Mediclaim: An Overview

What is Mediclaim?

Mediclaim insurance is a kind of health insurance that covers the cost of hospitalization in case of medical emergencies caused by illness or accidents.

Why should one opt for Mediclaim Policy?

Healthcare costs in India are only rising and since medical emergencies come unannounced, opting for Mediclaim is a financially prudent measure.

Types of Mediclaim policies in India

Individual Mediclaim- Covers only one individual.

Family floater Mediclaim- Provides coverage to one’s entire family consisting of one’s self, spouse and dependent parents and children. The sum assured can be shared by the entire family or even availed by a single member.

Points to consider while purchasing Mediclaim

With a number of options available in the market, here are some pointers to help you choose the best Mediclaim in India.

Health Care Coverage – Check what is covered by the policy you plan to opt for. Opt for a policy with a high sum insured.

Co-Payment - Co-payment is the predetermined percentage of the cost of treatment the insurance provider requires you to bear. Opt for a policy with no or low co-payment.

Check treatment-specific sub-limits – Sometimes insurers agree to bear only a limited part of the cost of treatment for certain ailments such as cataract, cardiac treatments, etc. Make sure to check the illnesses to which such sub-limits apply.

Waiting Period – Most insurers accept claims for certain illnesses only after a specified waiting period. Make sure to compare waiting periods and make sure to choose a policy with a reasonably short one.

Network Hospitals – Mediclaim providers only reimburse claims for treatment availed at hospitals registered in their network. Pick a provider who has a decent network in your locality.

Policy Exclusions - Make sure you know what illnesses your policy does not cover in order to avoid receiving unpleasant shocks at the time of filing claims. Some treatments commonly excluded are HIV/ AIDS, dental treatments, cosmetic surgery, pregnancy-related costs, etc.

Mediclaim Procedures

Cashless procedure

In a cashless procedure, when the insured avails of treatment with a network hospital, the insurance company directly settles the bill with the hospital (up to the sum assured), and the insured doesn’t have to make any payment out of his pocket at all.

How to make a claim?

To avail of a cashless procedure, the policyholder has to obtain a pre-authorization form from the insurance company’s desk at the hospital, fill it and submit it for approval. After being stamped by the doctor and the hospital it is sent to the insurance company, which after careful examination approves a specific sum for the treatment.


In the case of reimbursement, the policyholder pays the costs incurred. The insurance company reimburses the policyholder later.

How to make a claim

In the case of reimbursement, it is extremely important to inform the Mediclaim insurance company that a hospitalization has occurred or is likely to take place in the near future. This can be done over a call or by writing a mail. To get reimbursement, one needs to submit all bills, receipts and original discharge papers to the insurance company.


ManipalCigna Health Insurance Company Ltd (Formerly known as CignaTTK Health Insurance Company Limited) | CIN U66000MH2012PLC227948 | IRDAI Reg. No. 151 
Reg. Office: 401/402, 4th Floor, Raheja Titanium, off. Western Express Highway, Goregaon (East), Mumbai- 400 063 | Toll free number – 1800-102-4462 | Website address –
Trade Name / Trade Logo belongs to MEMG International India Private Limited and Cigna Intellectual Property Inc. and is being used by ManipalCigna Health Insurance Company Limited under license. For more details on risk factors, terms and conditions, please read the sales brochure/ sales document available on our website (Download section) before concluding a sale.

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