One Total Health

Health Blog

Mediclaim Inclusions and Exclusions: A Detailed Guide

In recent years, advancements in medical research and technology have contributed to an increased rate of recovery in healthcare. However, this progress comes bundled with the rising costs of medical care. Today, if you have to manage the costs pertaining to medical treatment and hospitalisation, then you need to be ready to shell out a lot of money. This can put a strain on your finances. 

With a health insurance policy, you can manage these costs with ease. However, before you buy a mediclaim insurance policy, you must ensure that you are aware of its inclusions and exclusions so that you can choose the best policy for your needs.

Inclusions of Mediclaim

Here are some of the common inclusions of a mediclaim insurance policy:

  • Hospitalisation costs – When you opt for a mediclaim policy, you can avail of a cashless hospitalisation facility at network hospitals. You will not have to carry money with you to commence the treatment. Usually, hospitalisation costs covered include room charges, ICU charges, doctor’s and surgeon’s fees, etc.
  • Before and after hospitalisation – All costs associated with pre and post-hospitalization are also covered under a mediclaim policy.
  • Yearly health check-ups – With a mediclaim policy, you can get yearly health check-ups done for all members insured under the policy. If you have a family insurance policy, then you can get a health checkup done for your entire family. This includes blood tests, blood sugar tests, urine tests, ECG, etc.
  • Daycare treatments – Mediclaim policies also offer coverage for daycare treatments like dialysis, cataract surgery, etc.
  • Domiciliary hospitalisation – If you are not in a condition to go to the hospital, then a mediclaim insurance policy can offer a domiciliary hospitalisation facility wherein you get a reimbursement for up to a few days as specified in the policy.

Apart from the inclusions specified above, you can also get free ambulance services, organ donor cover, and cover for alternative treatments.

Exclusions of Mediclaim

Here are some common exclusions of a health insurance plan:

  • Self-inflicted injury – Treatment of injuries caused due to self-inflicted wounds.
  • Pre-existing diseases – No cover for any disease that you had before buying the policy or if it is diagnosed within 30 days of purchasing it.
  • STDs – Unless specified otherwise, mediclaim policies do not cover expenses for the treatment of STDs like AIDS.
  • Infertility Treatment – Tests and/or treatment of infertility or IVF.
  • Congenital Diseases – These diseases are known to occur due to a birth defect. Therefore, they are not covered under regular mediclaim insurance policies.
  • Injuries Due To Substance Abuse – Medical treatment expenses for injuries or illnesses caused due to alcohol or the use of banned substances.
  • Pregnancy-related expenses – Unless the policy includes maternity cover, a mediclaim insurance policy does not cover costs associated with the treatment or hospitalization that can be traced to pregnancy, childbirth, abortion, miscarriage, and their consequences.
  • Cosmetic Surgery – Costs associated with cosmetic treatments and surgeries. Any treatment that does not have a medical basis is not covered by a mediclaim policy.
  • Man-made disasters – If there is a riot, strike, war, nuclear strike, or any other man-made disaster, then the policy does not offer coverage to the policyholder for hospitalisation or treatment.

Summing Up

In simple terms, a mediclaim policy offers coverage for expenses due to the treatment of various illnesses and diseases. Every insurer has a specific list of inclusions and exclusions. While we have tried to offer an overview of the same, before you buy a health insurance policy, make sure that you go through the inclusions and exclusions set by the insurer. Also, it is essential to understand the features and benefits of the mediclaim policy. 

This will allow you to understand the scope and extent of the coverage you can expect from the policy. If you are looking for health insurance plans for your family, then make sure that you understand how the insurer calculates premiums and the limits set for claims. Research the market, compare insurers and plans and buy the health insurance policy online. Good Luck! 




Related Posts