Mediclaim Policy: Know the Key Inclusions and Exclusions


An advancing medical infrastructure is a boon for all of us – it increases life expectancy and improves the quality of life. However, this advancing medical infrastructure comes with a bane  – the expense.

Healthcare is getting expensive by the day, so much so that you are always one hospital bill away from a serious financial crunch. It doesn’t really matter how much funds you have saved up in your reserve – it might turn out to be inadequate in the face of medical uncertainties.

This is where a mediclaim policy comes in to help you manage hospitalisation costs efficiently. But just so you know, unlike a health insurance policy, a mediclaim policy covers only limited medical expenses.

If you are planning to purchase a mediclaim policy, you must know what it includes and what it does not. Here’s a list of the inclusions and exclusions.

What Does a Mediclaim Policy Include?

A Mediclaim policy covers the following expenses:

1.In-Patient Hospitalisation:

Hospitalisation requires payment for several medical procedures and services. These expenses come under in-patient hospitalisation and are covered by all Mediclaim policies in India. Prescription fees, MRIs, or any other lab tests recommended by the medical practitioner are all examples of in-patient hospitalisation expenses.

2.Domiciliary Expenses:

In instances where hospital beds are not available and the patient is required immediate medical treatment,  the treatment is provided at home. Such expenses are called domiciliary expenses and may be covered by a Mediclaim policy or health insurance.  

3.Annual Health Check-ups:

In order to ensure that you are your healthiest self, medical check-ups are crucial. However, these health check-ups can get expensive. But with a Mediclaim policy, you can get these tests done without paying anything. Annual health check-ups are usually covered by a Mediclaim policy. However, you need to read the policy documents and check if your Mediclaim policy provides for annual health check-ups.

What Does it Not Include?

A Mediclaim policy does not include the following treatments and expenses:

1.Cosmetic and Dental Treatments:

A Mediclaim policy only covers treatments that are essential for one’s physical health. Consequently, cosmetic treatments that are not a necessity, merely a choice, are not covered under a Mediclaim policy.

These treatments can include dental treatments, nose jobs, lip surgery, etc. are not covered by a Mediclaim policy. However, essential ophthalmological and dental procedures such as cataract surgeries are often covered by a Mediclaim policy.

2.Pre-existing Diseases:

There is no use in buying a Mediclaim policy to manage the treatment costs of illnesses you are diagnosed with before the purchase. Pre-existing diseases are not covered for a while. This window wherein you cannot make any claim for a particular medical condition is known as a waiting period. A waiting period can range between a few months to years, depending on the Mediclaim policy.

3.External Medical Devices:

The cost of external medical devices such as hearing aid and contact lenses are not covered by a Mediclaim policy.

4.Pre and Post-Hospitalisation:

A Mediclaim policy also covers expenses incurred before or after hospitalisation, whether it be for diagnosing a medical condition or treating it. These can include doctor visits, medicine costs, and laboratory tests. It is important to note this coverage also depends on the number of days. In the case of post-hospitalisation costs, expenses incurred for sixty days starting from the time of discharge are included in this category. Also, therapy expenses such as naturopathy are not covered.

Key Things you Should Consider Before Buying a Mediclaim Policy:

  1. A Mediclaim policy only provides a limited cover. This cover might turn out to be insufficient if the insured is diagnosed with a critical illness.
  2. You cannot buy add-on riders with a Mediclaim policy.
  3. A Mediclaim policy offers little or no flexibility when it comes to customisation.
  4. A Mediclaim policy does not offer comprehensive coverage, unlike the best health insurance in India. Only expenses related to hospitalisation are covered by a Mediclaim policy.
  5. A Mediclaim policy is a budget-friendly option if you are tight on budget and only have limited medical requirements to take care of.

The Bottom Line:

A Mediclaim policy is a budget-friendly way of securing your physical and financial health in the face of medical emergencies. Now that you know all about the inclusions and exclusions of a Mediclaim policy, you will be able to make a well-informed purchase.

So, if the benefits of the Mediclaim policy align with your requirements, what are you waiting for? Buy a Mediclaim policy now!