Mediclaim Insurance – A Basic Guide

A research on Indian Council for Research on International Economic Relations shows that the boom in corporate profits and higher incomes for employees is one side of the coin. The other is surge in workplace stress and lifestyle diseases.

Heart disease, stroke and diabetes are few common diseases in India which reportedly wiped off $9bn (£4.4bn) off the Indian national income in 2005. The cost could reach more than £100bn over the next 10 years.

This has brought health insurance in limelight. It becomes a source of financial support to an individual who finds himself hospitalised.

Individuals aged 5 to 80 years can avail of mediclaim. Children between the age of 3 months and 5 years can also be covered provided one or both parents are covered concurrently.

However, if you prefer alternative systems of medicine such as homeopathy, chiropractic (treatment which focuses on manual therapy including spinal manipulation and other joint and soft tissue manipulation), naturopathic medicine (natural medicine), osteopathy (treatment emphasizing on a holistic approach and the skilled use of a range of manual and physical treatment interventions or traditional Chinese medicine), a mediclaim does not cover these expenses.


The mediclaim policy is available only for Allopathic, Ayurvedic and Unani systems of medicine.

A mediclaim or a health insurance policy provides for reimbursement of hospitalization. If for some reason, an individual is on bed at and needs an attendant or a nurse, the mediclaim policy will cover the expenses.

Expenses associated with treatments such as dialysis, chemotherapy, radiotherapy etc are also covered by the mediclaim policy. If an individual is taken to a hospital or a nursing home and the insured person-patient is discharged on the same day, the treatment will be considered to be taken under ‘Hospitalisation Benefit Scheme’.

However, there are some different benefits that can be claimed under the mediclaim insurance policy in the event of hospitalization.

Different heads of benefits under hospitalization that can be claimed under mediclaim:

• Room boarding expenses by the hospital nursing home

• Nursing expenses

• Surgeon, anaesthetist, medical practitioner, consultants, specialist’s fees

• Anaesthesia, blood, oxygen, operation charge, surgical appliances, medicines and drugs, diagnostic material and x-rays, dialysis and chemotherapy, radiotherapy, pacemaker, artificial limbs and cost of organs and similar expenses (all the above benefits are limited to the maximum sum insured)

The minimum period of hospitalisation should be for 24 hours. However, for certain treatments this limit is not applicable when package charges are levied for treatment by the hospital.

It is very important for you to check what all is covered by a mediclaim policy. Any disease or sickness existing before the mediclaim is taken will not be covered. Each mediclaim policy has a list of specific exclusions. Check the list. Most Insurance Companies do not offer mediclaim for obesity related illnesses, expenses arising from HIV or AIDS or the use of alcohol or drugs and expenses due to attempted suicide. Expenses associated with the treatment due to war, riots or a terrorist attack is not insured by policies.

About the Author : ApnaInsurance.com is India’s first online definitive guide to mediclaim insurance requirements. Learn & compare various insurance schemes and apply for insurance including compare health insurance, mediclaim, life insurance & car insurance schemes offered by different insurance companies in India.