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Mediclaim FAQs In case an individual is already suffering from a disease, will Mediclaim still reimburse his or her expenses related to the disease? The insurance company will not reimburse any expenses related to any disease or injury which already existed at the time of first obtaining the insurance cover. Are all diseases and injuries covered by Mediclaim ? There are certain diseases and injuries that are not covered by this policy. These fall under basically 3 categories The injuries or diseases not covered in the first year of operation of the policy are:
Note: The diseases listed above are only excluded from cover only for the first year of the policy and not afterwards. The injuries and diseases or medical conditions not covered at all under Mediclaim are:
The injuries and diseases not covered under certain circumstances are:
Are the tests prescribed by the doctor be reimbursed under Mediclaim ? All charges incurred at the hospital or nursing home primarily for diagnostic purposes such as X-rays, blood analysis, ECG, etc will be reimbursed only if they are consistent with or incidental to the diagnosis and treatment of the ailment for which the policyholder has been hospitalised and not otherwise. Can the Mediclaim the insurance contract be cancelled midway? The policy can be cancelled at any time during the course of its operation. In such cases, the insurance company will refund the premium paid (on the basis of the table provided below) only if no claim has been up to the date of cancellation.
Note: The policy may also be cancelled at any time by the insurance company by giving the insured person 30 days notice through a registered letter sent to the last known address of such person. such circumstances, the insurance company has to refund the premium pro-rata for the un-expired period of insurance. The insurance company is however liable for any claim made prior to the date of cancellation. What is the coverage offered by the Mediclaim policy ? A Mediclaim policy reimburses hospitalisation expenses for the treatment of sickness or accident occurring during the period of insurance. What type of hospitalisation expenses are covered by Mediclaim ? Mediclaim covers room, boarding charges, nursing expenses, surgeon, anaesthetist / doctor's fees, blood, oxygen, operation theatre charges, x-ray, other tests pertaining to sickness, etc. What kinds of medical tests are covered by Mediclaim ? Mediclaim covers medical tests connected with the sickness. Hospitalisation expenses for medical check up only are not covered. There has to be positive existence of diseases to claim under Mediclaim. Can treatment can be taken at any hospital or at a particular hospital under Mediclaim ? Under Mediclaim, treatment at all the hospitals / nursing homes registered with local authorities is allowed. In case there is no registration with the local authority the hospital should have at least 15 in-patient beds, a fully operational operation theatre, qualified nursing staff and doctor in charge. Only if these conditions are satisfied can the person go to his or her hospital of choice. Is there a minimum time limit for stay within the hospital under Mediclaim ? Under Mediclaim, the minimum stay within the hospital must be for a minimum of 24 hours. However for dialysis, chemotherapy, eye surgery, etc - the stay can be for less than 24 hours. What is considered as "domiciliary hospitalisation" under Mediclaim ? When the condition of the patient is such that he cannot be moved to the hospital or when there is no bed available in any of the hospitals, then the treatment taken at home only if it is like the treatment given at the hospital / nursing home is reimbursable under the Mediclaim policy. Are there any other restrictions on domiciliary hospitalisation benefits under Mediclaim ? Under Mediclaim, the limit of compensation is low and for certain diseases like asthma, bronchitis, diabetes, epilepsy, etc it is not available. Does Mediclaim cover any expenses besides hospitalisation costs ? Mediclaim covers pre-hospitalisation (limited up to 30 days) and post-hospitalisation (limited to 60 days from discharge) expenses also if they are connected with the sickness / accident for which the hospitalisation takes place. Under Mediclaim, is the limit of insurance per sickness or annual ? Under Mediclaim, the amount of insurance is the limit until which the insurance company will pay during any policy period. They are annual limits for all sicknesses / accident during a year. What happens when the limit of insurance is exhausted under Mediclaim ? Under Mediclaim, future expenses are not covered during the same policy period however when the policy is renewed, the limit of insurance starts afresh. Under Mediclaim, does a sickness for which a claim is lodged get covered under a future insurance policy or does it become pre-existent for the next policy term ? Under Mediclaim, a sickness for which a claim is lodged does not become pre-existent. It is covered provided the policy is renewed within time limits and there is no break in the term of the insurance policy. In case there is a break in the term of insurance (up to 7 days allowed subject to certain conditions) then it will definitely become pre-existent and exclusions will apply. Is the maternity benefit extension available under an individual Mediclaim policy ? No maternity benefit extension is available under an individual Mediclaim policy. What is family discount under Mediclaim ? Under Mediclaim, when the husband or the wife and children or dependant parents are covered under same policy, a discount of 10 percent is given on the total premium by way of family discount. What are the factors which determine the premium payable under Mediclaim ? Under Mediclaim, the age and the amount of cover are the factors that decide the premium. What are the minimum and maximum amounts for which a Mediclaim policy can be taken ? Under Mediclaim, the minimum amount that can be insured for is Rs.15,000/- and the maximum amount is Rs.5,00,000/- In any case, the amount for which the insurance company may grant insurance is at their own discretion. Does Mediclaim offer any advantages on renewal ? On renewal of Mediclaim for every claim free year. a bonus of five percent per year (maximum 50 percent) is allowed and after four continuous renewals, the cost of medical check up to the extent of one percent of cumulative insurance for the last four years is allowed. Who will receive the claim amount under Mediclaim if the policyholder dies during the time of treatment ? Under Mediclaim, the claim amount is paid to the nominee of the
policyholder. In case there is no nominee made under the policy,
then the insurance company will insist upon a succession certificate
from a court of law for disbursing the claim amount. Alternatively,
the insurers can deposit the claim amount in the court for disbursement
to the next legal heirs of the deceased. | |||||||||
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