It’s a coverage that covers the cost of an insured individual's medical and surgical expenses. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider.
The policy takes care of medical expenses following Hospitalisation/Domiciliary Hospitalisation of the insured in respect of the following situations:
- In case of sudden illness
- In case of an accident
- In case of any surgery which is required in respect of any disease which has arisen during the policy period.
Mediclaim usually has the following features:
- It only reimburses expenses or pays for expenses directly to your hospital including charges for doctors & nurses, OT charges, medicines, blood, oxygen, diagnostic materials and x-ray, chemotherapy, radiotherapy, pacemaker, donors expenses towards organ transplant, and so on for 30 days or so (you cannot make a financial income from the process).
- Certain pre hospitalization and post hospitalization charges are reimbursed. They may in addition provide assistance in availing emergency services and local ambulance services. It needs hospitalization for at least a day to become effective.
- Only a few procedures like cataract are reimbursed without hospitalisation.
- Many providers offer cash less mediclaim which means the insured can get treatment without payment of cash at specified hospitals where the insurance company has tie-ups with.
- A Family Floater is simply the same Mediclaim covering all members under a single policy.
