Understanding Medical Reimbursement vs. Mediclaim: Are Hospital Bills Covered by Both?

Hi,

What is the difference between medical reimbursement and mediclaim? Are hospitalization bills allowed for both medical reimbursement and mediclaim? Please clarify.

Regards,
Taksheel

Hi,

What is the difference between medical reimbursement and mediclaim? Are hospitalization bills allowed for medical reimbursement and mediclaim? Please clarify.

In my company, there are two options for medical benefits:
1. Reimbursement model: The employee pays out of pocket, and the next day, they reimburse the amount to the cashier via the HR department.
2. Insurance model with cashless facility: The employee simply visits the provider hospital/doctor, presents their insurance card, and goes cashless.

Does the above information align with what you meant? Please let me know.

Regards,
BSN

Hi,

The Medical Reimbursement is for the medical expenses incurred by the employee in day-to-day medicines, and only the bills and doctor's prescription (optional) are required for the claim.

On the other hand, in Mediclaim, it is an insurance policy to claim anything. For Mediclaim, hospitalization is required, and the amount of expenses is directly remitted to the hospital, not to the employee.

I hope this helps clarify your doubts.

Regards,
George

Certainly! Here is the revised version of your text:

"Can you please tell me what is the industry standard allowed for mediclaim and medical reimbursement."

If you have any further questions or need clarification, feel free to ask.

Hi Taksheel,

There is a major difference in medical reimbursement and mediclaim. You can get medical reimbursement of 15,000 (this can be more but then it is taxable) for your current organization for which you have to provide all your medical bills in original, and it is applied to any kind of medical expenditure.

However, mediclaim benefits can be availed only if you have a mediclaim policy. But to avail this benefit, there has to be hospitalization of at least 24 hours (there are some exceptions to this too like cataract surgery). For this, you have to submit all your original bills along with original discharge summary, main hospitalization bill, prescription by the doctors, and medicine bills, investigation reports, and all.

Mediclaim can be cashless if your insurance company has tied up with any of the TPA or hospitals directly. But there are also other procedures involved like pre-auth and all.

Do revert if you need any more clarification.

With regards,
Swarali

Medical reimbursement is usually submitted to your work organization as per the medical policy, whereas Mediclaim is usually submitted to the insurance company under their hospitalization scheme.

Ramzan Sheikh

Hello,

Can an employee avail tax benefits in both medical reimbursement up to Rs. 15,000 that the company provides against the bills and medical claim (up to Rs. 15,000) premium that an employee pays to the insurance company? Or can we only take advantage in one?

Nitin

Hi,

Regarding Mediclaim, I have one doubt. One of our employees was hospitalized on an emergency basis and received treatment. His mediclaim card was issued on the date of surgery, and after some time, we received the card. However, all the expenses were paid by him. Is there any option available to get the money back? Please inform me.

Thanks & Regards,

P. GSK
INDORE