It’s an Agreement between Insurance co. /TPA and Hospital to decrease the financial burden of the mediclaim card holders at the time hospitalization.

Mediclaim Insurance is a hospitalization benefit policy issued by Public & Private Sector General Insurance Companies (Life Insurance Companies for critical illness). The policy takes care of unforeseen medical expenses for a specific sum assured limit of the insured in case of:

• Sudden Illness
• An Accident
• A Surgery / Surgeries

In case of hospitalization you need to inform the respective TPA / Insurance Co. within 24 hrs. For more details please refer to cashless claim procedure available on their website for details.

List of documents required for availing hospitalization claim: -  Following documents in Original are required: -

• Intimation Letter.
• Completed claim form duly signed by insured.
• Discharge summary.
• Hospital bill with complete break up.
• Investigation reports along with X-Ray films.
• Pharmacy bills.
• Payment receipt including Advance Payment.
• Registration certificate of non network hospital/ nursing home.
• TPA / Insurer Health Card Copy.
• Cancelled Cheque having name of the insured.
• One copy of  PAN card and photo Id card  (self attested)

Yes, one can file a claim for reimbursement of the Pre & Post hospitalization expenses to their respective TPA / Insurance Co.

There are certain diseases that are not covered under the policy for a Particular time period after the Inception and few diseases are never covered as mentioned in the exclusion clauses of the Policy. These are called exclusions.

Below are some medical treatments & expenses which are generally not covered by most of the Insurance Co.:

• Any pre existing disease that was diagnosed 36/48 months prior to policy issuance.
• Any disease contracted during first 30 days of the inception of the policy, except those arising out of the accident.
• Medical expenses incurred on HIV/STD.
• By Birth (Congenital) disease.
• Test/treatment related to infertility and vitro fertilization (IVF).
• Accident taking place in an inebriated state.
• Payment receipt including Advance Payment.
• Expenses attributable to self-inflicted injury, including suicide attempt or suicide Person committed or attempting to commit criminal or illegal activity.
• TPA / Insurer Health Card Copy.
• Any individual’s participation in military, air force operations, racing, parachute jump, mountain climbing and any other such dangerous activities.
• Cost of spectacles, dental check-up and any other cosmetic surgery.

Charges for diagnostic test consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury are payable only as a part of pre & post hospitalization claim. It is not payable for OPD patients when there is no hospitalization.

No, Surgery for correction of eyesight due to refractive error is not covered. Treatment of obesity or any weight control and management programme /services/supplies or treatment is not covered