Health and Medical Insurance

Medical Insurance or Health Insurance or Mediclaim Policy are all used interchangeably – and refer to an insurance policy taken to cover expenses related to hospitalisation & medical treatment. The policy is taken to protect oneself from the financial burden of high Medical expenses in case he/she or a loved one has to undergo medical treatment due to illness or accident.

Factors to Be Considered While Choosing a Mediclaim Policy

The annual premium on a Medical Insurance policy is the obvious cost of taking the cover. However, the policy with the lowest premium is not necessarily the best policy for you. One should consider many factors before deciding on which Medical Insurance policy to choose. Some of the factors to be considered are mentioned below:

Sub Limits

Avoid policies with capping on Room Rent & Surgeon Fees, Eg. The Insurance Cover is Rs. 3 Lakhs but Room Rent reimbursement may be max. Rs. 3,000 per day (1%of total over) & Surgeon Fees capping maybe 25% Off the total bill amount.

Claim Based Loading

After a claim is availed, the next premium be Charged extra than the normal premium. Sometimes this extra amount can be 100% of the normal premium. Avoid policies with Claim Based Loading


Some policies require the customer to bear part Of the claim. This is called Co-pay.
Other things equal, policies
co-pay are cheaper than
policies without co-pay. Evaluate the cost Of Co-pay against benefit Of lower premium carefully.

Age Limit

Avoid a policy that allows renewal only up to a certain age.

Lifelong renewal iS a MUST HAVE
for a Mediclaim Policy.

The above list is not exhaustive. It is advisable to read through the detailed Terms & Conditions (referred to as Policy Wording) before taking the policy.

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Understanding Various Types of Mediclaim Policies

  1. Individual Policy: This type of policy covers the medical expenses of one individual only. To cover other family members, separate Individual policies can be taken. Same/different Sum Insured can be chosen for each family member.
  2. Family Floater Policy: As the name suggests, the Sum Insured ‘floats’ among the family members covered by the policy. Example – A 5 Lakh Sum Insured floater policy for a family of 4 persons would cover anyone/all members for Rs. 5 lakhs during the year.
  3. Top-up Policy: A Top-up mediclaim policy is a most suitable, low-cost option for people who already have a Mediclaim Policy (from their organization or take on their own) and would like to enhance the cover significantly. Such policies cover the expenses only if the medical bill crosses a certain ‘Deductible’ amount. For example, a Top-up policy starting from 2 lakhs up to 7 lakhs will come into play only if the medical treatment cost exceeds Rs. 2 lakhs and will reimburse the bill amount beyond Rs. 2 lakhs and upto Rs. 7 lakhs.

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