How Do I Navigate My BPO's Mediclaim for My Upcoming LASIK Surgery?

I am working in a BPO, and I have been enrolled in a mediclaim policy provided by the company. Now, I have a surgery lined up and would like to know the following:

How to Claim Mediclaim

1. How exactly do I claim for mediclaim?
2. Which diseases or surgeries are not covered under mediclaim?
3. Are there any eligibility criteria, such as whether the policy must be one year old to claim mediclaim?

Please help, as I am looking to get LASIK surgery done for myself. It's going to cost me Rs 40k.

Regards

You have been covered by your company in a group or individual Mediclaim insurance policy. How will an outsider who does not have access to the policy or know its terms be able to say whether the surgery will be covered? Either check the policy or go and speak to the HR department of your company.

Of course, there are certain restrictions. Soon after the policy document containing the terms and conditions is received, everyone should go through the contents very carefully to fully understand what all the restrictions and curtailments are. To highlight some of these restrictions and exclusions, I will indicate or quote from one such policy provider with whom I interacted for your reference:

Grace Period

"Grace Period means the specified period of time immediately following the premium due date during which a payment can be made to renew or continue a policy in force without loss of continuity benefits such as 'waiting periods' and coverage of pre-existing diseases. Coverage is not available for the period for which no premium is received.

VI Free Look period of 15 days shall be applicable at the inception of the first policy.

Exclusions

- All pre-existing diseases up to 48 months of continuous coverage.
- Any disease contracted during the first 30 days of the inception of the policy.
- Waiting period of 2/4 years for certain specified illnesses or treatments.
- Vaccination and inoculation of any kind unless it is post-animal bite.
- General debility and run-down conditions.
- Circumcision, cosmetic surgery, plastic surgery.
- HIV/AIDS.
- Psychiatric and psychosomatic disorders.
- Injury arising out of drug or alcohol abuse.
- Pregnancy, ailments related thereto, and childbirth.
- War, act of foreign enemy, ionizing radiation, and nuclear weapons.
- Naturopathy.
- Experimental or unproven treatment.
- All external equipment.
- Dental treatments."

You will also need to read the full text of the terms and conditions, which is in my possession and attached for your guidance.

It is advisable that everyone first goes through the terms and conditions of various policy providers, get all the doubts clarified, satisfy themselves about them, and then decide which terms are more agreeable before paying the policy premium. These are only sample conditions and may vary from company to company. So, it is necessary that the terms and conditions of the respective policy providers should be taken into consideration. Almost all policy providers have placed their terms and conditions on their websites to facilitate easy reference.

Regards

There are different types of policies, and no one can provide the correct answer until they have read the policy. Your HR person will be the right individual to give you 100% clarification because they are the ones who dealt with the insurance.

Thank you.