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Facts to know about Mediclaim Policy

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Facts to know about Mediclaim Policy
June 18, 2023
In India, almost all of the working class have a mediclaim policy. But not everyone is aware of the basics of the same. Below are some lesser known facts of a mediclaim policy:

a. Hospital Change -

Change of hospital is allowed only under two circumstances-

1) in case of better treatments

2) approved by TPA on the merits of the case and as per policy terms and conditions. It's always better to understand the network of hospitals the policy covers.

b. Benefits of sticking to one insurance provider -

a) If you are suffering from any pre-existing disease at the time of commencement of the mediclaim policy then complications of that disease will be covered only after 3 or 4 years of the commencement date.

b) If you stick to your mediclaim policy for more than one year or so, company may offer you bonus or give discount in premium.

c) After two years of mediclaim insurance commencement, you may get free health check-ups for every second year. Or you may get health services and product of market value up to 10% of your last paid premium.

c. Insurance for Working Couples -

If you are a working couple, then your insurance is double. If both of you have a policy for Rs. 2 lakh each, in case of medical expense, you can borrow the remaining amount from your spouse's policy. For e.g., if your bill is upto 2.5 lakhs, your policy will cover the 2 lakhs and you can utilize the 50,000 from your spouse's policy.

d. Cashless Transaction- 

You may be disallowed of cashless hospitalization if- 

1) Information about the treatment you submitted is insufficient to confirm the coverage

2) TPA is not in timely receipt of the request for the pre-authorization. In such case, you need to bear the expenses first and then send claim for reimbursement.

3) If hospital in which you are required to take treatment is not on the panel of the company.

Educate yourself before buying a policy. HDFC Life has a no of policies for you to choose from.

Related Article

ARN: ED/12/19/17049

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Francis Rodrigues Francis Rodrigues

Francis Rodrigues has a decade long experience in the insurance sector, and as SVP, E-Commerce and Digital Marketing, HDFC Life, manages the online sales channel, as well as digital and performance marketing. He has had hands-on experience in setting up sales channels and functional teams from scratch over a career spanning 2 decades.

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