A Mediclaim policy is your financial safety net in the face of rising medical expenses. Whether you’re buying it for yourself, your family, or your team now is the time to invest in health security. This blog covers everything you need to know about Mediclaim: its meaning, benefits, inclusions, exclusions, types, and top policies in India. Whether you're an individual or an employer, learn how Mediclaim can protect both your health and your finances
On a fine Friday evening, I went out to buy shawarma! Before I could reach the nearest shawarma outlet, I met with an accident. The moment I gained consciousness I figured out that I dislocated my shoulder. I was immediately taken to hospital and the doctor suggested my parents go for arthroscopic surgery. Without any second thought, my father proceeded with the paperwork. It was a day in surgery that lasted around 2 hours. The next morning the doctor told me that I can go back home. The nurse took my dad to reception for payment and there it was a six-digit long unappealing number! Yes, this couple of hours and overnight stay cost my father around 3 lakh rupees. Now with that much amount, I could have had shawarma for the rest of my life. As I was discussing this incident with my friend, he suggested a Mediclaim policy. Now this policy will work as a lifesaver. Had I known about this earlier, maybe I could have saved all that money gone for nothing.
Mediclaim policy is a type of insurance policy where the insurance company covers or reimburses the expenses incurred for the treatment of the medical condition to the policyholder. Some of the highlights of this policy are:
Medical inflation in India is rising at 14% annually (PwC India 2023), making Mediclaim policies essential for financial protection.
Due to the increased medical inflation rate, Mediclaim policies are a necessity for people to make healthcare affordable. This policy covers medical treatment for illness and hospitalization charges up to the insured amount. This policy is valid for a certain period and policyholders will have to renew to enjoy the benefits.
Also read: Why should Millennials invest in Health Insurance
Mediclaim policies are designed to meet different healthcare needs based on age, family structure, medical risk, and employment status. Choosing the right type depends on who needs coverage and how medical expenses are likely to arise.
An individual Mediclaim policy covers a single person under a fixed sum insured. The entire coverage is dedicated to that individual and cannot be shared with others.
2. Family floater mediclaim policy
A family floater Mediclaim policy covers multiple family members, usually the policyholder, spouse, children, and sometimes parents under one common sum insured. Any family member can use the insured amount during the policy year. This makes it more affordable than buying separate individual policies, especially when all members are relatively healthy.
A senior citizen mediclaim policy is designed for individuals aged 60 years and above. These policies cover age-related illnesses such as heart disease, diabetes, arthritis, and hypertension. Since medical risks are higher, these policies often come with higher premiums, waiting periods, and co-payment clauses, but they provide crucial financial support during medical emergencies.
A critical illness Mediclaim policy provides coverage for serious, life-threatening conditions such as cancer, heart attack, stroke, or kidney failure. Some plans offer a lump-sum payout upon diagnosis, while others reimburse hospitalization expenses related to the illness. The payout can also be used for non-medical costs like long-term treatment, recovery, or income loss.
A personal accident policy offers financial protection against accidental death, permanent disability, or partial disability caused by accidents. It does not cover illness-related hospitalization but acts as a strong supplement to a Mediclaim policy by covering accident-related risks and income loss.
An overseas Mediclaim policy covers medical expenses incurred while travelling or staying outside India. These policies often include emergency hospitalisation, medical evacuation, and repatriation costs.Many countries require overseas Mediclaim coverage as part of visa or travel requirements.
A special diseases Mediclaim policy provides coverage for specific illnesses such as dengue, malaria, chikungunya, or other vector-borne diseases. Coverage is limited to the diseases mentioned in the policy and is usually valid for a short duration. These plans are often offered seasonally in high-risk regions.
Low-cost Mediclaim policies provide basic hospitalization coverage at affordable premiums. These policies usually have lower sum insured amounts and limited benefits. They are commonly offered by employers, NGOs, or government-backed schemes to ensure essential healthcare access for underserved or low-income groups.
Group Health Insurance policy is purchased by the employer for the employees of their company.These policies typically offer better coverage at lower premiums due to risk pooling. Group Mediclaim policies often include benefits like minimal waiting periods, maternity cover, and dependent coverage, making them more comprehensive than individual plans.
Also read: Difference between mediclaim and health insurance - All you need to know
These costs include the rent of the room, diagnostic charges, operation theatre charges, blood, x-ray, oxygen, etc.
Some Mediclaim policies cover domiciliary hospitalization charges also, in cases where the patient cannot be taken to the hospital or the hospital does not have facilities to treat the patient.
Some policies include pre (30 days) before and post (60 days) after hospitalization expenses.
This includes all the hospital charges within 24 hours.
Consultation fee, the charge of nurses, tablets, and medication expenses are covered.
Although Mediclaim Policies cover most of the aspects of healthcare, there are few exemptions in this policy too:
1. Does not cover for pre-existing illness (until waiting period ends).
2. Any sort of dental treatment.
3. Birth control, Hormonal treatments, and STDs.
4. Vaccinations.
5. Plastic surgeries and cosmetic surgeries.
6. Non-medical expenses.
7. Any extra expenses like hearing devices, contact lenses, etc.
· Total sum coverage of the Mediclaim Policy.
· Is the policy for an individual or for the family?
· What are the network hospitals included in this policy?
· How long is the waiting period and what all is included in the waiting period.
· Is there any add-on available for the specified Mediclaim Policy?
· Are there any sub-limits in the policy?
· Is the policy a co-payment one where the insurer is expected to pay a certain percentage of the claims?
Also read: Health Insurance Claim Process - How Does It Work?
Choosing the right Mediclaim policy in 2026 is crucial, given rising healthcare costs and evolving coverage needs. Below are five of the most trusted and popular health insurance plans in India, known for their coverage depth, hospital network, and customer experience.
Aditya Birla Activ Health Assure offers flexible health insurance plans for both individuals and families, with a wide sum insured range from ₹2 lakh to ₹2 crore.
The policy covers daycare procedures, in-patient hospitalization expenses, and home treatment, making it suitable for modern treatment needs. One of its key highlights is its focus on wellness and preventive care.
Care Health Insurance is considered one of the leading health insurers in India in 2025, backed by a strong network of 11,400+ hospitals and a high claim settlement ratio.
Their plans include benefits such as maternity cover, organ donor expenses, annual health check-ups, and comprehensive hospitalization coverage. The insurer is especially popular among families due to its wide-ranging benefits.
Bajaj Allianz is among the largest health insurance providers in India, with an extensive network of over 12,268 hospitals across the country. The plans offer a sum insured ranging from ₹1.5 lakh to ₹1 crore and include benefits such as pre- and post-hospitalization expenses, road ambulance cover, maternity benefits, and preventive health check-ups.
Kotak Mahindra’s health insurance plans start at an affordable price point and provide essential coverage features such as in-patient hospitalisation, daycare treatments, ambulance cover, and free health check-ups. The sum insured ranges from ₹3 lakh to ₹1 crore , making it suitable for individuals and small families seeking reliable, budget-friendly coverage.
Star Health Insurance is a well-known standalone health insurer in India. Key features include room rent benefits of up to ₹5,000 per day, AYUSH treatment, assisted reproduction treatment, newborn baby cover, and pre- & post-hospitalization expenses. The sum insured ranges from ₹3 lakh to ₹crore.
A quick checklist for choosing the right plan:
Not all benefits start from day one.
Understanding the process helps avoid claim rejection.
Pro Tip: Always keep copies of discharge summaries, original bills, and prescriptions.
Pazcare offers group health insurance for enterprises of as low as 7 employees, with the best prices in the market. Also, we provide additional benefits like mental wellness, unlimited doctor consultations, super-top, health check-ups, laboratory allowance, and more. Employers will get a sophisticated dashboard to easily manage and track the group health insurance policies and all other employee benefits provided. And employees can manage their benefits with our Pazcare app.
Yes, it is highly recommended. A Mediclaim policy protects your savings from unexpected hospital bills and ensures access to quality care.
There is no fixed salary requirement. Even individuals earning ₹15,000–₹20,000 per month can opt for affordable Mediclaim plans starting as low as ₹400–₹600/month.
Yes, with a family floater policy, your spouse, children, and parents can all be covered under one plan.
A Mediclaim policy is a type of health insurance that helps you pay for hospitalization and medical expenses, either through cashless treatment or reimbursement.
Yes, senior citizen Mediclaim policies are designed specifically for people above 60, though premiums may be higher.
Best pricing for you.
Best claim support for your team.
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