best guide for mediclaim insurance policy for bfl customers


best guide for mediclaim insurance policy for bfl customers

Studies show that 70% of Indians are yet to opt for any health insurance cover against hospitalization expenses, despite rising inflation rates due to a boom in healthcare spending.

best guide for mediclaim insurance policy for bfl customers

It is surprising to know that in a fast developing country like India, people still do not understand the need to plan suitable arrangements to deal with any financial emergency arising suddenly from accidents or diseases.

1- What is Mediclaim policy?

Mediclaim insurance policy is the best and most economical way to be prepared for a medical emergency and protect your savings.

  • It takes care of the hospitalization and subsequent medical expenses for illness, accident, and even urgent surgery.
  • The bills pay through the cashless treatment facility or reimbursement mode offered by the insurance company.

2- Why is it necessary to take a mediclaim insurance policy for bfl customers?

  • Mediclaim policy comes in handy to protect your deposits and get hospitalized due to an accident or any disease.
  • It covers nursing, lodging, and treatment costs which are equal to the coverage amount while purchasing the policy.
  • Most Mediclaim policies cover the treatment for the disease due to which admitted to the hospital.
  • This time frame depends on the insurer and typically ranges between 30-60 days before and 60-120 days after hospitalization.

3- Features and Benefits of mediclaim insurance policy for bfl customers

  1. Annual renewal. Some insurers offer renewal for 2 or 3 years.
  2. can be chosen for individual or family
  3. For anyone between the ages of 91 days to 65 years
  4. Pre-existing medical conditions are cover after a waiting period of 2-4 years.
  5. You can buy online without any paperwork.
  6. Sum Assured chosen can be ₹ 50 lakh or more.
  7. This policy gives you complete health cover and good savings.
  8. You can get high coverage at an affordable premium.
  9. It is the cheapest means of access to adequate medical assistance.
  10. Cashless hospitalization ensures that you do not incur any out-of-pocket medical expenses.
  11. It is easy to buy online from the comfort of your home.
  12. Get tax deduction on premium paid under Section 80D of the Income Tax Act, 1961.

4- How is the premium determined?

Insurance companies consider many aspects while determining the premium for a Mediclaim policy.

Age, Sum Assured, Geographical location, any pre-existing medical condition, number of members to be insured, the extent of coverage, etc.

IRDAI farmed these rules, the health insurance companies take the final decision regarding premium calculation based on your needs and requirements. The broader your needs, the higher the premium amount.

5- What is not covered?

  1. Medical expenses do not include administrative charges, service charges, toiletries, diapers, syringes, etc.
  2. Illness/diseases contracted within a specified period from policy purchase.
  3. Sexually transmitted diseases like HIV.
  4. Cosmetic surgery, circumcision, or plastic surgery
  5. vaccination
  6. Medical coverage not be given in consequence of addiction to alcohol, smoking, drug abuse, etc.
  7. Health conditions arising from war, nuclear weapons, etc.

6- Tips to buy mediclaim insurance policy for bfl customers

Investing in Mediclaim is a good decision. Consider all the factors involved and choose the right policy accordingly. 

Below are some of the aspects that you need to consider before buying a policy:

1- Sum Assured (Coverage Amount): 

  • While choosing the sum assured or coverage amount, it is advisable to consider factors like rising healthcare costs, inflation rate, etc.   
  • If You live in metro cities, the cost of hospitalization is higher as compared to rural areas. Similarly, if you are opting for coverage for your dependents, you consider a higher sum assured.

2- Individual or family floaters:

  • This decision depends on you. If you are single and looking to cover for yourself, then you can opt for an individual policy.
  • If you opt for cover for your parents and your entire family, then you can choose a family floater plan as the ideal option.
  • It is less expensive to spend on a family floater plan than individual policies and discounts offered by insurance companies.

3- Room Rent Sub-limit:

Most Mediclaim plans are designed with a sub-limit on room rent. These limits may depend on the insurance companies.

4- Co-Payment:

Many Mediclaim policies are built-in with co-pays. Co-pay is the percentage amount, and The policyholder has to pay before settles the balance.

This co-payment can range between 10% and 30%, depending on the insurance company.

5- Exclusions

Every Mediclaim policy is to cover your risk. However, and Certain exclusions are cover or not in a specific period.

The conditions arising from suicide attempts, HIV infection, congenital diseases, alcohol or drug addiction, etc, are not covered by any policy. The expenses like maternity, hysterectomy, gall bladder surgery, stones, etc, are covered after a specific waiting period.

6- Hospital Network:

The advantage of choosing a Mediclaim policy is the facility of cashless settlement of hospitalization expenses. 

Each insurance company has a network of hospitals and admitted to any of these hospitals, you are entitled to cashless treatment if it is within the scope of hospitalization/treatment coverage.

So, find out about the hospitals in your area that are in tie-up with the insurance company.

7- The reputation of the Company

Lastly, the important thing is that it is always prudent to check the reliability and enduring market of the insurance company you want to buy Mediclaim Policy. In addition, learn about the claim settlement ratio.

7- How to claim mediclaim insurance policy for bfl customers?

With the advancement in the insurance sector, claiming your Mediclaim policy has become a very convenient and hassle-free task. As you know, you can claim in two ways – cashless and reimbursed.

  • If you want to opt for cashless treatment in a network hospital, you will have to approach the TPA (Third Party Administrator) help desk at the time of admission to the hospital. 
  • A claim form has to be submitted along with the doctor’s report to seek approval for cashless treatment. The insurance company/TPA settles the bills for expenses directly with the hospital without involving the policyholder. It is the most convenient way to claim your Mediclaim policy.
  • Any reason you are unable to avail of the cashless treatment, then you can opt for reimbursement. The claim form with the dues, discharge summary, and other relevant prescriptions with the doctor’s report delivered to the Insurance Company/TPA.
  • The Insurance Company/TPA will verify the veracity of the documents against the policy terms and the policy terms before taking the final decision on claim settlement. This process takes about 15-25 business days.

8- FAQ/Frequently Asked Questions

Q.1. How is TPA different from an Insurance company?

TPA is a third-party administrator licensed by IRDAI to act as a service provider for all insurance companies. They help in the health insurance policies by offering their services in claims management, policy documents, health card dispatch, after-sales services, etc.

Q.2. Can I claim my pre and post-surgery expenses?

Yes, you can. Most Mediclaim policies cover expenses for 30-60 days before and 60-120 days after hospitalization. Please check the terms of your insurance policy to check this section.

Q.3. Is there any limit on the number of claims made on my Mediclaim policy?

No. You can claim multiple times during the policy term up to the maximum amount of your Sum Assured.

Q.4. Can I use home remedies under the Mediclaim policy?

Yes, you can use a home remedy. However, only domestic hospitalization is covered under the Mediclaim policy. This treatment should be for any malaise/disease that requires home hospitalization due to the following reasons:

  1. The patient is not in a position to be transferred to the hospital, or there is a lack of accommodation in the hospital itself.
  2. Pre and post-hospitalization expenses and treatment for diseases like Epilepsy, Asthma, Chronic disorder, Bronchitis, Cough, Cold, Hypertension, Influenza, Dysentery or Diarrhea, etc

Q.5. What types of mediclaim insurance policy for bfl customers are available in India?

There are two types of Mediclaim insurance policy for bfl customers:

  1. Individual Mediclaim Policy- It covers an individual or an individual. The premium is calculated according to the age of the individual. The insured can claim the entire Sum Assured under this type of Mediclaim insurance. If the Sum Assured is ₹ 10 Lakh, you can claim only up to ₹ 10 Lakh.
  2.  Floater Mediclaim Policy- Your family can be covered under this type of Mediclaim policy. Here, the premium is calculated as per the age of the eldest member of the policy. If the Sum Assured is ₹ 10 lakh, an individual or the entire family can claim the Sum Assured up to ₹ 10 lakh.

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