Healthcare expenses have steadily risen over the past decade, and for many individuals and families, an unexpected hospital visit can disrupt monthly finances. There can be specialist consultations, surgeries and post-treatment care involved, and even a short hospital stay can cost tens of thousands of rupees. In this environment, having a mediclaim policy is no longer optional.
How Does a Mediclaim Policy Work?
When you buy a mediclaim policy, you pay a fixed premium in exchange for a promised cover amount. This amount can be used to either:
- Pay directly at partner (network) hospitals through cashless claims.
- Get reimbursed after you pay the bills out of your own pocket first.
The policy remains active for a fixed period, after which it must be renewed. If you continue without claims, many policies also offer No-Claim Bonuses, which effectively increase your overall coverage over time at no extra cost to you.
And if you choose a premium policy that includes critical illness cover, you also receive a lump sum payout upon diagnosis of listed illnesses like cancer, heart attack, or kidney failure.
Understanding the Claim Settlement Ratio and Its Importance
The Claim Settlement Ratio is a number that shows the percentage of claims received in a year that the insurer settles. A high ratio, usually above 95%, is generally a sign that the company processes claims smoothly and accepts them unnecessarily.
Premium providers like Axis Max Life Insurance maintain a Claim Settlement Ratio of 99.70%, which gives you some sense of how well they support policyholders when it matters most. When comparing policies, especially online, don’t just look at premium costs or flashy features but dig a little deeper. A lower-cost plan with a poor claim track record is no real help in an emergency.
Different Types of Mediclaim Policies You Can Choose From
Depending on your age, family structure, and health risks, you’ll need to choose between different formats. Fortunately, there are several types available to us in India. The common ones are listed below to help you better understand how they differ from each other and which one is the right one for you.
| Policy Type | Who It’s For | Key Features |
| Individual Mediclaim | For solo coverage | Fixed insured amount for one person; can claim the entire cover if needed. |
| Family-Floater Mediclaim | Families with dependents | Shared sum insured for spouse, children, and sometimes parents. |
| Senior Citizen Mediclaim | Individuals above 60 years | Tailored coverage for age-related conditions; usually higher premiums. |
| Critical Illness Mediclaim | Anyone with a higher risk or family history | Lump sum on diagnosis of listed critical illnesses; covers loss of income too. |
| Group Mediclaim | Employees or group members | Typically offered by employers, limited personalisation, but valuable for basic cover. |
What’s Covered Under Most Mediclaim Policies
What’s included in a mediclaim policy can vary from one provider to another, but some of the features you can expect from a comprehensive plan are as follows.
- In-patient hospitalisation: For stays longer than 24 hours.
- Daycare procedures: Like cataract surgery or chemotherapy that don’t require overnight admission.
- Pre- and post-hospitalisation expenses: Covers diagnostics, scans, medicines, and doctor visits up to a certain window before and after admission.
- Domiciliary treatment: If hospitalisation isn’t possible, treatment at home may be allowed.
- Preventive health checkups: Included in many plans if you haven’t made any claims for a few years.
What’s Not Covered In Most Mediclaim Policies and Why You Should Know
Not all medical costs are eligible for claims. Most mediclaim policies exclude the following, and it’s important to read the fine print, because understanding what isn’t covered helps you avoid surprises during a claim.
- Pre-existing conditions until after the waiting period (usually 1–4 years).
- Alternative treatments, such as Ayurveda, homoeopathy, and acupuncture, are not included unless otherwise specified in the policy document.
- Cosmetic surgeries are not medically required after accidents.
- Diseases like HIV/AIDS which are often permanently excluded.
- Congenital disorders or birth conditions are covered in most standard plans.
Tax Benefits of Mediclaim are a Hidden Advantage
Many people know that mediclaim helps with medical bills. But fewer realise it also reduces your tax repercussions in a financial year. You can claim deductions for the premium paid for yourself and family, under Section 80D (under the old tax regime). Depending on the age and number of people covered, you could save up to ₹46,800 in taxes per year.
| Who You’re Insuring | Deduction Limit |
| Yourself + Spouse + Kids | ₹25,000 |
| Parents (below 60 years) | Additional ₹25,000 |
| Parents (above 60 years) | Additional ₹50,000 |
| If You and your Parents are both above 60 | ₹50,000 + ₹50,000 = ₹1 Lakh |
Tax is just one part of the value. But in a year when you don’t fall ill, this benefit still makes your policy worthwhile.
Cashless or Reimbursement and Which Claim Process Works Better?
Most reputable insurers offer both cashless and reimbursement options, but cashless claims are the more convenient choice if you’re admitted to a network hospital.
| Claim Type | How It Works | When It’s Useful |
| Cashless Claim | You inform the insurer and get pre-authorisation. Bills are settled directly with the hospital. | Useful for planned surgeries or emergencies at network hospitals. |
| Reimbursement Claim | You pay out of pocket first, then submit documents for the claim. | Works when the hospital isn’t on the network or when cashless is denied. |
Conclusion
Buying a mediclaim policy is never about checking a box for financial planning. On the contrary, it is about being practical about your savings and maintaining dignity during difficult times. A policy that covers you well today will serve you far more than a savings account you didn’t have to break.
Premium insurance providers like Axis Max Life Insurance offer a wide range of health-linked covers and smart claim features, backed by a trusted track record. Whether you’re just starting out or updating your cover mid-career, don’t delay this step.
When you look at rising healthcare costs, evolving lifestyles, and inflation in the medical sector, there’s really only one conclusion: the earlier you start, the better your safety net will be.
Standard T&C apply
Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms and conditions, please read the sales brochure/policy wording carefully before concluding a sale.
Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on several secondary sources on the internet and is subject to changes. Please consult an expert before making any related decisions.
Tax benefit is subject to change as per the prevailing tax laws.
