The document summarizes the key features of a Mediclaim insurance policy in India. Mediclaim is a hospitalization insurance policy offered by public and private insurers that reimburses expenses from hospitalization, surgery, accidents, or illnesses. There are individual, family, and senior citizen policies. Family policies allow the sum assured to be used by any family member. Mediclaim provides cashless payment of bills to hospitals and tax benefits. The key benefits covered are room costs, nursing, surgeon fees, medicines, and diagnostic tests.

1. Mediclaim policies and their
silent features
PREPARED BY : SWETA RAJPUT (2078)

2. Mediclaim policy is a hospitalization benefit that is offered by
both public and private sector general insurance companies
in India.
The Mediclaim insurance policy takes care of expenses
following hospitalization/domiciliary hospitalization of the
insured in respect of the below situations:
 In case of an accident
 In case of sudden illness
 In case of any surgery which required in respect of any
disease which has arisen during your policy period.

3.  Mediclaim policy is an insurance coverage where in any of your health related
hospitalizations bills can be claimed from the insurance company.
 There are two different ways to get your bills claimed either by cashless facility i.e.
your bills are directly paid to the hospital or you can pay your bills in the hospital
and get an reimbursement after submission of the same to the insurance
company.
 Mediclaim policy helps employee for take the benefit of medical treatment.
Employee’s come under it who pays amount to insurance company.

5. Scope of cover
 The policy basically available to persons between the age of 5 and 80 years
(children between the age group of 3 months to 5 years can be covered if one or
both their parents are also covered concurrently)
 Basic cover
 Pre hospitalization benefits
 Post hospitalization benefits
 Sponsored health checkups
 Discount in premium for family cover

6. Types of medical policies
 Individual Mediclaim policy
 Family Mediclaim policy
 Senior citizen Mediclaim policy

7. Individual Mediclaim policy
 This policy is ideal for you if you want to cover just yourself & medical treatment
that only you will need.
 Company will reimburse the medical expenses incurred while the insured was
admitted in the hospital as an in patient.
 Individual Mediclaim policy also covers surgeon, anesthetist, medical practitioner,
consultants, specialist fees.

8. Family Mediclaim policy
 It is the enhanced version of Mediclaim policy in which the sum assured value
floats among the family members i.e. each member of the family is covered under
a single plan and sum assured can be claimed by any member of the family.
 Family floater policy covers your complete family so if any medical emergency
arise, you have to worry only about choosing the right hospital not about the
financial costs.
 Family Definition:
 Self+Spouse+2 Dependent Children

9. Senior citizen Mediclaim policy
 The senior citizen Mediclaim policies are for people aged between 65 years and 80
years & this policy is little more expensive then the others.
 It covers:
 Hospitalization
 Day care
 Medical expenses

10. Salient Feature of Mediclaim policies:
 Mediclaim insurance policy has been devised under the aegis of the Government of
India. The policy provides the following benefits.
Reimbursement of hospitalization expenses which are reasonably and necessarily incurred,
under the following heads:
 a) Room, boarding expenses as provided by the hospital/nursing home.
 b) Nursing expenses.
 c) Fees of surgeon, anesthetist, medical practitioner, consultant and specialist.
 d) Expenses on account of anesthesia, blood, oxygen, operation theatre charges,
surgical appliances, medicines and drugs, diagnostic material, X-ray, dialysis,
chemotherapy, radiotherapy, cost of pacemaker, artificial limbs and cost of organs and
similar expenses.

11.  The Scheme covers existing illness of the members.
 The Scheme provides a family floater of Rs.1 lakh with a Corporate buffer of
Rs.50 lakhs.
 It is a cost effective way of health care
 Offers peace of mind
 Availability of cashless hospitalization
 No out of pocket medical expense
 Medical expenses managed by the insurance company itself
 Tax benefits
Under the Income Tax Act, under Section 80D, the insured person who
takes out the policy can claim for tax deductions.
Rs.25,000 for self, spouse and dependent children.
Rs. 30,000/- for parents
 For dependent parents there will be a limit of Rs.1 lakh for Critical illness and
Rs.50,000/- for non-critical illness for each parent.