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Mediclaim Policy

Medical emergencies can cause considerable distress not just physically & emotionally, but also financially. The health of our loved ones is of prime importance and this is why we seek to get them the best treatment available which can sometimes prove to be a financial burden. This is where a mediclaim policy can prove to be useful. This blog details all about mediclaim and its importance in our everyday lives.

Table of Contents

What is a Mediclaim Policy?

Simply put, mediclaim plans are a product of health insurance that provides financial coverage against unforeseen medical emergencies. In the case of treatment or hospitalization required, a mediclaim policy can be used to avail of cashless treatment or get the cost reimbursed from the insurer. The insurance company would be liable to pay for all medical costs incurred in the treatment of the insured who has taken a mediclaim plan.

Mediclaim policies can be purchased both in an individual’s name and for the family as a whole. A mediclaim policy for a family covers all the family members under a single health insurance plan. 

Additionally, health insurance plans in India offer two options: cashless and reimbursement. In cashless treatments, the insurance company provides the insured with a list of network hospitals. You can choose to go to any hospital on the list and avail of hospitalization without the need to pay any cash.

Under a reimbursement plan though, the patient can get the treatment first at a non-network hospital and later inform the company of a planned or emergency hospitalization. On submission of all relevant documents, the patient is reimbursed by the insurer for the actual expenses incurred. 

Note that for all kinds of medical insurance plans, you are eligible for tax exemption on the premium amount as defined under section 80D of the Income Tax Act, 1961.

Key Features of a Mediclaim Policy

  • Tax benefits: Buying mediclaim insurance entitles you to certain tax deductions under Section 80D of the Income Tax Act, 1961. Deductions up to Rs. 25,000 on income tax are offered on premiums payable for the mediclaim policy. Tax deductions are also available for senior citizens up to Rs. 50,000. 
  • Sufficient financial coverage: Mediclaim plans are designed to provide adequate financial protection to the insured in the event of any medical emergency, planned or unexpected. In the case of urgent hospitalization or planned treatment options, your mediclaim policy will take care of all medical expenses incurred. The insurer will be liable to pay for the amount involved in the treatment.
  • Cashless treatment: Emergency hospitalization can be a huge financial burden on you and your loved ones. Cashless treatment saves you from this financial load by giving you the option of receiving the best treatment at your insurer’s network hospital (affiliated with the provider) without the need to pay anything from your pocket. Your health insurance provider will settle all hospital and other medical bills directly with its network hospital.
  • Multiple policy options: Mediclaim can be purchased for an individual as well as well as for all the members of your family. You can easily choose the best mediclaim policy for your family from the varied options available with your health insurance company. Based on your requirements, you can choose the mediclaim policy that best matches them.

Benefits of Buying a Mediclaim Policy 

The growing number of lifestyle diseases and the rising cost of healthcare have made it necessary to buy health insurance plans. It is important to buy a personal health insurance policy based on your requirements as well as a family health cover that takes care of all healthcare needs of each of your loved ones. Listed below are some of the reasons to buy mediclaim health insurance:

  • Much-needed financial assistance to your family in case of medical emergencies
  • A cashless facility is available at each of the network hospitals of the insurance company, which reduces the burden of unpredictable expenses during unfortunate events 
  • Dual cover that includes both family floater and individual coverage 
  • Highly affordable healthcare services without exhausting your savings 
  • Lifelong renewability option on buying a mediclaim policy as per the chosen plan 
  • Coverage for in-patient hospitalization like doctor’s fees, OT charges, cost of medicines, nursing charges, etc. 
  • Tax exemption on the policy premium each year under Section 80D of the ITA
  • Additional benefits like room rent, ICU charges, and more 

Mediclaim vs Health Insurance – Difference between Health Insurance and Mediclaim 

These two terms are often confused and used interchangeably. However, there is a considerable difference between mediclaim and health insurance. The table below highlights the key parameters covered in mediclaim vs health insurance plans:

MediclaimHealth Insurance
An indemnity product that compensates the policyholder for the costs incurred on the treatment up to the sum assuredA benefit product that provides a lump sum amount to the insured as specified in the policy
Covers only the cost of hospitalization due to critical illness, accident, or surgeryAlong with hospitalization costs, also covers pre- and post-hospitalization expenses, ambulance charges, reimbursement for lost income, daycare procedures, Ayush and other alternative treatments, and domiciliary care
The upper limit of the cover is generally depending on the plan opted forThe upper limit can go up to crores if required
More than one claim can be made until the sum assured amount is exhaustedLimited to a single claim; lump sum is paid only once
Generally, no add-ons are offered under the policySeveral add-ons can be included in the plan, including disability cover, critical illness cover, and maternity cover 

Types of Mediclaim Policy

There are different types of mediclaim plans offered to customers to meet their varied healthcare requirements. Additionally, add-ons can be purchased over and above a basic health insurance plan to extend the coverage of the policy.

Based on the number of people covered under the plan, mediclaim plans can be divided into the following categories:

  • Individual Mediclaim Plans: These plans cater to only one individual. Medical costs incurred by only the policyholder are covered by the insurer under this plan. This policy is generally ideal for individuals without any dependents.
  • Family Mediclaim Plans: Mediclaim plans for family cover the entire family under one single policy. Medical costs incurred by the parents, spouse, and children of the policyholder are covered by the insurer. Financial coverage for the entire family is provided under one premium.
  • Personal Accident Mediclaim Plans: This policy provides coverage against death due to accident, and partial and complete disability of the policyholder.
  • Senior Citizen Mediclaim Policy: These plans are specially designed to meet the healthcare needs of senior citizens or the elderly aged 60 years and above. All age-related illnesses are covered that are generally not included in basic mediclaim plans.
  • Critical Illness Mediclaim Plan: The treatment options for chronic and severe illnesses such as heart ailments, cancer, or kidney failure can be quite expensive and create a financial burden on your family. Critical illness mediclaim policy provides financial coverage for hospitalization, treatment, and care involved in such health conditions. It can be purchased as a stand-alone policy or an add-on rider.
  • Top-up Plan: This is an add-on cover over and above an existing mediclaim insurance policy. It covers expenses incurred beyond the limit of the sum insured for the basic policy.

Buy suitable family health insurance plans for you and your loved ones with Turtlemint

Points to Consider Before Buying Mediclaim or Health Insurance

Before investing in a mediclaim insurance plan, make sure to note the following points in mind:

  • Opt for health insurance at an early age: The premiums are lower if you start early on.
  • Check for the premium to be paid: Note however that a higher premium does not necessarily mean a better policy.
  • Read the fine print carefully: This will help you understand what is covered in the policy and what is excluded. It will also explain the process of claims and reimbursements, waiting periods, tax deductions, etc.
  • Assess your lifestyle and requirements before buying a policy.
  • Clarify all doubts, no matter how silly and insignificant they might seem.
  • Understand the exclusions: Under a mediclaim policy, certain expenses are not covered by the insurance provider. For example, health conditions resulting from drugs, HIV, alcohol addiction, etc., are excluded from the policy. Make sure to check the exclusions of the policy before buying. 
  • Check coverage for pre-existing illnesses: Most insurance companies cover pre-existing diseases after a certain waiting period. While making a policy purchase, make sure to check the pre-existing waiting period of the plan. 
  • Go for a higher coverage amount: While selecting the coverage amount for your plan, it is recommended to consider a wide range of factors such as surging healthcare costs, rate of inflation, etc. In addition, if you reside in an urban area, hospitalization costs will be higher than those in rural areas. Do consider going for a higher sum assured. 
  • Check for flexibility in policy renewal: Some plans are available with a lifetime renewability option that helps older people renew insurance at any age. It is better to go for a mediclaim insurance policy with lifetime renewability. 
  • Check for co-payment too: Several mediclaim policies tag a co-payment clause that the insured needs to bear while raising a claim. Make sure to check the co-payment option under the chosen policy.
  • Ask for the list of network hospitals: Every insurance company has a list of network hospitals where policyholders can avail of cashless hospitalization. 

Also Read: List of best health insurance companies in India

What is Covered in a Mediclaim Policy?

A mediclaim policy offers comprehensive coverage for several hospital expenses. Below is a list of services that the policy covers: 

  1. Hospitalization costs: This covers a wide range of expenses incurred during patient hospitalization. Moreover, pre- and post-hospitalization care is also covered under the policy. To name a few, the mediclaim policy covers the following expenses:
  • Blood tests 
  • Diagnostic procedures 
  • Oxygen masks 
  • Chemotherapy 
  • X-ray reports  
  • Medicines 
  • Donor expenses 
  • Radiotherapy 
  • Pacemakers
  • Accidental hospitalization
  1. Room Rent: All charges incurred in the Intensive Care Unit (ICU) and regular wards are compensated under the policy. However, note that this cashless hospitalization takes place at network hospitals only.
  1. Medical Professionals’ Fee: This involves fees charged by all medical professionals. The insurance policy provides compensation for doctors, anesthetists, surgeons, nurses, etc. 
  1. Daycare Treatment: Procedures that do not require hospitalization for more than 24 hours are covered under the mediclaim plan.
  1.  Domiciliary Hospitalization: Sometimes patient care may need to be done at home owing to a shortage of hospital beds or in cases when the patient cannot be taken to the hospital. These expenses are also covered.
  1. Yearly health check-ups: Most mediclaim plans offer a provision for free annual health check-ups that serve as preventive checks on any potential illnesses. 

What is Not Covered in a Mediclaim Policy?

The mediclaim policy has a set of exclusions in which case claims cannot be made. Listed below are a few common expenses not covered under a mediclaim insurance plan: 

  • Diseases arising out of addiction to drugs and alcohol 
  • Pre-existing ailments until the completion of the waiting period 
  • Critical illness or medical conditions treated within 30 days of the start date of the policy 
  • Certain ailments like joint replacement surgeries are excluded for 2-4 years under the terms of the policy 
  • Suicide cases 
  • Hormonal treatments
  • Birth control 
  • Congenital anomalies 
  • Expenses on dental surgeries (unless the surgery calls for hospitalization) 
  • Complications during ectopic pregnancy 
  • Childbirth 

Note: To get complete information on the list of exclusions in a mediclaim policy, read the policy document carefully.

Why Should You Read a Mediclaim Policy Thoroughly?

After purchasing the mediclaim plan, make sure to read it in detail, including the fine print. The policy document contains all essential details on all that is covered and excluded in your mediclaim plan. Here are some reasons why it is a good idea to read your policy document carefully after buying the insurance plan:

  • It gives information on permanent exclusions: These include congenital diseases that are often commonly confused with pre-existing diseases or health conditions, such as hernia, cataract, and the like, which are generally covered after the completion of a waiting period of 3-4 years. Congenital diseases however are different and refer to genetic disorders like cystic fibrosis or Down Syndrome. These conditions are permanently excluded from coverage by all health insurers and are generally mentioned in the policy document’s fine print.
  • It provides details on important timelines: These include the lock-in period, waiting period, and also a few associated costs and risks involved in buying the insurance policy. A brief overview of the same can be helpful before buying the insurance plan.  

Health Insurance Eligibility Criteria

Even though health insurance is an ideal requirement for people of all age groups, not everyone is eligible to avail of the benefits of a mediclaim policy. Listed below are the common eligibility criteria to enter a mediclaim insurance plan:

  • Age limit: The entry age for purchasing health insurance plans in India is 18 years and the max age limit is 65 years. Children aged between 3 months and 18 years are eligible to avail of health insurance.
  • Existing medical conditions, if any: Before buying a mediclaim plan, you need to provide a self-declaration of good health. Sometimes, the insurer may also insist on medical tests to evaluate any health risks before offering a mediclaim facility to a prospective policyholder.

Factors to Consider while Buying a Mediclaim Policy

Before buying a mediclaim policy, there are certain factors that need utmost attention. Don’t skip on considering these factors to purchase the best policy available in the market. Have a look! 

  1. Plan Availability: There are two types of plans: Individual and Family Floater. Under individual plans, each individual gets insured for a certain amount. On the other hand, in a family floater plan, the entire family gets insured under a fixed sum. Furthermore in the case of a family floater plan, note that when the insured individual reaches an exit age or dies, the policy gets closed. Hereafter, other members of the family cannot renew the plan. However, in the case of an individual plan, the individual stays insured under the sum assured even if the policyholder reaches the exit age or dies during the policy term. 
  2. Exclusions: Under a mediclaim policy, there are certain expenses that are covered by the insurance provider and that are not covered by the insurance provider. For example, drugs, HIV, alcohol addiction, etc. are excluded from the policy. However, certain surgeries including gall bladder and kidney stones are covered under the plan. Ensure checking the exclusions of policies before buying. 
  3. Pre-existing Illness: Typically, every insurance company covers pre-existing diseases after a certain waiting period. Hence, while making a policy purchase, make sure to check on the pre-existing waiting period of the plan. 
  4. Coverage Amount: This factor needs utmost attention. While selecting a coverage amount, we recommend you to consider a range of factors including surging healthcare cost, rate of inflation, etc. In addition, if you reside in an urban city, know that the hospitalization costs will be 3x times more than rural areas. Hence, if you wish to cover your precious people in the policy, consider going for a higher sum assured. 
  5. Flexibility In Policy Renewal: Some plans are available with a lifetime renewability option. In other terms, such policies denote that you can renew your insurance policy at any age. As many policies have an age limit, these facilities help older people to renew insurance at any age. 
  6. Co-payment Facility: Several mediclaim policies tag a co-payment clause with it. Ideally, co-payment is a percentage of the sum insured that the insured individual needs to bear while raising a claim. However, this takes place before the insurance company settles the surplus amount. Note that this co payment can range anywhere from 10-30% as per the insurance provider. Make sure to check the co-payment option under the chosen policy.
  7. Network Hospitals: The ideal objective of mediclaim policy is to ease unforeseen financial expenses incurred at unusual events and hospitalizations. Bear in mind that every insurance company has a list of network hospitals wherein policyholders can avail cashless hospitalization expenses. Hence, check the list of network hospitals that the insurance company is associated with. 

Documents Required While Buying a Mediclaim Policy 

Along with meeting the required eligibility criteria for a mediclaim policy, you may also need to submit a set of documents to your insurer before buying the plan. The following documents are required for purchasing a mediclaim insurance plan in India:

  • Address proof: This includes Aadhar card, driving license, passport, etc. 
  • Age proof: This includes passport, voter ID card, Aadhar card, etc. 
  • Duly filled application/proposal form 
  • Identity proof: This includes driving license, Aadhar card, passport, etc. 
  • Pre-policy medical test reports 
  • Two passport-sized recent photographs 

Best Mediclaim Policy in India 2024

Several insurance companies offer a wide range of mediclaim insurance plans. The table below highlights a comparative list of the top mediclaim plans offered by these companies to help you make an informed choice for the best mediclaim policy in India:

Health Insurance PlansCoverageWaiting PeriodSum Insured Range (in lakhs)Maximum Entry Age
Cigna TTK ProHealth Protect PlanUp to 4 family members4 years2.5 – 10None
HDFC ERGO Health Suraksha InsuranceUp to 4 family members4 years2 – 1055 years
IFFCO Tokio Individual Medishield PolicyUp to 5 family members3 years1 – 580 years
Niva Bupa Health Companion Up to 4 family members3 years2 – 100None
Reliance Health Gain InsuranceUp to 6 family members3 years3 – 965 years
Care Health Insurance PlanUp to 6 family members4 years3 – 60None
SBI Health InsuranceUp to 4 family members4 years0.5 – 565 years
Star Health and Allied Insurance Family Health Optima PlanUp to 4 family members4 years2 – 2565 years

Mediclaim Policy Claim Procedure 

Two types of claims can be made by policyholders under a mediclaim policy. These are detailed below:

  1. Cashless Claim Procedure

    These claims ensure that a patient receives free (cashless) treatment in a network hospital. The insurance company compensates for the hospital bills on behalf of the insured with the network hospital directly. To raise a cashless claim, follow the steps below:
    • Visit the network hospital of your insurance firm to receive treatment.
    • Get a pre-authorization application form from the insurance desk at the hospital. 
    • Fill out the form accurately.
    • Get a stamp on the form from the hospital. The hospital sends your form to the insurer/TPA (Third-Party Administrator). 
    • The insurer reviews the form and other documents.
    • Upon approval, the insurance company verifies the treatment received. 
    • The company briefs the hospital on the total amount of expenses it will bear.
    • After treatment, sign all necessary documents at the time of hospital discharge. 
    • Your insurer will settle your hospital expenses.
  2. Reimbursement Claim Procedure

In case you choose to receive treatment at a non-network hospital, you may get the expenses reimbursed later from your insurer by following the simple steps below:

  • Inform your insurance firm about the hospitalization that is likely to take place or has taken place.
  • At the end of the treatment, make sure to collect all medical bills/documents from the hospital. To claim a reimbursement, you would need to submit all payment receipts, hospital bills, medical bills, and the like, issued during the treatment. 
  • You also need to attach the claim form and the original discharge summary with the other documents. 
  • The insurance provider will review and assess your claim. 
  • Upon approval, the insurance company will settle the reimbursement amount.

Why Choose Turtlemint to Buy a Mediclaim Policy?

Turtlemint is a one-stop destination for all your health insurance needs and aims to make the entire process smooth, quick, and convenient for you. It allows you to:

  • Compare all health insurance policies with just one click and find the best health insurance plans in India.
  • Calculate the premium using our free premium calculator online to understand the cost.
  • Contact our experts to resolve any queries through online chat or telephonic discussions.
  • Renew health insurance online easily.

Once you find the most appropriate policy for your healthcare requiremnts and have gone through all its details, you can buy the best policy online at Turtlemint.

Health Insurance Renewal Online

As convenient as it is to buy a health insurance plan sitting in the comfort of your home, it is equally hassle-free to get it renewed upon policy lapse. Health insurance policies can be purchased for a maximum of two to three years. To ensure continuous coverage, you need to renew your policy before it expires. Most companies offer a grace period of 15 days for renewal. Once this grace period expires, the policy lapses. However, with the easy renewability option, and some insurers offering lifetime renewals as well, you can continue enjoying the benefits of your mediclaim plan without a break. The best part is that the entire process can be carried out online just by the click of a mouse! 

How to Renew Health Insurance Plans at Turtlemint?

Renewing your health insurance at Turtlemint is easy. With convenient payment options and ease of porting from one insurer to another, it takes just a few minutes:

  1. Visit https://www.turtlemint.com/
  2. Fill in the basic policy details.
  3. Select the payment option and make the payment.
  4. Once the payment is authorized, a digitally signed copy of the renewed policy is issued.

During the health insurance renewal process, you are provided with a username and password. You can use these credentials to check your policy details online on your health insurance provider’s official website.

Know how to renew your health insurance policy online

Tax Exemptions on Health Insurance/Mediclaim Policy

As stated in the blog earlier, Section 80D of the Income Tax Act allows for deductions in income tax for premiums paid for medical insurance plans. The following rules apply to the deductions:

  • Deductions up to a maximum of Rs. 25,000/- can be claimed by policyholders below 60 years of age.
  • The deduction upper limit is Rs 50,000 for policyholders over 60 years of age.
  • Additional deduction can be claimed if you have health insurance for parents (any or both). 
  • In the case of parents below 60 years old, the limit is up to Rs. 25,000/– and for those older than 60 years, the limit is Rs. 50,000/-.
  • The limit for preventive health check-ups is Rs. 5,000 for individuals aged less than 60 years and Rs. 7,000 for senior citizens.  


It is designed to cover the expenses of a large group of individuals such as companies that offer mediclaim facilities to their employees. In this case, the premium is paid for by the employer.

The claim for most mediclaim insurance plans can generally be made all over India. However, it would be best to check with your specific insurer regarding its coverage scope.

CCN refers to the Claim Communication Number and is a unique identification number issued by a health insurance company for each claim request submitted by the policyholder.

The IRDAI requires all insurance companies to settle the claims received within 30 days of the claim being raised. Some insurers may settle faster, however, the average time limit is set at 30 days.

Health insurance plans in India can be bought either online or offline. For offline purchases, you can go to a bank or an insurance company’s branch office near you. For online, you can either directly go to the insurance company’s website or go to an insurance aggregator’s website (like Turtlemint), compare the different available products, and make the best-informed choice.

The entry age for buying a health insurance policy is 90 days up to 18 years for children, and 18–65 years for adults.

A Mediclaim plan covers only hospitalization costs. Pregnancy and associated complications, congenital disorders, alternative treatments, and critical illnesses are generally excluded from Mediclaim policies.

You can buy a family floater health insurance policy to cover yourself, your spouse, up to two children, your parents, and your parents-in-law. The sum assured will be shared by all the family members in this case.

If the primary insured dies, the policy can be renewed for other family members, but only if the premium has been paid. The family needs to fill up a form to change the primary insured. The premium would then be recalculated based on the age of the new primary insured.

You can only increase the sum insured at the time of renewal of the policy. Also, the waiting period will be applicable once again on the extra sum insured. The insurer may also sometimes insist on taking fresh medical tests.

Your mediclaim policy can be canceled within the freelook period (usually 15 days) and a refund will be provided. This refunded amount will be calculated after the deduction of applicable taxes, proportionate risks, premium amount, and the expenses incurred for medical check-ups. The policy termination clauses can provide a clearer idea about the actual refund.

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