Mediclaim: Things You Should Know Before Buying One



Health insurance or popularly, mediclaim as we call it is of course part of the 5 must have insurance covers in India. Hence everyone should have it. However, if you are still not convinced on why should you have a mediclaim; we suggest you read the following carefully to understand the things to keep in mind before you get a mediclaim in India:

1. Pre-existing diseases

Disclose any pre-existing disease you may have at the time of taking the policy or else this will result in your claim not being approved when you need it. Any disease that you have at the time of taking the health insurance India policy is termed as the pre-existing disease. This can be anything, diabetes, asthma you had since childhood etc. Pre-existing disease will be covered only after 3-5 years of continuous policy renewals and only if it was declared by you at the time of taking the policy. There are also policies that will specifically cover some pre-existing diseases from the first year itself, you can ask about them to you advisor.

2. Yearly Affair and Minimum waiting period

Your policy gets reviewed and renewed every year. However it is considered in effect from the first year you paid the premium for but will have to be renewed every year and at that time, your claims, if any in the previous policy year will be checked and the premium may go up in case you had a claim in that year.

3. Loading with age

As your age increases, you will be liable to pay the higher premium for the same mediclaim policy. This is called ‘loading’. For instance, the amount of premium you will pay when you will be in the age group of 35-40 will be higher compared to the premium you paid when you were in the 25-30 age group.

4. Reimbursement only in case of Hospitalisation

The reimbursement under a mediclaim policy will be made only in case of hospitalisation and that too, for a time frame of at least 24 hours. Day-care procedures or in other words any hospitalisation that is required for less than 24 hours will not be covered under your mediclaim. However, some policies provide the exception to this case and certain procedures may be covered even when the hospitalisation is for less than 24 hours.

5. Maximum age for renewal

Mediclaim is not a life-long affair and once you cross a certain age, the mediclaim will stop to exist for you. The existing policy that you took when you were in your 20’s or 30’s, will no longer work when you will cross 65 or 70. Some mediclaim do provide an upper limit of 75 years but that is it. Beyond that, you will have to opt for a separate senior citizen medical insurance plan.

6. Maternity expense clause

A lot of mediclaim insurance providers avoid covering maternity expenses. Even if they do, it is usually with a time limit after which it will be covered and is usually 3 years from the time of paying your first premium. Very few insurance providers cover maternity expenses right from the word go. So keep this in mind.

7. Diseases, exceptions, and medical procedures NOT covered

Lastly, please make sure to go through the list of ‘Exceptions’ or ‘List of Disease or Medical procedures not Covered’ by your mediclaim. Usually cataract, dental procedures, cosmetic procedures etc. will not be covered. Also, any hospitalisation resulting from diseases that are in the ‘Not Covered’ section of your policy will not be reimbursed. You can opt for a separate critical illness cover for that. Also, there will be certain cases and scenarios, under which medical expenses may not be reimbursed, be aware of that.

New Woman Team

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