Mediclaim Policy Queries

What is a Mediclaim Policy?

The ‘MEDICLAIM’ is the scheme of Health Insurance Coverage which takes care of medical expenses following hospitalization / domiciliary expenditure of the insured for treatment of any disease or Bodily injury through an accident.

What all Insurance companies offer medicliam policies?

Presently the Mediclaim policies are offer by 4 subsidiaries of GIC and some other Private Insurance companies.

Are Mediclaim policies available with GHPL?

GHPL does not directly market these policies. You can purchase this policy from the Insurance Company directly or get in touch with your insurance agent.

Who can be the beneficiaries of the Mediclaim Policy?

As per the Insurance Company Definition, the insurance is available to any person between the age of 3 Months and 75 years. A family includes

  1. The person insured
  2. Spouse
  3. Eligible dependant Children
  4. Dependant Parents

What is the coverage of a mediclaim policy?

In general, the Policy covers reimbursement of Hospital / Nursing Home expenses incurred by the insured as an inpatient for treatment of any disease or Bodily injury through an accident. The expense incurred in the policy period, covered up to a maximum of the sum insured in aggregate are:

Room, Boarding Expenses as provided by the Hospital / Nursing Home, Nursing Expenses, Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists fees.

Anesthesia, Blood, Oxygen, OT Charges, Surgical appliances, Medicine and Drugs, Diagnostic Materials and X-Ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs & Cost of Organs and Similar Expenses.

Is Domiciliary Hospitalization covered under the mediclaim Policy?

For Domiciliary Hospitalization to be covered it should fulfill the following conditions:

Medical Treatment must exceed 3 Days and Condition of the patient is such that he cannot be removed to a Hospital / Nursing Home or Accommodation in a Hospital / Nursing Home not available.

The Domiciliary Hospitalization Benefits do not cover the following Diseases: Asthma, Bronchitis, Chronic Nephritis and Nephritic syndrome, Diarrhea and all type of Dysenteries including Gastro-enteritis, Diabetes Mellitus and Insipides, Epilepsy, Hypertension, Influenza cough & cold, all Psychiatric & Psychosomatic Disorders, Pyrexia of unknown origin for less than 10 days, Tonsillitis and upper Respiratory Tract infection including Laryngitis and Pharingitis, Arthritis, Gout and Rheumatism.

Are Maternity expenses covered under the policy?

This is an optional cover which can be obtained by payment of additional premium under the policy.

Are Outpatient Consultation / Treatment and Diagnostics covered under the insurance policy?

Outpatient Consultation / Treatment is NOT covered under the insurance policy. Charges incurred at the Hospital or Nursing Home primarily for diagnostic, X-Ray or Laboratory Examinations not consistent with or incidental to the diagnosis and treatment of the positive existence or presence of any ailment, sickness or injury, for which confinement is required at a Hospital / Nursing Home are not covered under the policy.

Are eligible medical expenses incurred in another country, Reimbursable under the policy?

Till now, the medical expenses for treatment of ailments that are incurred overseas are not covered by GHPL.

What is the procedure to be followed in case when the newborn needs to be enrolled in the middle of the policy (only in Group Insurance policies), or the name of self or the dependant be changed?

In such case, the request for inclusion / Change should be forwarded to the HR of the company, who in turn will forward it to the Insurance company and GHPL. Please note that the baby should have completed 3 months of age, copy of all appropriate certificates like Birth Certificate, Change of name affidavit etc need to be enclosed.