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Mediclaim policy: Tips for selecting an appropriate policy

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Having a comprehensive mediclaim policy is essential to safeguard yourself and your family against unforeseen medical expenses. A mediclaim policy, also known as a health insurance policy, provides financial coverage for medical treatments and hospitalisation expenses. With rising healthcare costs, investing in the best health insurance plans becomes crucial to ensure access to quality healthcare without worrying about the financial burden. This article aims to guide you through the process of selecting an apt mediclaim policy, providing essential tips to help you make an informed decision.

Pre-existing condition coverage

Check if the policy covers pre-existing medical conditions, as some policies have a waiting period before they provide coverage for such conditions.

Assess your needs

Start by assessing your particular medical needs, including medical history, age, and any existing medical condition. This evaluation will assist you decide the cover you need. 

Coverage amount

Opt for a policy that offers adequate coverage based on your healthcare needs and affordability. Consider the rising medical costs and choose a coverage amount that can sufficiently protect you in case of emergencies.

Cashless hospital network

Ensure that the policy has a wide network of cashless hospitals in your area. This feature allows you to avail treatment without making any upfront payments.

Daycare procedures

Check if the policy covers expenses for daycare procedures, such as cataract surgery or dialysis, which do not require hospitalisation exceeding 24 hours.

In-patient hospitalisation

Verify that the policy covers expenses related to in-patient hospitalisation, including room charges, doctor’s fees, nursing charges, and surgical expenses.

Out-patient department (OPD) coverage

Consider policies that offer OPD coverage, including doctor consultations, diagnostic tests, and medications, as these expenses can add up significantly.

No Claim Bonus (NCB)

Look for policies that offer NCB benefits, which provide a bonus or increased coverage for every claim-free year.

Maternity coverage

If you are planning to start a family, opt for a policy that provides maternity coverage, including pre-natal and post-natal expenses, delivery charges, and newborn baby coverage.

Network hospitals

Check if the policy includes reputed hospitals in its network, ensuring easy access to quality healthcare facilities.

Sub-limits and co-payments

Understand the policy’s sub-limits and co-payment requirements, as these may affect the claim settlement process. Avoid policies with excessive sub-limits or high co-payment percentages.

Waiting periods

Be aware of the waiting period for specific treatments, as some policies have waiting periods for pre-existing conditions, certain illnesses, and specific procedures.

Claim settlement ratio

Research the insurer’s claim settlement ratio, indicating their efficiency in settling claims. Choose a provider with a higher ratio to avoid any hassles during the claim process.


Carefully review the policy’s list of exclusions to understand what conditions or treatments are not covered. Compare policies to find the one with the least number of exclusions.

Premium amount

Compare the premiums of different policies, taking into account the coverage provided. Choose a policy that offers a balance between coverage and affordability.


Opt for a policy that offers lifelong renewability to ensure coverage during old age when the need for medical care increases.

Co-payment options

Evaluate if the policy allows for co-payment options, wherein you share a percentage of the medical expenses. This can help reduce the premium amount.

Alternative treatment coverage

If you prefer alternative treatments such as Ayurveda or Homeopathy, consider policies that cover these treatments to meet your specific healthcare preferences.

No-claim periods

Check if the policy offers a grace period after a claim is made, during which you can make subsequent claims without losing any NCB benefits.

Hospital daily cash allowance

Look for policies that provide a daily cash allowance during hospitalisation to cover incidental expenses not covered by the policy.

Premium loading

Understand if the mediclaim policy has premium loading based on age or claim history, as this can affect the affordability of the policy in the long run.

Geographic coverage

If you frequently travel outside India, choose a policy that offers international coverage, ensuring you receive medical treatment even when abroad.

Customer support

Consider the insurer’s reputation for customer support and their responsiveness in handling queries and claim-related issues.

Read the policy document

Thoroughly read and understand the policy document, including terms, conditions, and exclusions, before making a final decision. Seek clarification from the insurer if required.

Family floater plans

If you want to cover your entire family, explore family floater plans that provide coverage for all family members under a single policy.

Network of specialists

Check if the policy includes a network of specialists, such as cardiologists, orthopaedic surgeons, or neurologists. Having access to specialised healthcare professionals can ensure better treatment for specific medical conditions.

Exclusions for the waiting period

Be aware of any specific exclusions during the waiting period. Some policies may not cover certain illnesses or treatments during the initial waiting period, even if they are not pre-existing conditions. Understanding these exclusions will help you plan accordingly.

Wellness benefits

Factor in insurance that provide wellness benefits like preventive screenings, and check-ups, and covers fitness programs. Such benefits assist you maintain a good lifestyle and figure out potential medical conditions at an initial stage. 

Online policy purchase and renewal

Consider policies that offer the convenience of online purchase and renewal. Online platforms provide easy access to policy information, instant quotes, and hassle-free transactions, saving time and effort.

Health insurance portability

In the case you already hold a medical policy and are looking to switch, look for insurance that provides health policy portability. This permits you to easily transfer your prevailing policy benefits involving NCB, waiting periods, and coverage to new insurance without losing accrued benefits. 


In a time where healthcare costs continue to rise, investing in a comprehensive mediclaim policy is a wise decision. By considering these tips, you can confidently choose an appropriate health insurance plan that meets your specific needs. Remember, safeguarding your health and financial well-being through the best health insurance plans is essential, as no mediclaim can exhaust the entire corpus saved for long-term goals like retirement or a child’s higher education. Prioritise your health and secure your future by selecting the right mediclaim policy.

Also Read: 5 Must-Have Features in Healthcare Revenue Cycle Management Software



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