide you with financial assistance when you need hospitalization. It covers your treatment costs, nursing, lab tests, room rent, consultation, etc. The best mediclaim policy in India will also cover costs before and after hospitalization.

If you are planning to invest in a Mediclaim policy, here are some tips to help you make a wise purchase decision.

1. Sum Assured

When choosing the coverage amount or the sum assured, it is advised to keep factors like inflation rate, rising medical costs, etc., in mind. This will help you choose the right amount. Also, people living in cities will have to pay higher costs of hospitalization than someone living in rural or semi-urban area. If you want your policy to cover your dependents, then you must consider a higher amount.

2. Choose Between Family Floater and Individual Plan

The best mediclaim policy in India is the one that meets your needs, be it an individual plan or a family floater. The decision should be made based on your current family status and your lifestyle. For example, if you are buying insurance for the first time and only want to cover yourself, an individual plan may be best. But if you want to provide coverage for your entire family, then consider family floater plans. They are much more affordable as compared to individual policies due to discount offered by insurers.

3. Sub-Limits

Most Mediclaim policies include room rent sub-limit. These limits will vary from insurer to insurer. These sub-limits will put a cap on the amount of money you will get reimbursed for your hospital room. It is always a good plan to educate yourself about these limits so that you know what to expect when you file for claims.

4. Co-Payment Clause

According to the co-payment clause, the insured person is liable to pay some percentage of the amount at the time of claim settlement, while the insurance company will pay the rest. These co-payments can be anything between 10-30%, depending on the insurance provider.

For example, if you choose a Mediclaim with a 10% co-payment and your bill is Rs. 1,00,000, you would have to pay Rs. 10,000 from your pocket, and the rest will be paid by the insurer as per the policy terms and conditions. Some insurance providers may also be willing to cover the pre-existing medical conditions, albeit with higher co-payment.

5. Exclusions

Even though a Mediclaim policy is meant to cover all your medical risks, certain things are excluded or not covered after a certain period. For example, complications arising due to suicide attempt, substance abuse, HIV, etc. However, expenses such as maternity, gall bladder removal, kidney stones, etc., are covered after a waiting period mentioned in the policy document. Most insurance providers will offer any coverage for pre-existing medical conditions only after 3-4 years.

6. Network of Hospitals

The best mediclaim policy in India is often the preferred choice for many investors because it offers cashless settlement of medical bills at the hospital network. Every insurance company has a list of hospitals that they have added to their network. When you seek treatment at one of these hospitals, you become entitled to get cashless treatment. It can provide immense financial relief to the patient and their family, who can now focus on recovery rather than worrying about the bills.

Insurance companies will calculate your premium based on certain factors, such as age, lifestyle, geographic location, pre-existing medical condition, etc. However, the final premium is determined based on your financial needs and IRDAI guidelines.

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The views expressed in this article are those of the authors and do not necessarily reflect the views or policies of The World Financial Review.