Medical Insurance or Health Insurance or Mediclaim Policy are all used interchangeably - and refer to an insurance policy taken to cover expenses related to hospitalisation & medical treatment. The policy is taken to protect one-self from the financial burden of high Medical expenses in case he/she or a loved one has to undergo Medical treatment due to illness or accident.

The annual premium on a Medical Insurance policy is the obvious cost of taking the cover. However, the policy with lowest premium is not necessarily the best policy for you. One should consider many factors before deciding on which Medical Insurance policy to choose. Some of the factors to be considered are mentioned below:
  1. Maximum Renewal Age - Some policies guarantee renewal only upto a certain age. What if the policyholder wants to be covered beyond that age. It is almost impossible to get a new medical insurance policy beyond 75 years of age. Even if entry after 75 years age is allowed, there will be restrictions on maximum Sum Insured allowed, etc.
  2. Co-Pay - Some policies require the policyholder to bear a certain percentage of the hospital bill. This is referred to as Co-Pay. Eg. if a policy specifies 10% Co-pay, it implies that the policyholder has to bear 10% of the claim amount. Policies with higher Co-Pay will have a lower premium, other things being equal.
  3. Sub-Limits - A majority of the Mediclaim policies specify sub-limits on certain expenses. For example:
      • Room Rent per day: This is the maximum amount the insurance company will reimburse for hospital room rent. Generally the limit is 1%. Therefore, if the policy Sum Insured is Rs. 3,00,000 the maximum room rent reimbursement will be Rs. 3,000 per day.
      • Surgeon Fees/Doctor Fees : The policy may limit the Doctor's / Surgeon's fee to 25% of Sum Insured. 
  4. Claim based Loading - If there are claims in the policy, the Company may charge higher renewal premiums. In certain policies, the claim based loading can go as high as 200% depending on claim history!!
The above list is not exhaustive. It is advisable to read through the detailed Terms & Conditions (referred to as Policy Wording) before taking the policy.

  1. INDIVIDUAL POLICY: This type of policy covers the medical expenses of one individual only. To cover other family members, separate Individual policies can be taken. Same/different Sum Insured can be chosen for each family member.
  2. FAMILY FLOATER POLICY: As the name suggests, the Sum Insured 'floats' among the family members covered by the policy. Example - A 5 Lakh Sum Insured floater policy for a family of 4 persons would cover any one/all members for Rs. 5 lakhs during the year.
  3. TOP-UP POLICY: A Top-up mediclaim policy is a most suitable, low-cost option for people who already have a Mediclaim Policy (from their organization or taken on their own) and would like to enhance the cover significantly. Such policies cover the expenses only if the medical bill crosses a certain 'Deductible' amount. For example, a Top-up policy starting from 2 lakhs upto 7 lakhs will come into play only if the medical treatment cost exceeds Rs. 2 lakhs and will reimburse the bill amount beyond Rs. 2 lakhs and upto Rs. 7 lakhs.