Dear All, Can any body give me the details regarding mediclaim policies. Regards, Shreekanth.P.R
From India, Mumbai
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24From India, Mumbai
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What are the details that you are looking at? You can start by outlining the exact nature of the coverage you want to provide to your employees. From there, obtain insurance quotes from various insurers and decide on the one that offers the optimum benefits.
Please let me know the size of the company, and I can assist you in designing the coverage and obtaining quotes.
Regards,
Deepak
From India, New Delhi
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Please let me know the size of the company, and I can assist you in designing the coverage and obtaining quotes.
Regards,
Deepak
From India, New Delhi
Acknowledge(0)Amend(0)
Types of Mediclaim Policies
Mediclaim policies are generally of two types:
1. **Floater:** The sum insured here is common for the whole family for a particular year. If any family member falls sick, they can avail themselves of this amount.
2. **Individual Sum Insured:** The sum insured is for each individual in the family. If a particular person falls sick, he/she can claim the amount for the extent covered.
Cashless Schemes
These days, companies offer cashless schemes where the insured person, if planning to undergo medical treatment, gets pre-authorization from the insurance company based on a budget indicated by the hospital where treatment is likely to take place. If the insurance company approves the amount, then the medical treatment can be undergone to the extent covered. However, the hospital where treatment is sought must be listed in the insurance company's master list. If treatment is done in a hospital not listed, the individual needs to pay the amount and then claim reimbursement.
Claiming Reimbursement
When claiming reimbursement, the person must submit all medical bills and reports duly supported by prescriptions and enclose the discharge summary to claim the amount.
Corporate Group Mediclaim Policy
In the case of corporates, they take a group mediclaim policy that covers all employees.
Premium Calculation
The premium for a mediclaim policy is based on the age of the sum insured. The older the person, the higher the premium.
In the case of individual policies, if no claim is made, the sum insured increases by 5% each year, subject to a maximum of 50% over 10 years. However, the premium amount is paid based on the basic sum insured and the age and does not include the no-claim bonus amount.
Exclusions and Waiting Periods
Generally, insurance companies exclude coverage for pre-existing ailments at the time of first coverage. For example, if a person suffers from a heart ailment at the time of first coverage, the treatment for that ailment is not covered.
To enable claiming mediclaim, a minimum of 24 hours of hospitalization 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 ailments such as hernia, hydrocele, etc. In other words, you cannot claim any amount immediately upon taking the insurance cover. However, after a certain number of months, coverage is possible.
Additional Benefits
Insurance companies also permit reimbursement for medical checks for every 4 claim-free years, subject to a maximum of 1% of the sum insured.
Insurance companies also adjust premiums appropriately in case the insured person makes claims year upon year.
Medical expenses incurred by the person in respect of the ailment 30 days prior to hospitalization and 60 days post-hospitalization are also admissible. Nevertheless, all medical claims must be supported by proper prescriptions.
Deciding on Insurance Cover
To take an insurance cover, decide on the following:
1. The number of persons you wish to cover.
2. Do you intend to cover their families (Define family as spouse, children, parents, etc.)?
3. Your preference for a floater policy, individual policy, or a group policy.
4. The age profile of the insured persons.
5. Sum insured for each person.
In case you need any further information, please feel free to contact me at [Email Removed For Privacy Reasons].
Regards,
M.V. Kannan
From India, Madras
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Mediclaim policies are generally of two types:
1. **Floater:** The sum insured here is common for the whole family for a particular year. If any family member falls sick, they can avail themselves of this amount.
2. **Individual Sum Insured:** The sum insured is for each individual in the family. If a particular person falls sick, he/she can claim the amount for the extent covered.
Cashless Schemes
These days, companies offer cashless schemes where the insured person, if planning to undergo medical treatment, gets pre-authorization from the insurance company based on a budget indicated by the hospital where treatment is likely to take place. If the insurance company approves the amount, then the medical treatment can be undergone to the extent covered. However, the hospital where treatment is sought must be listed in the insurance company's master list. If treatment is done in a hospital not listed, the individual needs to pay the amount and then claim reimbursement.
Claiming Reimbursement
When claiming reimbursement, the person must submit all medical bills and reports duly supported by prescriptions and enclose the discharge summary to claim the amount.
Corporate Group Mediclaim Policy
In the case of corporates, they take a group mediclaim policy that covers all employees.
Premium Calculation
The premium for a mediclaim policy is based on the age of the sum insured. The older the person, the higher the premium.
In the case of individual policies, if no claim is made, the sum insured increases by 5% each year, subject to a maximum of 50% over 10 years. However, the premium amount is paid based on the basic sum insured and the age and does not include the no-claim bonus amount.
Exclusions and Waiting Periods
Generally, insurance companies exclude coverage for pre-existing ailments at the time of first coverage. For example, if a person suffers from a heart ailment at the time of first coverage, the treatment for that ailment is not covered.
To enable claiming mediclaim, a minimum of 24 hours of hospitalization 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 ailments such as hernia, hydrocele, etc. In other words, you cannot claim any amount immediately upon taking the insurance cover. However, after a certain number of months, coverage is possible.
Additional Benefits
Insurance companies also permit reimbursement for medical checks for every 4 claim-free years, subject to a maximum of 1% of the sum insured.
Insurance companies also adjust premiums appropriately in case the insured person makes claims year upon year.
Medical expenses incurred by the person in respect of the ailment 30 days prior to hospitalization and 60 days post-hospitalization are also admissible. Nevertheless, all medical claims must be supported by proper prescriptions.
Deciding on Insurance Cover
To take an insurance cover, decide on the following:
1. The number of persons you wish to cover.
2. Do you intend to cover their families (Define family as spouse, children, parents, etc.)?
3. Your preference for a floater policy, individual policy, or a group policy.
4. The age profile of the insured persons.
5. Sum insured for each person.
In case you need any further information, please feel free to contact me at [Email Removed For Privacy Reasons].
Regards,
M.V. Kannan
From India, Madras
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What Mr. Kannan has highlighted is absolutely correct. Mostly, these are true, with some deviations for most insurance companies. However, in case you are looking at Group Health Insurance Covers (or Group Mediclaim), there can be slight variations in the above, wherein you can have some benefit features changed or tailor-made. These include coverage for maternity, coverage of pre-existing diseases, waiver of 30 days and 1-year waiting periods (which are standard in individual health insurance covers), and child coverage can begin from Day 1, etc.
Regards,
Deepak
From India, New Delhi
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Regards,
Deepak
From India, New Delhi
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