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Mediclaim Policy

Mediclaim Policy provides cover for healthcare expenses incurred by insured in a hospital due to a medical emergency, be it due to illness or an accident that leads to hospitalisation.
This policy provides coverage to the individuals and their covered family members against expenses that include hospital room/ICU charges, diagnostic charges, medicine and other medical expenses.

Key Benefits

  • The policy offers the ease of cashless hospitalisation.
  • You can opt for self or the entire family
  • It shields you from the financial burden
  • Removes expenses paid from your pocket
  • Insurance companies will handle the expenses arising out of hospitalisation
  • Ease of buying through online health insurance companies
  • It offers tax exemptions
  • Avail, cost-effective healthcare services

Coverages

  • In-Patient Hospitalisation
    • Room Rent/ICU
    • Nursing
    • Medicines and Drugs
    • Consumables
    • Medical Practitioner's (Surgeon, Anesthetist, Consultant etc.) fees
    • Blood, oxygen, anaesthesia, diagnostic and pathological tests, operation theatre charges, cost of chemotherapy, dialysis, pacemaker, artificial limbs etc.
    • Registration, Service Charges, Surcharges
  • Pre-Hospitalization Medical Exp
  • Post Hospitalization Medical Exp
  • Day Care Procedures
  • Domiciliary Treatment
  • Organ Donor
  • Accidental Dental Treatment
  • Ayush Benefit
  • Daily Allowance
  • Emergency Ambulance

Exclusions

  • Any pre-existing disease, for four years of continuous coverage from the inception of Insured's first Medical Policy
  • An initial 30-day waiting period for newly incurred conditions (not accidents)
  • One year and two year exclusion periods for certain specified diseases, as listed in the policy
  • Cost of spectacles, contact lens or hearing aids
  • Convalescence, general debility, congenital diseases/defects, sterility
  • Claims arising out of participation in dangerous sports/activities
  • Claims arising from or related to HIV/AIDS
  • War, terrorism and nuclear risks
  • All non-medical expenses, including personal comfort and convenience item services
  • Treatment of obesity, hormone replacement therapy, sex change and any weight control program
  • Genetic disorders, stem cell implantation and surgery
  • Expenses on naturopathy, experimental or alternative medicine, acupressure, acupuncture, magnetic and similar therapies
  • Any Insured Person committing or attempting to commit a breach of law with criminal intent, or intentional self-injury or attempted suicide while sane or insane.
  • The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction or any other substance abuse treatment or services, or supplies
  • Pregnancy (including voluntary termination), miscarriage (except as a result of an Accident or Illness), maternity or birth (including caesarean section) except in the case of ectopic pregnancy
  • Sterility, treatment whether to effect or to treat infertility; any fertility, sub-fertility or assisted conception procedure; surrogate or vicarious pregnancy; birth control, contraceptive supplies or services including complications arising due to supplying services
  • Plastic surgery or cosmetic surgery unless necessary as a part of medically necessary treatment certified by the attending Medical Practitioner for reconstruction following an accident, cancer or burns

Claim process

In case of any medical requirement, there are two methods to use your insurance card:

  • Cashless

  • Reimbursement

  • For Cashless Treatment

    • Use Health card.
    • Planned - Take approval in advance
    • Emergency -- Take approval within 24 hours

  • For Reimbursement Treatment
    Please note following documents are required for reimbursement Claim.

    • Duly filled Claim form.
    • Final Hospital bill with detail breakup and payment proof.
    • Medicals claimed- Medical bills, Prescriptions, Discharge summary (Original)
    • For all miscellaneous charges-detail bills with supporting prescription of the Treating doctor.

Why Choose PrishaPolicy

5 Reasons why you should choose us to be your policy issuing partner of choice. Allow us to tell you why we are one of the fastest growing insurance brokers.

Customer-Centric Culture

For us, you always come first. Our products and services are designed to find the best coverage for all.

A Decade of Market Leadership

Our teams expertise and experience makes them the perfect guides in choosing a policy that fits your needs.

Reliable and Consistent

Rest assured that everything will be taken care of without a glitch. From shortlisting to claims processing & delivering promises without a hitch.

Guided Policy Assistance

Our experts are forever ready to assist you through each policy detail with a fine-tooth comb.

Claims Assistance

Our DNA prompts - Sales is incomplete without timely support. From start to end, we facilitate smooth processing from lodging to settlement.

Still Thinking About It?

Get on a call with us. We take pride in being associated with you for competitively managing your risks with the best insurance covers and delivering a stress-free experience.

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Questions You Might Have

What are pre and post-hospitalization expenses in health insurance?

Pre-hospitalization expenses refer to the medical expenses incurred before getting admitted to a hospital. Post-hospitalization expenses refer to the cost of follow-up tests and consultation treatment charges incurred after getting discharged from the hospital. Health plans in India mostly cover pre-hospitalization expenses up to 30 to 60 days and post-hospitalization expenses up to 60 to 90 days, depending on the plan.

At what age can I include my children in my health insurance plan?

You can include your children in a family floater policy from day 1. In some health plans, children are covered from 91 days onwards. Nonetheless, you are advised to go through the terms and conditions of a health plan carefully to know about the entry age for children.

Which diseases are not covered in health insurance?

A health insurance policy usually does not cover HIV/AIDS treatment except for a few companies. Any claims arising out of congenital disorders, venereal diseases, general debility. sexually transmitted disease and dental treatment/surgery (unless required as a part of treatment) is excluded from health insurance coverage. But do check your policy wordings to know more about the detailed list of exclusions in a health insurance plan.

What is a Cumulative Bonus in a health insurance plan?

A cumulative bonus in health insurance implies monetary benefits that the insurer provides you as a reward for not filing a claim during the previous policy year. For instance, discount on premium or sum insured enhancement. It is also called a No Claim Bonus similar to that in car insurance. However, the policy benefits differ from one health insurance company to another.

What do you mean by No claim bonus in health insurance plans?

No claim bonus (NCB) is a discount on the base premium offered if no claim on the health policy is made during the previous policy term. This bonus is usually given in the form of a premium discount or enhancement of the sum insured amount.

What is the maximum number of health insurance claims allowed in a year?

The maximum number of claims allowed under health insurance during a policy year varies from one plan to another. While some plans allow you to raise only one or two claims per policy tenure, a lot of plans do not come with any limit to the number of claims that you can file during a policy year as long as the sum insured is not exhausted. You can contact your insurer to know about the number of claims that you are permitted to file during a policy year.

What to do if my health insurance policy renewal date is missed?

Ans: If you have missed the renewal date of your health insurance policy, you must renew your policy as soon as possible. You can renew it during the grace period preventing the policy from getting lapsed. But if you renew your policy after the grace period, it will get lapsed and you may have to undergo a medical test or pay a higher renewal premium.