Health Insurance and Mediclaim: Comparing Policy Terms

Health insurance products can use different names, including Mediclaim. A product name alone does not establish its benefits, claim limits or exclusions. Compare the policy wording and Customer Information Sheet for the specific products you are considering.

Check the benefits individually

Hospital expenses, eligible day-care procedures, treatment before or after admission and outpatient consultations can have different rules. Do not assume every Mediclaim policy requires a 24-hour hospital stay for every covered treatment. For example, New India Assurance's Premier Mediclaim product information includes eligible day-care treatment. That example does not establish what another policy covers.

Likewise, there is no single sum-insured ceiling that can safely be inferred from the word Mediclaim. Read the available options and limits for each product. A family floater shares a limit between insured members; individual arrangements and benefit-based policies can operate differently.

Compare costs beyond the premium

• The sum insured and any room, treatment or disease-specific sub-limits.
• Deductibles and co-payments that may leave part of an eligible bill payable by you.
• Initial and condition-specific waiting periods, exclusions and renewal terms.
• Cashless hospital arrangements and the claim documents required.
• Optional benefits and their additional cost.

A low premium alone cannot show which policy is suitable. Nor does a higher premium guarantee that every medical expense will be paid. These checks are reflected in IRDAI's health insurance guidance.

Make a decision using written terms

Describe your requirements accurately, disclose requested health information and ask the insurer or intermediary to identify the clause that answers each important question. Keep copies of the quotation and policy documents. A website comparison is general information; the accepted policy determines the cover and applicable claim conditions.