Mediclaim Insurance with Cashless Hospitalization: Don’t let medical expenses become a burden on your wallet. Compare and find the best Mediclaim plan at PolicyBazaar.
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Mediclaim policy is a hospitalization benefit that is offered by both public and private sector general insurance companies in India. The mediclaim insurance policy takes care of expenses following hospitalization/domiciliary hospitalization in case of any of the following situations-
In case of sudden illness or surgery
In case of an accident
In case of any surgery during the policy tenure
Comparison between Mediclaim Policy and Health Insurance
Read in Detail: Mediclaim Insurance Vs Health Insurance
How does Mediclaim Policy work?
There are two types of claims available under Mediclaim policy-
Cashless is a mechanism wherein a patient is treated in a network hospital, then insurer settles either the part of the claim or the entire claim with the hospital. It means, a patient doesnt need to pay a penny to the hospital for the treatment. There are certain procedures which you need to follow to ensure the smooth claim process.
At the first level, all empanelled hospitals will have an insurance desk in their premises. A policyholder has to obtain a pre-authorization form from this desk, which has to be dully filled with correct information because any missed detail will only delay the entire process. This filled form needs to be stamped by the hospital and the doctor and then it has to fax across Third Party Administrator (TPA) or the insurer. After carefully examining the form, the company will approve a certain sum and send a fax back to the hospital saying that `X amount has been sanctioned for the treatment.
Let us understand this procedure with an example. If the hospital has given a treatment cost of Rs 4 lakh, the insurer and TPA will rework and for instance, approve Rs 3 lakh for treatment. Now, they will inform the hospital that they will reimburse expenses up to Rs 3 lakh only under cashless and if the total cost would be more than this limit, they will look at it later. However, at the time of discharge, the total billing amount comes at Rs 3.60 lakh. In this case, the policyholder has two options. The first option is, he will send all discharge letters and final bill copy to the insurer and wait for the revert. No doubt, it will take time. The other option is, policyholder himself pays the remaining amount, which is Rs 40,000 in this case, and then he submits those original bill receipts to the policy provider to get reimbursement of Rs 40,000.
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In the case of reimbursement, it is pivotal to inform your insurance company that a hospitalization has been taken place or likely to take place in a near future. Either you could that by sending an email or by making a call. To get reimbursement, you need to submit all payment receipts, including bills of those medicines which you have bought from outside chemist. You need to make sure that original discharge card, final bills and payment receipts should be in one place, so that they can be submitted to the insurance company to get reimbursement.
3 Checklists Before Buying a Mediclaim Plan
If you havent bought a mediclaim policy and are planning to apply for the one, then it is highly recommended to check below points to make sure that you buy best policy. These factors can also be used to compare different insurance plan options available in the market.
Individual and family floater:
In individual plan, each individual is insured for a specific amount, whereas, in family floater, the whole family is insured for a fixed sum assured. In case of family floater, when the primary person dies or reaches a specific age, the policy is closed even other members who are still younger cant renew the policy. In Individual plan, the individual is insured on separate parameters. The attainment of specific age will not impact insurance coverage of other family members.
Although, policy offers coverage for one year only, but in reality, it is a relationship between you and the insurance company. So, your health Insurance policy should cover as you age because it is tough to get insurance at that age. If your policy doesnt provide you coverage at that point of time then buying such a policy will not give peace of mind.
This is relevant only if you have a pre-existing disease at the time of taking insurance plan. It also covers those diseases which might arise from a pre-existing disease. For example, if you have diabetes at the time of taking the plan and later develop heart problem, then even the heart problem will be considered as a pre-existing disease. Almost all insurance companies have a clause that states that a pre-existing disease will be covered only if the plan has been renewed for a certain number of years. A best mediclaim insurance plan covers pre-existing diseases as soon as possible.