Mediclaim Policy

In today’s fast-paced world, where health risks are on the rise, securing a mediclaim policy isn’t just an option—it’s a necessity. At Digibima, we understand the importance of having a comprehensive healthcare safety net, and a mediclaim policy serves just that purpose. This article aims to demystify the complexities of mediclaim policies, ensuring that you, as a consumer, are well-informed to make the best decisions for your health and financial well-being.

What is a Mediclaim Policy?

A Mediclaim policy is a type of health insurance that provides coverage for medical expenses incurred due to illnesses or accidents. It typically covers hospitalization expenses, pre and post-hospitalization charges, and sometimes day-care procedures. The objective is to mitigate the financial burden during medical emergencies, allowing you to focus solely on recovery.

Who Is Mediclaim For?

Mediclaim policies are designed to cater to a wide array of individuals and families, ensuring everyone can find a plan that suits their specific health and financial needs. Here’s who can benefit most from a mediclaim policy:


  • Young Professionals: Starting early with a mediclaim policy can be advantageous as premiums are lower for younger individuals and it helps cover unexpected medical emergencies without depleting savings.
  • Families with Children: Families can opt for family floater plans that cover the spouse and children under a single sum insured, which is more cost-effective than individual plans and ensures that all family members are protected.
  • Senior Citizens: Older adults often face more health issues and having a mediclaim policy means they have access to the best medical treatment without worrying about high medical costs.
  • Individuals with Pre-existing Conditions: People with chronic health issues can benefit from a mediclaim policy as it covers the cost of regular medical treatment after the initial waiting period is completed.
  • Business Owners and Self-employed Individuals: Those who do not benefit from corporate health plans should consider a mediclaim policy to avoid financial disruptions due to health issues.

Key Features of Mediclaim Policies

  • Cashless Treatment: Most mediclaim policies come with a cashless treatment option where the insurance company directly settles the bills with the network hospitals.
  • Cumulative Bonus: For every claim-free year, many insurers offer a cumulative bonus, which either increases the sum insured or decreases the premium for the next year.
  • Tax Benefits: Premiums paid towards mediclaim policies are eligible for tax deductions under Section 80D of the Income Tax Act, providing dual benefits of health coverage and tax savings.

How Does a Mediclaim Policy Work?

Understanding the inner workings of a mediclaim policy will empower you to utilize it effectively. Here’s a simple scenario:


Suppose Mr. Sharma has a mediclaim policy with a sum insured of Rs. 5 lakhs. Unfortunately, he meets with an accident and is hospitalized. The total medical expenses amount to Rs. 2 lakhs. Mr. Sharma notifies his insurer about his hospitalization. Given that he is admitted to a network hospital, he chooses cashless treatment. The insurer evaluates the claim and directly settles the bill with the hospital. Mr. Sharma focuses on his recovery without worrying about the financial implications.


This scenario highlights the cashless benefit of mediclaim policies, showcasing how crucial they are during medical emergencies.

Choosing the Right Mediclaim Policy

With myriad options available, choosing the right mediclaim policy can be daunting. Here are some tips to help you select the most suitable one:


  • Assess Your Health Needs: Consider your and your family’s health conditions, age, and medical history.
  • Compare Policies: Use platforms like Digibima to compare different mediclaim policies on coverage, premium, exclusions, and other features.
  • Read the Fine Print: Understand the terms and conditions, especially the exclusions and waiting periods for certain diseases.

Real-Life Example to Illustrate Benefits

Consider the case of Mrs. Gupta, who purchased a mediclaim policy covering her family of four. During a routine medical check-up, a critical illness was diagnosed early, and the policy covered the expensive treatment without any hassle. This not only provided financial relief but also ensured quality medical care, demonstrating the significant impact of having a reliable mediclaim policy.


A mediclaim policy is an essential component of your financial planning, providing a safety net against medical emergencies. Understanding its basics and inner workings can significantly ease the process of choosing and utilizing your mediclaim policy effectively. 

At Digibima, our commitment is to guide you through the intricacies of mediclaim policies. We aim to assist you in making well-informed decisions that resonate with both your health requirements and financial objectives. Protect yourself and your loved ones by choosing the right mediclaim policy today!

FAQs about Mediclaim Policies

Q1. What is the difference between mediclaim and health insurance?

Mediclaim coverage focuses solely on hospitalization and associated expenses. In contrast, health insurance provides a wider scope of coverage, encompassing critical illness and benefits related to accidents.


Q2. Can I include my family members in one mediclaim policy?

Yes, most mediclaim policies offer a family floater plan, where you can include your spouse, children, and sometimes dependent parents.


Q3. Are all pre-existing diseases covered by mediclaim policies?

Coverage for pre-existing diseases is usually subject to a waiting period, which varies from one insurer to another.


Q4. How can I claim my mediclaim?

You have two options for claiming your mediclaim. The first is utilizing the cashless facility at network hospitals. Alternatively, you can opt for reimbursement by providing the insurer with the necessary bills and documents.


Q5. Does a mediclaim policy cover maternity expenses?

Some mediclaim policies cover maternity expenses, but they come with a waiting period and might have different terms, so it’s crucial to check the policy details.