Understanding the Basics
Q1: What is the difference between mediclaim and health insurance?
Medical cover provide hospital care, whereas Health care policy provides additional options such as maternity coverage, outpatient services, etc. Therefore, mediclaim plans fall within the scope of health insurance while also being separate from them.
Q2: Is mediclaim the same as health insurance?
No. Cashless hospitalisation covers only the hospital stay/surgical procedures while Health coverage has additional coverage for outpatient visits/day care hospitalization cover/maternity benefits etc. Therefore, Health policies are generally a larger offering than straight forward Mediclaim policies.
Q3: What is 5 lakh health insurance?
Health Insurance (i.e. 5 lakh) provides up to Rs.5,00,000 in coverage for eligible medical expenses. In the event of payment to a hospital, doctor or any other party, the maximum that will be paid under the policy is the specific amount agreed upon by the insurer. For an individual or family needing financial protection from a more than moderate amount of money spent on a single incident or event; this plan offers reasonable value to cover significant expenses associated with medical emergencies.
Policy Features & Customization
Q1: Can I customize a health policy to fit my specific needs?
Yes, most insurance companies provide you the option of customizing your health care policy. Examples of add-ons would be maternity benefits, critical illness riders, outpatient costs, and/or wellness benefits. Customizing your health cover policy allows you to tailor your policy according to your age, your health status, and your family size while taking into account your budget; therefore, you will only pay for coverage that you need.
Q2: What additional coverage is typically offered with health insurance?
The most common examples of additional coverage available with medical insurance are hospitalization, outpatient care, baby care, critical illness insurance, daily cash allowance, pathology and wellness costs, dental and vision expenses, ambulance costs, and no-claims bonus. Each of these optional policies expands the level of protection beyond hospitalization provided under the standard health care plan.
Q3: How much mediclaim is enough?
When determining how much Cashless hospitalization coverage you need, you must consider your health risk, family size, and income. Most families will require mediclaim coverage of a minimum of Rs.3-5 lakh. Given the current trend of increasing healthcare costs, it is advisable to purchase enough coverage that will provide Rs.5-10 lakh in order to prevent having to pay out-of-pocket for healthcare expenses.
Q4: What is a good cover amount for health insurance?
A general rule of thumb for determining the right amount of health insurance coverage would be to purchase a policy that provides a minimum of Rs.5 lakh in coverage and up to Rs.50 lakh in coverage or more based on the size of your family or how high your health risk is. The exact amount you should purchase will depend on your previous medical history, your lifestyle, and potential future healthcare expenses.
Costs & Premiums
Q1: How do premium costs compare between health insurance and mediclaim?
Compared to comprehensive health plan, Mediclaim premiums will normally be less expensive than a comparable level of benefit due to the fewer number of benefits provided in the case of Cashless hospitalization. For example, an insurance policy that includes many optional coverages and has higher limits on claimable amounts will have a higher premium than a standard comprehensive health insurance policy. Premiums for individual individuals will vary based on age, health, amount of coverage, and insurer.
Q2: What is the minimum premium health plan?
The minimum medical plan premium is decided by each individual insurer & plan type. There are some basic health insurance policies that have premiums starting from as low as approx. Rs.3000 to Rs. 5000 pa (annually) for younger, healthier individuals and up to very low amounts of coverage.
Q3: What is a healthy premium plan?
A “healthy” medical plan premium is one that provides you with sufficient medical coverage while remaining reasonable in terms of cost (i.e., it should not subject you to excessive out-of-pocket expenses for covered medical services), as well as providing you the ability to increase the level of coverage or add on additional coverages as the need for the additional coverage arises because of the emergence of a change in your health situation.
Claims & Coverage
Q1: How does the coverage for pre- and post-hospitalization expenses differ?
Pre-hospitalization expenses are medical expenses that occur up to 30–60 days prior to a hospital admission. Test bills incurred prior to the hospital admission and doctor’s visits prior to the hospital admission may fall under this category. Post-hospitalization expenses are expenses that occur 30–90 days after a hospital discharge. Health insurance will typically cover both pre-hospitalization and post-hospitalization expenses; however, traditional cashless hospitalization policies typically cover neither type of expense.
Q2: What is the hospital discount at mediclaim?
Some insurance companies provide something they may refer to as a “hospital discount.” This discount is applied if you choose to receive a cashless method of treatment at one of the insurer’s “network hospitals.” Cashless treatment means you have to pay only part of your hospital bill upfront, or perhaps nothing upfront, and then the insurer pays the hospital for your treatment.
Q3: What is the rule of mediclaim?
There are certain rules associated with all cashless hospitalization policies. These policies all include their own specific limits (coverage limits) and waiting periods for pre-existing diseases. In addition, everything that is covered under a mediclaim policy is only for hospital inpatient expenses. Many times, an insured person will have to pay for a specific reason or item that is excluded from mediclaim. Some possibilities for exclusions are different treatments and conditions depending on each individual policy.
Q4: How do you compare mediclaim?
To determine the best available cashless hospitalization policy, you need to compare policies according to the following criteria:
Coverage limits, policy exclusion list, claim settlement ratio, amount of premium to be paid for sum insured coverage, list of hospitals that make up your insurer’s network, and any additional benefits that you may want to add to the policy.
Tax & Salary-Linked Questions
Q1: Is mediclaim taxable?
Mediclaim premiums are tax-deductible, but if you were reimbursed, you have no taxable income.
Q2: What is 80D mediclaim?
Section 80D provides individuals with an opportunity to claim deductions for premium payments made toward a Pre and post hospitalization expenses or health insurance policy. A taxpayer can claim this deduction up to a limit stated by the Internal Revenue Service.
Q3: How do you calculate mediclaim in salary?
Some employers provide Pre and post hospitalization expenses as a component of their salary package; others reimburse their employees directly for the cost of their employment-related insurance. The amount of taxable income received by the employee for reimbursements is dependent upon the employer’s mediclaim policy and change-of-law rules.
Q4: What is the minimum salary for mediclaim?
You do not need a minimum amount of salary to purchase a mediclaim insurance policy; anyone, regardless of their income or salary amount, can buy a Pre and post hospitalization expensespolicy, although the ability to afford to pay premiums will vary from employee to employee.
Government & Senior Citizen Schemes
Q1: What is PM Modi’s insurance scheme?
Under PM Modi’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) health care insurance scheme, coverage of up to Rs.500,000 per year per family for secondary and tertiary care hospitalization will be provided to eligible economically vulnerable families.
Q2: Who is eligible for the Ayushman card?
Economically disadvantaged families are eligible to receive an Ayushman Card. The Ayushman Card will provide access to the benefits of free healthcare insurance through the PM-JAY scheme. This is based on the Socio-Economic Caste Census (SECC).
Q3: What is PM 5 lakh health insurance?
The term “Rs.5 lakh” refers to the maximum insurance benefit provided by the Ayushman Bharat scheme, which will allow specified families to receive free hospitalization for eligible claimable treatment.
Q4: Which is the best government mediclaim?
PM-Ayushman Bharat (PM-JAY) is India’s leading government health plan & Pre and post hospitalization plan, the best government health cover plan for families with lower incomes. The plan has the widest available coverage and cashless hospitalization benefits.
Q5: What is the senior citizen mediclaim policy?
Senior citizen Pre and post hospitalization policies cover individuals 60 years old and over, usually have higher premiums than standard medical insurance policies, cover hospitalization, and provide benefits for illnesses based on age.
Q6: What is the scheme for 70+ people?
Some insurers and government agencies offer specialized health plans for 70+, covering diseases related to their age with little paperwork but higher premiums generally.
Life Insurance vs Health Insurance
Q1: Do I need both health and life insurance?
Yes, you need both types of insurance. Health care covers medical bills. Life insurance ensures that your family has a steady stream of income if something happens to you. Both types of insurance will provide you with complete protection.
Q2: Which is better, LIC or health insurance?
LIC mainly sells products that guarantee death benefits, but they do provide some health care options. Most of their products only provide health benefits if you purchase a specific rider for them. Private or public insurers generally provide better coverage for health coverage than LIC.
Q3: What is the limit of LIC medical insurance?
LIC has policies and riders related to health, but the coverage amounts vary based on the plan selected. In general, dedicated health policies provide a greater amount of coverage than LIC.
