Guide: Services Covered & Not Covered Under Mediclaim Policies

It is a common misunderstanding that medical as well as health insurance are interchangeable terms; however, this is not the case. Rather, the two terms serve distinct functions. Both of these things are aspects of the same coin. Although the terms are frequently used interchangeably, the mediclaim policies only cover the costs associated with hospitalization, while health insurance provides more comprehensive coverage. 

Mediclaim, which is also frequently known as mediclaim policies, is a type of health cover that reduces the financial risk that you are exposed to in the event of a medical emergency. It pays for the costs of your hospitalization as well as any specific illnesses and treatments which you incur while you are there. Section 80D of the Income Tax Act allows you to receive tax benefits in addition to a health insurance policy for a predetermined cost through the Mediclaim program. The insurance premium that you pay for your family is eligible for a deduction of this kind under regulations governing taxes.

The purchase of health insurance coverage that includes mediclaim policies can be advantageous in several ways. When you have medical insurance coverage, you can go to the hospital without worrying about coming up with cash, and you also have the luxury of letting your insurance provider handle any costs that you incur as a result of being hospitalized or receiving treatment that’s also required.

What Mediclaim policies cover?

Hospital Charges 

This includes costs such as the oxygen cylinder, blood, expenses associated with organ donors, lodging charges, organ donation, and many diagnostics.

Treatment during Day Care

This includes the treatment which does not necessitate the patient to be hospitalized, and after receiving it, they will be discharged in fewer than twenty-four hours.

Before and after being admitted to the hospital

Insurance policies typically include coverage for expenses incurred both before and after an insured person is admitted to the hospital. There are several costs associated with the therapy, both before and after the patient is admitted to the hospital. This is also covered by medical insurance.

A Stay in the Hospital

When you are admitted to a hospital, you may be responsible for bed charges that total several thousand dollars. The money that was spent on private rooms, wards, or the intensive care unit is covered by the policy’s mediclaim provision.

Charges for consultations and expenses incurred by the doctor

The costs of seeing a specialist or seeing a doctor for consultation are typically covered by medical insurance policies.


Conditions That Were Already Present

If the waiting period for such pre-existing illnesses has not elapsed, then a mediclaim policy would not give coverage for such conditions.

Procedures Related to Cosmetics

Mediclaim would not pay for any cosmetic operations that are performed for a purpose other than that of treating a medical condition.

Dental Procedures

In addition, dental operations are not covered by standard medical insurance plans.

Contraception and Pregnancy Termination

Medical bills associated with having an abortion are not covered in any way by medical insurance policies. Pregnancies that have already existed at the time of purchasing insurance aren’t protected either because they are considered a pre-existing disease.


According to the latest available statistics, more than 427 million Indian individuals were protected by a variety of mediclaim policies and health insurance plans during the current financial year (2019). In 2018, approximately 35 percent of the Indian population was protected by some kind of medical insurance policy. Policies that cover medical expenses are an absolute necessity for any person or family.