AN EXTERNAL PERSPECTIVE
What is health insurance?
It essentially acts as an agreement where the insurance company agrees to pay for your hospital bills (up to a specific pre-defined limit called the Sum Insured) in exchange for a regular premium payment.
Deliverables:
Risk Mitigation
Risk Mitigation
Risk Mitigation
Risk Mitigation
Risk Mitigation
Risk Mitigation
How Mediclaim Works
01/
You Pay Premiums
You pay an annual fee to keep the policy active.
02/
Hospitalization Triggers Cover
If you get sick or have an accident that requires you to be admitted to a hospital (usually for a minimum of 24 hours), the policy kicks in.
03/
Cashless Treatment
If you pass away while the policy is active, your family files a claim, and the insurance company cuts them a tax-free check for the amount you chose when you bought the policy (the Sum Assured).
04/
Reimbursement
If you go to a non-network hospital, you pay the bills yourself first, submit the original documents to the insurer later, and they refund the money.
Important Limitations & Exclusions
01
Pure Protection
Waiting Periods
You cannot claim for existing illnesses (like diabetes or hypertension) from day one. There is usually a waiting period of 2 to 4 years for pre-existing diseases.
02
Protection + Savings
Room Rent Caps
Many plans restrict room rent to 1% of the Sum Insured per day. If you exceed this cap, you have to pay the proportionate difference for the entire hospital bill out of pocket
03
Liquidity + Protection
Co-payment
A clause where you agree to pay a fixed percentage (e.g., 10% or 20%) of the total claim amount, and the insurer pays the rest.
Framework
What Does Mediclaim Usually Cover?
In-patient Hospitalization
Room rent, ICU charges, doctor/surgeon fees, nursing charges, and OT expenses.
Pre and Post-Hospitalization
Medical expenses incurred a few days before admission (like diagnostic tests) and a set number of days after discharge (like follow-up medicines)
Daycare Procedures
Treatments that take less than 24 hours due to advanced medical technology (e.g., cataract surgery, dialysis, chemotherapy)
Road Ambulance Charges
Cost of transporting the patient to the hospital in an emergency.
Financial planning is not a one-time decision. It’s a lifelong conversation.
