Mediclaim Insurance

What is Mediclaim ?

Offered by the four GIC Subsidiaries, Mediclaim is a Health Insurance Product.  After the introduction of the TPA (Third Party Administration) scheme this product has gained a strong edge over all the products in the category due to Cash Less Services and speedier settlement of claims. Keeping in view the current insurance scenario in the country Mediclaim is the only comprehensive medical assurance product offered by the risk underwriters.

Mediclaim Insurance is a cover, which takes care of the hospitalization expenses subject to maximum sum insured of the Insured in respect of the following situations:

  1. In case of a sudden illness.
  2. In case of an accident.
  3. In case of any surgery, which is required in respect of any disease which has arisen during the policy period.

What are the salient features of this policy ?

  1. Reimbursement for Hospitalization due to disease/ surgery.
  2. Reimbursement for Domicillary Hospitalization expenses in lieu of Hospitalization.
  3. Pre-hospitalization expenses upto 30 days.
  4. Post-hospitalization expenses upto 60 days.
  5. Age limit: 5 years to 80 years. Children between the age of 3 months to 5 years can be covered provided one or both parents are covered concurrently.

What treatments are covered ?

  1. Expenses on Hospitalization for a minimum period of 24 hours.
  2. In case of treatments like Dialysis, Chemotherapy, Lithoripsy, Radiotherapy, Eye surgery, Dental Surgery (if Coverage of your Policy), Tonsillectomy, D&C taken in Hospital/Nursing Home, the time limit of 24 hours is not applicable.

What are the important exclusions under this policy ?

  1. Any pre-existing diseases.
  2. Treatment for cataract, benign prostatic hypertrophy, hysterectomy for menorrhagia or fibromyoma, hernia, hydrocele, congenital internal diseases, fistula in anus, piles, sinusitis and related disorders for 1st year of policy.
  3. Any disease within 30 days of inseption of the policy.

What are the other benefits ?

  1. Family Discount: A family discount of 10% in total premium will be allowed if a person takes cover himself and any one of the following:
    • Spouse
    • Dependent Children
    • Dependent Parents
  2. Cumulative Bonus: Benefits payable will be increased by 5% each claim free year, up to a maximum of 50% for continuous policy periods only.
  3. Cost of Health Checkup: Reimbursement of cost of medical check-up once at the end of a block of every four continuous policy years which are claim free, subject to a maximum of 1% of the average sum insured during the period.
  4. Income Tax: Premium paid for the policy towards self, spouse, 2 dependent children and dependent parents are exempt from income Tax under Sec. 80 D of the I.T. Act.

What is the sum insured ?

The range available is from Rs.15,000 to Rs.5,00,000/- to be opted for in multiples of Rs.5000/- .

What is the premium ?

It ranges from Rs.175/- onwards depending upon Age and Sum insured (you can download the latest Medcliam Premium Chart by)


Mediclaim premium is eligible for relief u/s 80D upto a max. of Rs.10000/-. Where a corporate or group policy has been taken through employee contribution, A certificate from the employer should be adequate proof for the claim, of relief under Sec. 80D.