All you Need to Know About Mediclaim Before you Purchase it

Both the terms mediclaim and health insurance are interchangeably used in insurance policies since the coverage is offered in terms of medical benefits, hospitalization expenses and more. Well, the term ‘hospitalization expenses’ refers to the tie-up between the insurance company and various hospitals across the country, which is aimed at providing medical benefits to their customers. 

In other words, you can avail medical benefits at any of the network hospitals under the cashless facility. Therefore, make sure you have a network hospital in your nearby area so that you can get the maximum benefit in the least possible time. Also, you have two options when it comes to hospitalization. Listed below are the choices offered by the best mediclaim policy you should choose:

II.Unplanned Hospitalization: In this case, you undergo a medical emergency that leads to emergency hospitalization.

No matter which option you choose out of the above ones, the policy does cover your medical expenses and you do not have to pay even a single penny out of your own pocket unless you chose the ‘Co-pay’ option when purchasing the policy. The insurance company is liable to take care of your medical expenses subject to the maximum limit of coverage (i.e. sum assured) as per the policy documents.

If you are planning hospitalization, it’s your plan when to get hospitalized and at which network hospital, preferably at a nearby location. Meanwhile, you need to keep the TPA informed about your plan to get hospitalized. Also, you need to submit a duly filled claim reimbursement form to let the insurer process your case. Based on your mediclaim type and other terms, your claim can be accepted or rejected while the terms are mentioned in the documents already.

Know more-: About health insurance provides in India

In case you get your claim approved, you can go to the hospital and get admitted to availing the required treatment without fussing about the medical expenses. In case your insurer does not agree to allow you for the cashless facility, you can later file a claim for expense reimbursement.

The insurance company or your TPA might reject your claim because of some unsuitable conditions while you can always go for the claim for expense reimbursement. For this, you have to first discharge from the hospital, and then you get the required documents from the hospital. Once you get those documents (such as hospital discharge summary, medical bills, and other documents) from the hospital or doctor, you can attach the required ones with the claim form and submit it physically in the branch of the insurance company you purchase the policy from.

Note: In case your insurance company is not reachable due to any scenario, you can get in touch with your TPA and let them know about the claim.