Mediclaim Policy: Top Features You Need to Know

Mediclaim Policy

In today’s uncertain times, having a comprehensive health insurance policy is crucial. A Mediclaim policy, specifically tailored to cover medical expenses, offers financial protection against unforeseen healthcare costs. It ensures individuals receive the necessary treatment without worrying about the financial burden. 

At Digibima, we understand the importance of choosing the right mediclaim policy. This guide highlights the top features of a mediclaim policy to help you make an informed decision for your health insurance needs.

What is a Mediclaim Policy?

A mediclaim policy is a type of health insurance that reimburses the policyholder for medical expenses incurred during hospitalization or treatment. It covers a range of medical expenses, including hospital room charges, doctor’s fees, surgery costs, and more, depending on the policy’s coverage.

Top Features of a Mediclaim Policy

  1. Coverage for Hospitalization: A mediclaim policy typically covers hospitalization expenses, including room charges, nursing expenses, ICU charges, and more. Some policies also cover pre and post-hospitalization expenses for a specified period.
  2. Cashless Treatment: Many mediclaim policies offer cashless treatment facilities at network hospitals. This means you can avail of medical treatment without paying cash, as the insurer settles the bill directly with the hospital.
  3. Pre-Existing Diseases Coverage: Some mediclaim policies cover pre-existing diseases after a waiting period, ensuring you receive coverage for existing health conditions.
  4. No Claim Bonus: Insurers often offer a no-claim bonus for every claim-free year. This bonus can be in the form of increased coverage or a reduction in premium for the next year.
  5. Lifelong Renewability: Most mediclaim policies offer lifelong renewability, ensuring you can continue to avail of coverage even as you age.
  6. Maternity Coverage: Some policies offer maternity coverage, covering expenses related to childbirth, including pre and post-natal care.
  7. Day Care Procedures: Mediclaim policies also cover day-care procedures that do not require 24-hour hospitalization but are medically necessary.
  8. Ambulance Charges: Many policies cover ambulance charges for transporting the insured to the hospital in case of an emergency.

Understanding Sub-Limits and Co-Payments

Some mediclaim policies have sub-limits on specific medical expenses, such as room rent, doctor’s fees, and diagnostic tests. It’s essential to understand these sub-limits to avoid unexpected out-of-pocket expenses.

Co-payment is a cost-sharing requirement where the policyholder pays a percentage of the claim amount, and the insurer pays the rest. It’s crucial to know if your policy has a co-payment clause and the percentage you are responsible for.

Exclusions in Mediclaim Policies

  1. Pre-Existing Diseases: Most policies have a waiting period for coverage of pre-existing diseases. It’s important to be aware of this waiting period and any exclusions related to pre-existing conditions.
  2. Non-Medical Expenses: Mediclaim policies typically do not cover non-medical expenses such as cosmetic surgeries, vitamins, and health supplements, unless medically necessary.
  3. Injuries from Hazardous Activities: Injuries sustained from participating in hazardous activities such as adventure sports or illegal activities are usually not covered under a mediclaim policy.

Regular health check-ups can help detect health issues early, allowing for timely treatment and potentially reducing the need for extensive medical care in the future. Some insurers offer incentives such as a reduction in premiums or increased coverage for policyholders who undergo regular health check-ups.

Tips for Choosing the Right Mediclaim Policy

  • Assess Your Needs: Consider factors such as your age, health status, and family medical history to determine the coverage amount and type of policy that best suits your needs.
  • Compare Policies: Compare different mediclaim policies based on coverage, premiums, network hospitals, and customer reviews to find the most suitable policy for you.
  • Read the Fine Print: Carefully read the policy document to understand the terms, conditions, and exclusions of the policy before making a decision.
  • Consult an Expert: If you’re unsure about which policy to choose, consult an insurance expert at Digibima who can provide guidance based on your specific requirements.

Examples of Mediclaim Policy Features in Action

Consider the case of Mr. and Mrs. Sharma, who have a family floater mediclaim policy. When Mrs. Sharma required surgery for a pre-existing condition, their policy covered the hospitalization expenses, including the surgery costs and post-operative care. Additionally, since they had not made any claims in the previous year, they received a no-claim bonus, which reduced their premium for the next year.


A mediclaim policy is an essential investment in your health and financial well-being. By understanding the top features of a mediclaim policy, you can choose a policy that meets your healthcare needs and provides financial security for you and your family. At Digibima, we’re here to help you navigate the complexities of health insurance and find the right mediclaim policy for you. Stay protected, stay healthy!

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FAQs about Mediclaim Policies

Q1: Can I avail of tax benefits on mediclaim policy premiums?

Yes, premiums paid for a mediclaim policy are eligible for tax deductions under Section 80D of the Income Tax Act.

Q2: Are there any waiting periods in a mediclaim policy?

Yes, there are waiting periods for pre-existing diseases, typically ranging from 1 to 4 years, depending on the policy.

Q3: Can I include my parents in my mediclaim policy?

Yes, most insurers offer family floater policies that allow you to include your parents as dependents.

Can I switch to a different mediclaim policy?

Yes, you can switch to a different mediclaim policy at the time of renewal, ensuring there is no gap in coverage.


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