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Mediclaim Policy: Types and Steps to Claim It

21 September, 2018

India records one of the highest per-capita out-of-pocket health expenditure in the world. Not only does it have a very low insurance penetration, most of the people are still unaware of the arrangements to tackle financial emergencies that arise due to accidents or illnesses. Mediclaim policy is an insurance policy which is especially designed to take care of your healthcare expenses if in case you face any sort of medical emergency, whether it’s an illness or accident that leads to hospitalization. In simple terms, a mediclaim insurance policy comes to you as a savior in case you are hospitalized due to an accident or illness. Mediclaim insurance policy reimburses your actual medical expenses, besides covering you for lodging, nursing, and treatment costs up to the coverage amount that you choose while purchasing the policy. It’s good to invest in a mediclaim policy if you want to safeguard your financial well-being.


Types of mediclaim policies in India:


  • Individual mediclaim policy: In an individual mediclaim policy, a single person is insured for a specific amount. This policy offers mediclaim and other hospitalization benefits to just one person. The insured person can claim the entire sum insuredassured, when required.

  • Family-floater mediclaim policy: In case of a family-floater mediclaim policy, the whole family is insured for a fixed sum insuredassured. This offers coverage to self, spouse, dependent children, and in most of the cases it provides coverage to dependent parents also. The sum insuredassured can be used by the entire family or even by a single member.

  • Senior citizen mediclaim policy: Senior citizen mediclaim policy is an important plan for older individuals. If you are planning to retire or near to your retiring age, then you might have to live on pension or some interest income from savings. In case of an emergency, you may get stuck in a financial crisis. Thus, to avoid such situation, it’s good to go with a senior citizen mediclaim policy.

  • Critical illness mediclaim policy: When a person is detected with a critical illness disease which is covered under the policy, the sum insuredassured is paid as a lump sum to the policyholder. Afterwards, the policyholder can plan the whole treatment accordingly. A general mediclaim policy will just take care of your hospitalization expenses, but a critical illness mediclaim policy is good for all sorts of illnesses that affect your work and lifestyle. Critical illness mediclaim policies usually provide a higher claimable amount as compared to other policies. It includes some of the following illnesses:
    • Cancer
    • Kidney failure
    • Heart attack
    • Aorta graft surgery
    • Paralysis
    • Stroke
    • Major organ transplant
    • Coronary artery bypass surgery
    • Multiple sclerosis
    • Primary pulmonary arterial hypertension

  • Group mediclaim policy: This is a type of insurance policy where an employer or person in charge of a group of people wants to add to their remuneration the benefits of cashless hospitalization or the reimbursement on hospitalization expenses.


Types of mediclaims:

With the advancement in technology, claiming on your mediclaim policy has become quite time saving, convenient, and hassle-free. You can claim it via two ways-


  • Cashless mediclaims: If you are planning to opt for a cashless treatment in a hospital, then you should contact the insurance company at the time of hospital admission. The hospitalization expenses are either collected from the insurance company directly or from their third-party administrator. You need to submit a claim form along with the doctor’s report in order to seek approval for the cashless treatment. If the request is approved, the third-party administrator or insurance company will settle all the bills directly with the hospital without the involvement of a policyholder. This is one of the most convenient methods of making a claim on your mediclaim policy. This facility can only be availed if the illness or injury is covered under your policy.

  • Reimbursement mediclaims: If due to any reason, you are unable to make cashless claims, then you can opt for reimbursement claims. So, once the treatment is done and the amount is settled, the next step is to send the claim form, doctor’s reports, and other related prescriptions to the insurance company. Thereafter, the insurance company will scrutinize all the documents for correctness and will check everything before making the final decision. Here’re the following documents that need to be submitted during reimbursement claim process –
    • Bills and receipts
    • Duly filled claim form
    • Medical certificate or form signed by the doctor
    • Investigation report
    • Patient’s discharge summary
    • Prescription from pharmacy or hospital
    • In case of an accident, Medico Legal Certificate or FIR is also required


Step-by-step guide on how to file a claim


It is actually quite simple to file a mediclaim in India, if you follow the right steps –


  • Firstly, you need to put all your medical bills, receipts, and medical reports in order. Check all your documents that contain the required information such as the patient’s name, cost price, etc.
  • Secondly, you can ask your insurance company about the claim form. Also, you can download it from the company’s website. Read all the instructions that are mentioned in the claim form carefully. Next, get it signed by the policyholder and stamped with the official hospital’s seal. Now, attach all the relevant medical and policy documents along with the form.
  • You need to submit the original as well as the photocopies of the documents along with the claim form. Review the documents carefully and ensure none of the documents is missing.
  • After submitting the documents, you must inform the health insurance company that the claim has been submitted by sending them a set of copied documents.


So, if you are looking for a reliable and economical option for being prepared for medical emergencies, then you should opt for a mediclaim insurance policy. Royal Sundaram provides comprehensive health insurance policy and Arogya Sanjeevani Policy at affordable rates. Their flexible mediclaim plans offer a wide range of benefits to take care of you and your family.


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