What is Covered and Not Covered Under Mediclaim Policy?

Advances in medical technology have led to a reduction in the mortality rate and an increase in the rate at which people recover from diseases and infections. However, the cost of medical treatment is increasing dramatically day by day. So, if you do not have a health insurance plan, you must buy a mediclaim or a health insurance policy for yourself. Hence, it becomes essential for you to understand the inclusions and exclusions under a mediclaim policy. The article below will give you detailed information about what is and is not covered under a health insurance mediclaim policy.

What is Covered Under Health Insurance Mediclaim Policy?

Below mentioned are some of the coverage benefits offered under health insurance mediclaim policy:

• In-patient Hospitalization

A policyholder can avail of in-patient cashless hospitalization facilities in the network hospital of the health insurance company. The policyholder can get cashless hospitalization only if they are admitted to the hospital for more than 24 hours.

• Pre and post-Hospitalization

The medical expenses incurred before and after the hospitalization, such as medicine expenses, diagnostic, doctor consultation fees, etc., are covered in a mediclaim policy.

• Daycare Treatment

Any treatments that need less than 24 hours of hospitalization, such as chemotherapy, cataract, etc., are covered under the mediclaim policy.

• Domiciliary hospitalization

A health insurance mediclaim policy cover expenses incurred due to domiciliary hospitalization. The expense incurred due to domiciliary hospitalization will be covered if the treatment lasts more than three days.

• AYUSH Treatment

Alternative treatments such as Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy are covered under health insurance mediclaim policy.

• OPD Charges

The health insurance mediclaim policy covers the doctor’s prescription and the prescribed medical test cost.

• Annual Health Check-up

A mediclaim policy covers the expense incurred due to annual health checkups of the policyholders. It includes tests such as kidney function, ECG, urine test, etc.

• Preventive Health Check-up

A health insurance mediclaim policy offers free health checkups to the policyholder on a monthly basis, which will help them maintain a healthy lifestyle.

• Extra Coverage

A mediclaim policy covers additional coverage benefits such as ambulance service, ICU charges, organ donor cover, etc.

What is Not Covered Under Mediclaim Policy?

Below mentioned are some of the diseases and conditions that are not covered under the mediclaim policy:

• Corrective Cosmetic Surgery

Any congenital illnesses are not covered under mediclaim policies, which are illnesses or disabilities that happen due to birth deformity. 

• Inherent Diseases

Any congenital illnesses are not covered under mediclaim policies. These are the illnesses or disabilities happen due to birth deformity.

• Infertility Treatment

Any treatment cost related to infertility treatment is not covered under mediclaim policy or health insurance.

• Pregnancy

Any treatment cost arising due to pregnancy, child labour, abortion, unnatural birth cycle, etc., are not covered under health insurance or mediclaim policy.

• Sexually Transmitted Diseases

Medical costs arise due to the treatment of sexually transmitted diseases such as HPV, Chlamydia, HIV, Syphilis, Herpes, etc. are not covered under mediclaim policy or health insurance.

• Pre-Existing Diseases

Any pre-existing disease will not be covered before the waiting period 3 to 4 years under mediclaim policy or health insurance plan.

• Injuries inflicted Due to Alcohol Consumption

Any expenses related to alcohol or drug abuse or misuse are not covered under health insurance or mediclaim policy.

• Self-Induced Injuries

Expenses related to self-inflicted injuries, including but not limited to bungee jumping, attempted suicide, and suicidal tendencies, are not covered under the mediclaim policy.

• Permanent Exclusions

Medical costs arising from war, riots, mob strikes, and nuclear attacks are not covered under mediclaim health insurance.

Some Other Important Health Insurance Pages

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AYUSH Treatment in Health Insurance

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Best Health Insurance Plans in India

Conclusion

The above article will help you understand the inclusion and exclusion under health insurance or mediclaim policy. It will help you make an informed decision while choosing a health insurance plan for you or your family. It would be best if you did not ignore the importance of health insurance as it forfeits your medical expenses in case of a medical emergency. It is advisable to buy a health insurance plan offered by a trusted health insurance company, whether you are buying it for yourself or your family. It is an ideal investment to save hard-earned money and protect your family.