Mediclaim policy offers hospitalisation benefit if the policyholder is admitted to a hospital for treatment of sudden illness or injuries caused by an accident or for any type of surgery.
Under the mediclaim policy, the insurerpays for expenses of hospitalisation or domiciliary treatment.
Mediclaim policy can be bought for each individual separately or for the entire family as a group. In individual plan, each individual is insured separately for a specified coverage amount, while in a family floater plan, all members of the family are covered for a fixed sum assured.
There are two types of claims under mediclaim policies, namely, cashless and reimbursement. The salient features of these two types of policy claims are as follows:
A cashless policy is a policy that enables treatment of a patient without the patient having to pay any amount to the hospital. In this case, the patient is admitted in a network hospital of the insurer and the insurer then pays either a specified part of the amount or the entire amount of the treatment of the patient at the hospital directly with the hospital.
To avail cashless benefit, the policyholder has to fill up a pre-authorisation form with all the necessary details and then submit it to the insurer or its third party administrator.
In this policy, the patient has to initially pay all hospitalisation and treatment expenses to the hospital from his own pocket and then claim reimbursement of the expenses from the insurer. To claim reimbursement of expenses, the insured has to submit all the hospital bills and payment receipts of all the medicines purchased from the hospital or from outside chemists.
The insurer also has to be informed about hospitalisation before or at the time of hospitalisation by the policyholder or his representative.