MEDICLAIM

• Mediclaim forms a part of miscellaneous insurance category.
  
  
• It can be used by the age group between 5 & 75 years.
  
  
• It covers costs of major illnesses that require hospitalisation.
  
  
• The policy covers reimbursement of medical costs of hospitalisation or domiciliary hospitalisation expenses.

EXPENSES COVERED:

Hospital room.

Nursing expenses.

Doctors fees.

Medical supplies.

Diagnostic costs.

Operation costs.

WHY

Recognition as an industry

Socio Economic changes

Brand Development

Extension to related business


AGE LIMIT

Between age of 5 and 80 years


Children between the age of 3 months and 5 years can be covered provided one or both parents are covered concurrently


TYPES OF HOSPITALISATION EXPENSES COVERED BY MEDICLAIM

• Room Charges
  
  
• Boarding Charges
  
  
• Nursing Expenses
  
  
• Surgeon and Surgery Fees
  
  
• Anesthetist / Doctor's Fees
  
  
• Blood Charges
  
  
• Oxygen Cylinder Charges
  
  
• Operation Theatre Charges
  
  
• X-ray Etc
  

.


TIME LIMIT FOR STAY WITHIN THE HOSPITAL

Minimum of 24 hours

However for dialysis, chemotherapy, eye surgery, etc - the stay can be for less than 24 hours


SUM INSURED IN MEDICLAIM INSURANCE

• The insured will have to choose the sum insured ranging from Rs. 15,000/- to Rs 5,00,000/-.
  
  
• The limit of liability for Domiciliary Hospitalization is about 15% of the sum insured.

DOMICILIARY HOSPITALIZATION

Special conditions for Domiciliary hospitalisation claims :

Medical treatment for more than 3 days.

Hospitalization treatment at home under following conditions

Patient condition serious

Lack of accommodation facilities in the hospital


EXCLUSIONS

Pre-existing disease.


30 days waiting period.


1st yr exclusion of specific diseases.


Cosmetic treatment


Dental treatment (unless hospitalisation)


Others like : Maternity, Cost of Specs and Hearing Aids, Naturopathy, Vitamin Prescriptions, etc.




DOES MEDICLAIM COVER ANY EXPENSES BESIDES HOSPITALISATION COSTS ?

• Mediclaim covers pre-hospitalisation (limited up to 30 days)
  
  
• Post-hospitalisation (limited to 60 days from discharge) expenses also if they are connected with the sickness / accident for which the hospitalisation takes place

ADDITIONAL BENEFITS


Family discount – 10 %


Cumulative bonus – 5% for each claim (subject to a max of 50%) Incase of claim – 10% reduction


MARKET PLAYERS

• ICICI Lombard General Insurance organization.
  
  
• TATA AIG Insurance Company Ltd
  
  
• Bajaj Allianz
  
  
• HDFC Chubb General Insurance
  
  
• Reliance General Insurance Company Limited
  
  
• Royal Sundaram
  
  
• Cholamandalam MS General Insurance Company Limited
  
  
• GIC and Four subsidiaries
  
  

Cost of medical check-ups available (after 4 claim-free yrs – 1% of sum insured)

Premium upto Rs.10000/- qualifies for tax benefit under Section 80 D of Income Tax Act.

Domiciliary hospitalisation – limited to 15% of sum assured.