Mediclaim
Health Insurance
Health insurance can simply be defined as contract between the insurer and the insured wherein insurer agrees to pay hospitalization expenses to the extent of an agreed sum assured in the event of any medical treatment arising out of an illness or an injury.
COVER – Cover is available for reimbursement of Hospitalisation expenses in India in respect of both individuals and Groups. This insurance provides cashless Hospitalisation, for the treatment of any covered illness or disease or accidental injury contracted during the Policy period. For administering this arrangement and to provide hassle free admission and discharge from the Network hospitals, Third Party Administrators (TPAs) have been empanelled by Insurance Companies. There are various options for the extent of coverage sought to be insured – i.e. the Sum Insured. It differs from Insurer to Insurer and ranges from Rs. 1 lakh to Rs. 50 lakh per person.
The expenses covered usually include
- Cost of room bed
- Boarding expenses
- Nursing expenses
- Doctor’s fees
- Diagnostic fees Medicines and Drugs
- Operation theatre charges and
- Expenses related to surgical appliances and the like Diagnostic Materials and x-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs and Cost of Organs and similar expenses
What is not covered
Health insurance policies in India normally provide a comprehensive health cover, covering nearly all illnesses and injuries requiring minimum 24 hours of hospitalization, subject to a few exclusions namely AIDS, STDs, mental disorders, congenital defects. Typical health insurance policy does not cover medical expenses that are routine in nature or incurred for routine health check-ups, cosmetic surgery, plastic surgery, dental treatment, aesthetic treatment, etc.
Persons residing in India and aged between 5 to 80 years can be covered. Children between the age of 3 months and 5 years can be covered, provided one or both parents are covered concurrently.
Families as defined under the Policy can avail discount in premium under the Package covers.
Groups maybe Associations/Institutions/Corporates and Groups with more than 50 persons provided it has a central administration. Discounts in premium can be availed of depending on the group size and profile.