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• What is mediclaim?
• When is the claim payable under Mediclaim?
• Does Mediclaim cover treatment in hospital only?
• Can my whole family be covered under a single Mediclaim policy?
• To whom is the claim paid if nominee is dead?

Mediclaim Insurance is a hospitalisation benefit policy offered by public sector general insruance companies. The policy takes care of medical expenses following Hospitalisaton/Domiciliary Hospitalisation of the insured in respect of the following situations:

• in case of sudden illness,

• in case of an accident

• in case of any surgery which is required in respect of any disease which has arisen during the policy period.

The claim is payable, when treatment is from a registered hospital or nursing home.However, in case of non registered hospital or nursing home the treatment can be covered under the policy subject to hospital/nursing home conforming to the following guidelines:

• The hospital/nursing home should have 15 inpatient beds

• It should have qualified nursing staff round the clock

• Qualified doctors round the clock

• Fully equipped operation theatre

Though the main purpose of the policy is to provide reimbursement in respect of treatment taken in the hospital/nursing home, the policy also provides reimbursement in respect of domiciliary hospitalisation. However for a claim to be processed under domiciliary hospitalisation the following conditions should be satisfied:

• Medical treatment should be for more than 3 days.

• The treatment should be such for an illness/disease/injury which in the normal course would require treatment and care in the hospital/nursing home but actually taken whilst confined at home due to any of the following circumstances:

  
  

  1. Condition of the patient is such that he/she cannot be moved to the hospital/nursing home or

  2. The patient cannot be moved to hospital/nursing home for lack of accomodation there in.

Yes. In fact a family package discount of 10% is also available.

The insurance company will insist upon a succession certificate from a court of law for disbursing the claim amount. In the alternative the insurers can deposit the claim amount in the court for disbursement to next legal heirs of the deceased.