Imagine you have an extremely important and challenging exam coming up, but you decide not to study for it. Unsurprisingly, on the day of results, you see that you have failed. This analogy can be applied to several aspects of our daily lives, one of them being insurance. When people decide to buy health insurance without conducting thorough research, they end up making critical mistakes.
One common mistake is assuming that mediclaim is the same as health insurance. In reality, it’s a form of insurance that provides financial assistance and protection during hospitalisation due to accidents or illnesses. It is available in several categories such as family floater mediclaim, critical illness mediclaim, senior citizen mediclaim, mediclaim for pregnancy, overseas mediclaim policy, and group mediclaim policy.
Mediclaim Policy Explained
As already mentioned, mediclaim provides specific financial protection against expenses due to hospitalisation as a result of accident or illness. Unlike health insurance, mediclaim does not provide add-ons like infertility cover, critical illness, and room-rent waiver.
Instead, there are different categories of mediclaim, and you can choose the one that is best suited to your requirements. Now, let’s take a look at what is covered in mediclaim policy:
- Medical expenses incurred during hospitalisation, such as diagnostic tests and procedures, medicines, X-ray, oxygen, and operation theatre charges. Some mediclaim policies also include coverage for 30 days pre and 60 days post-hospitalisation.
- ICU or regular room charges are also included in mediclaim.
- Surgeon, nurse, and doctor consultation fees are covered under this policy.
- Medical expenses for day care treatment where patients do not have to be hospitalised for more than 24 hours.
As with other insurance policies, there are some exclusions under mediclaim as well. Some of these include dental treatments, vaccinations, non-medical expenses like administrative expenses and service charges, hormonal treatments, STDs, cosmetic surgery, and birth control.
Mediclaim for Pregnancy
Mediclaim for pregnancy is one of the more flexible categories in terms of the inclusions and exclusions provided. A mediclaim for pregnancy policy can be an individual plan or even a family floater plan. However, in the case of the family floater plan, you get maternity coverage once a predetermined amount from the base policy is used.
Furthermore, a key aspect of mediclaim pregnancy coverage is that there is a waiting period present as well. A waiting period, in insurance terms, is defined as the period before the activation of the insurance coverage.
In other words, you cannot submit a claim to your insurance provider before a certain period of time elapses. In the case of pregnancy mediclaim, the waiting period is usually 2-4 years.
A pregnancy mediclaim policy includes certain specialised elements, such as:
- Coverage for normal and caesarean delivery across partner hospitals.
- Room charges are also covered in pregnancy mediclaim.
- Pre- and Post- Hospitalisation charges relating to maternity are also covered. Notably, this is only applicable for 30 days pre-delivery and 60 days post-delivery.
- Post-delivery complications may or may not be included as this depends on the insurance provider.
Things to Consider
Here are some of the things to keep in mind when purchasing mediclaim for pregnancy:
1. Sum Insured
When deciding on a mediclaim policy, ensure that the coverage amount is adequate and meets your requirements. Even if you pay a higher premium, it is worth it since the mediclaim policy chosen would be based on your needs.
2. Waiting Period
As mentioned earlier, mediclaim policies have a waiting period. The same holds for mediclaim for pregnancy as well. Hence, you should purchase your pregnancy mediclaim policy 2-3 years before planning your pregnancy.
While choosing your mediclaim for pregnancy plan, study the co-payment clause in the policy papers thoroughly. According to the co-payment clause, the policyholder pays a part of the claim, while the insurance provider covers the remaining amount. Thus, carefully choose a plan that limits your co-payment percentage.
4. Network Hospitals
Another important aspect to sensibly consider when choosing your mediclaim policy is the insurance provider’s hospital network. A larger hospital network might be beneficial for you, and it would also provide you with cashless benefits and claims.
Mediclaim for pregnancy or health insurance with pregnancy cover? It all depends on your perspective and several other aspects like your financial condition, low premiums or high premiums, and short-term planning or long-term planning.
Ultimately, carry out your research, keeping in mind the importance of choosing reliable insurance providers such as Care Health Insurance who provide a variety of benefits with their maternity plans. So, use the information available wisely and decide because only you know what is best for your family and you.