Dear Shreekanth,
Mediclaim policies are of two types generally.
1. Floater - The sum insured here is common for the whole family for a particular year. In the event any member of the family fall sick then they can avail this amount.
2. Individual Sum Insured - The sum insured here is for each individual in the family and if a particular person falls sick then he/ she can claim the amount for the extent covered.
These days companies offer Cashless schemes wherein the insured person (if he plans to undergo medical treatment) gets a pre authorisation from the insurance company based on a budget indicated by the hospital where he is likely to undergo treatment. If the insurance company approves the amount then he can undergo medical treatment to the extent covered. But the hospital wherein he undergoes treatment must be listed in the insurance companies master list. If he prefers to undergo treatment in a hospital that is not listed then he need to spend the amount and then claim reimbursement.
While claiming the reimbursement the person must submit all the medical bills and reports duly supported by prescriptions and must enclose the discharge summary for claiming the amount.
In case of corporates they take a group mediclaim policy that covers all employees.
The premium for a mediclaim policy is based on the age of the sum insured. The older the person the higher the premium.
In case of individual policies if you do not make a claim then the sum insured increases by 5% each year subject to a maximum of 50% over 10 years but the premium amount is paid based on the basic sum insured and the age and does not include the no claim bonus amount.
Generally insurance companies exclude coverage for pre existing ailments at the time of first coverage. For example a person suffers from heart ailment at the time of first coverage then treatment taken by him for that ailment is not covered.
To enable claim mediclaim minimum of 24 hours hospitalisation is a must. However, this time limit is not applicable for certain ailments such as cataract, kidney stone removal etc.,
Certain insurance companies also have a waiting period for certain aliments such as hernia, hydrocele etc. In other words you cannot claim any amount immediately upon taking the insurance cover. But after certain months the coverage is possible.
Insurance companies also permit you to get a reimbursement for medical check for every 4 claim free years subject to a maximum of 1% of the sum insured.
Insurance companies also load premiums appropriately in case the insured person makes claims year upon year.
Medical expenditure incurred by the person in respect of the ailment 30 days prior to hospitalisation and 60 days post hospitalisation is also admissible. But please remember all medical claims must be supported by proper prescriptions.
To take an insurance cover decide the following
1. The number of persons you wish to cover.
2. Do you intend to cover their families (Define family spouse, children, parents etc)
3. You prefer a floater policy, individual policy or a group policy.
4. Age profile of the insured persons.
5. Sum insured for each person
In case you need any further information, please feel to contact me at [Login to view].
M.V.KANNAN