Mediclaim Policy Details Benefits and Drawbacks

Marketopedia / Personal Finance / Mediclaim Policy Details Benefits and Drawbacks
  1. Day Care Treatments

There was a case study of a young man who was playing cards with his friends when he suddenly experienced an intense abdominal cramp. He had grown used to these isolated episodes occurring occasionally, so didn’t give it any serious thought at first. However, the pain only got worse and eventually became unbearable. His friends then took him to the hospital and after inspection, the doctor informed him that he needed immediate surgery for appendicitis.

Although the doctor confirms he will be released shortly, the bill proves to be quite a surprise. The Rs 80,000 cost is far more than he anticipated, and he eagerly contacts his insurer in hopes of full coverage. Unfortunately, they cannot help him, outlining that their policy rules out payments for treatments received during hospitalisation of less than 24 hours. Examples include chemotherapy, dialysis and, in this case, appendicitis.

The main takeaway here is that you need to confirm that your insurer covers daycare treatments. There’s no requirement for them to cover 500 different procedures, although the more procedures covered, the better. But the essential ones should be taken care of.

Verdict: Not a gimmick

  1. No Claim Bonus

We had mentioned to you before how insurers have an incentive to keep you well. It might not be apparent at first, but they could offer something like a No Claim Bonus. In other words, if you remain claim-free for a set length of time based on their policy, the insurer will reward you with an amplified coverage amount.

Imagine you bought a policy with a sum insured of Rs. 10 lakhs and a no-claim bonus of 50%. By the end of the year, if no claim is made, your Cover will be increased by 50%. This means that if you opt to renew the policy, you could have an assured Cover of Rs. 15 lakhs. If you manage to yet again go without making a claim the following year, your sum insured will get another additional jump of 50% from its initial figure (Rs. 10 lakhs). As a result, you’d have total protection worth Rs 20 lakhs.

Truly, this is an outstanding feature.

It’s important to know that this cover expansion won’t last forever. Different companies have different limits to how high they will go, anywhere from 200% to 50%. Additionally, some insurers will reduce the bonus if you make a claim during the year. For example, if you had built up coverage of Rs. 20 lakhs and then needed to make a claim, in the subsequent year your coverage would be reduced to Rs. 15 lakhs. Subsequent claims will bring it down to Rs. 10 lakhs, which is the minimum amount available.

Having a no-claim bonus can be beneficial, provided the premium is adequate and the clawback doesn’t take away from any benefit.

Verdict: Not a Gimmick

  1. Domiciliary Cover

Imagine a pandemic spreading across the world. Your job demands that you go out daily, and one morning you wake up with the signs of a cold. You start coughing incessantly and struggle to breathe properly. To make matters worse, medical services let you know there is no available bed for you. You have no choice but to stay home and hope somebody will come to your house and provide medical care.

If one is lucky to find a service provider, cost becomes a consideration. Expenses can quickly mount up and leave an individual in a financial pinch unless their insurance plan offers coverage for home hospitalisation and pays out their bills. When asked if these services are available, it is always with the understanding that there may be certain conditions that apply.

For example, domiciliary hospitalizations are only eligible for coverage if the necessary prerequisites are fulfilled.

  1. You must be able to demonstrate that you are unable to secure a hospital bed in your locality, or have an issue that prohibits you from entering a medical facility.
  1. A medical professional must determine that hospitalisation is essential, lasting for at least 72 hours.
  1. All costs must be considered equitable and sensible. This is especially significant in this situation, where the service provider could potentially furnish unnecessary options for your care. Consequently, it is necessary to be mindful.

Insurers don’t tend to be proactive when it comes to dealing with such claims, and often find excuses not to honour them. This means that if you were relying on this feature, it could be wise to look at other options.

Verdict: Slightly Gimmicky


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