Understanding Mediclaim Policies: Who's Covered and How to Navigate the Process?

Hi,

I am working in a manufacturing company where we have a mediclaim policy. I want to know what the procedure is for that and who comes under it.

Thanks & Regards,
Dilip

Hi Dilip,

Mediclaim Policy means coverage of employees on health or medical grounds up to a certain limit in a year. It facilitates employees with free medical check-ups and other medical emergencies completely free up to a certain limit. Many insurance companies provide the same. Those covered under this policy or scheme receive a Health Card and a list of network hospitals where hospitalization is completely free up to the given limit. Even if one gets hospitalized in a non-network hospital, they can reimburse the expenses by producing the receipts. This scheme mostly benefits employees who are not covered by ESI.

Regards,
Amit Seth.

Hi Dilip,

Mediclaim Policy is an insurance coverage wherein any of your health-related hospitalization bills can be claimed from the insurance company. There are two different ways to get your bills claimed: either by cashless facility, i.e., your bills are directly paid to the hospital, or you can pay your bills in the hospital and get reimbursement after submission of the same to the insurance company.

Major exclusions of the policy are: Pre-existing diseases will not be covered. There are a couple of diseases which will not be covered in the first/second year depending on the company. 24 hours of hospitalization or more is compulsory for a claim to be settled.

This is just a gist of mediclaim insurance. I am an insurance consultant located in Chennai and handle both life and general insurance. For any clarification, you can either post a topic or email me at lngindia@gmail.com.

Thanks

Employees whose salary is above $10,000 per month come under MediClaim, while those earning below $10,000 come under ESI.

Dear Sharda,

It's true that it is applicable for those who are not covered under ESI Act. However, it is not certain that all those whose gross salary is above Rs. 10,000 will be eligible for this. There will be a certain period of time after which all these will apply. In my case, even though my salary is above Rs. 10,000, I am eligible for this after one year only (depends on the company).

Dear Samanaveenkumar, in reading, please express your opinion on the above said things. Am I right?

Truly Yours,
Kumar H.P

Hi Guys,

I have one query related to mediclaim policy:

1) What are the sickness benefits we can avail of?
2) Can we undergo skin surgery under mediclaim?
3) Is free treatment available for eye-related diseases such as correcting vision, providing glasses, etc.?

I understand that this information can be provided specifically by the insurance company, but if anyone has knowledge about this, please let me know. I would be grateful for any insights.

As you know, Insurance Companies often do not provide accurate information or the whole truth.

Thanks,
Amit Shah

Hi,

I have seen Saman stating that mediclaim is for people who get a salary above 10,000 and ESI is for people below. I think it needs to be checked because in our company, everyone has mediclaim with no discrimination regarding salary. I am not sure of the rules of mediclaim. If such rules exist, please let me know so that my employees do not face any setbacks.

Regards

Hi All,

I don't think there is any cap on the salary for an employee to take a Mediclaim Insurance. It differs from company to company. A mediclaim insurance can be taken if the company doesn't have ESI, which is a better option.

To Mr. Amit's Query:

1) Any illness, disease, or sickness can be covered after one month of the policy issuance date. This can also be waived off if the company pays an extra amount (it differs from company to company).

2) If it is not a cosmetic surgery and was caused due to any accident, then it is permissible. Pre-existing diseases are not covered, i.e., for example, if Mr. X met with an accident before the commencement of the policy and is undergoing grafting or skin surgery, etc., after the commencement of the policy, then it is not allowed.

3) You will not be paid for glasses, contact lenses, etc.

I don't know what you mean by "TAKING OUT THE EYE NUMBER." Please specify.

To Mr. Dilip's Query:

I am working in a manufacturing company where we have a mediclaim policy. I want to know what the procedure for that is and who comes under it.

Thanks & Regards,

If your company has taken a group mediclaim policy, then all employees are covered under it. I hope they would have given you the procedures because it differs from company to company and the insurance coverage taken by your employer.

For any queries, you can post your message or email me at lngindia@gmail.com.

Thanks,

Anne :P

As Saman said, employees with a salary of more than $10,000 will be covered under the mediclaim policy, and employees earning less than $10,000 will be covered under ESI. I was not aware of it. In our company, we do not have such tariffs or statements made. It's equal for all. However, I also agree that it may differ from company to company!!!