What is a Mediclaim Policy?

A mediclaim policy is a type of health insurance that covers medical and treatment expenses incurred during hospitalisation. Under this policy, you pay a regular premium, and eligible medical expenses are reimbursed after claim approval.

This policy type is especially critical in India, where nearly 70% of the population (as of 2025) is still uninsured. Keep reading to know more.

What are the Different Types of Mediclaim Policies?

Mediclaim plans are available in different formats to suit varied healthcare needs. Apart from the individual mediclaim plan, the other common types include:

1. Comprehensive Mediclaim Policy

It offers wider coverage with higher limits than standalone plans. Hospitalisation costs may include pre- and post-hospitalisation expenses and outpatient treatment, depending on the policy terms.

2. Family Mediclaim Policy

It provides cover for the policyholder and immediate family members, such as a spouse, children, and sometimes parents, under a single policy. These are often cost-effective compared to buying separate covers for each family member.

3. Senior Citizen Mediclaim Policy

It is designed for people typically between 60 and 75 years of age. It focuses on expenses linked to age-related health conditions and, in many cases, can be purchased without mandatory pre-policy medical tests.

What are the Key Features of a Mediclaim Policy?

To understand how a mediclaim policy functions, it helps to look at its key features. They include:

● Medical Cover

It pays for hospitalisation expenses arising from an accident, surgery, or critical illnesses, such as cancer, kidney failure, or heart attack, during the policy period.

● Premium Payment

Paying the premiums at regular intervals keeps the mediclaim policy active and eligible for claims.

● Policy Renewal

Mediclaim policies are issued for a fixed term between 1 and 3 years. You need to renew the cover at the end of each term to continue receiving medical coverage.

● Claim Settlement

You can choose between cashless treatment and reimbursement. With cashless hospitalisation, the insurer settles the bill directly with a network hospital.

Under reimbursement, you pay the expenses yourself and later claim the eligible amount from the insurer.

What are the Inclusions of a Mediclaim Policy?

Coverage may vary based on the type of mediclaim plan and the insurer. Most policies include the following:

● In-Patient Hospitalisation

It covers hospitalisation costs when the insured person is admitted to a hospital for 24 hours or more. These expenses may include room charges, ICU (intensive care unit) charges, doctor’s fees, blood, and oxygen.

● Day Care Procedures

It covers treatments that do not require an overnight hospital stay, made possible by medical or technological advancements.

● Pre- and Post-Hospitalisation Expenses

It covers eligible medical expenses incurred within 30 days before hospitalisation and within 60 days after discharge, as per the policy terms.

● Domiciliary Treatment

It covers treatment taken at home when hospital beds are unavailable, or the patient cannot be moved to a hospital.

● Preventive Health Check-Ups

Many mediclaim policies offer free health check-ups at defined intervals, usually after a certain number of claim-free years.

Mediclaim policies also offer a cumulative bonus, in which insurers increase the sum insured for each claim-free year without raising the premium. Thus, it is crucial to maintain an active mediclaim policy to strengthen both your health and financial aspects.