Mediclaim Insurance

Medical cost has risen exponentially during last two decades which lead people lean towards Health Insurance as solution. Health Insurance, in India, majorly covers your medical expenses during hospitalization and pre-post hospitalization expenses.

Currently, Every General & Standalone Health Insurance Companies offer health insurance products of combination of Benefits such as lower waiting period of pre-existing ailments, Higher Room Rent Eligibility, Health Check up etc. Primarily, Health Insurance is categorized in two ways i.e Family Floater Health Insurances and Individual Health Insurances.

Family Floater Insurance

Under Family Floater Health Insurance, All Family members are covered under one Single Coverage Amount that means, Either one Family member or All Family Member may cumulatively consume entire Sum Insured in one policy year. Family Floater Health Insurances are largest selling Health Insurance Products in India since it is more cost efficient health Insurance solution.

Individual Health Insurance

Under Individual Health Insurance, Every Person is covered under separate Sum Insured/Coverage Amount. Here, since, coverage amount is entirely to each member therefore cost of this insurance category usually more than former.

Top Up Cover

Top up health Insurance is basically a form of Health Insurance only but works beyond a specified claim which is called deductible. For an example, If a customer has Top Up Plan with coverage amount of Rs 20 lakh with deductible of Rs 3 lakh then it means that his/her Top up Health Insurance will cover all expenses beyond claim of Rs 3 lakh.

Common Queries

Check out the answers for your most common queries. Still if you are not satisfied with the information, contact us right away!
Which is the best insurance company in India?

Every Insurance company in India, is operating under Regulations laid by IRDAI (Insurance Regulatory Development & Authority of India) which ensures that Insurers are financially stable to offer insurance for their customers. Thus All registered Insurance Companies are good. However, choice of an Insurance Company may differ depending upon customer  need in terms of Insurance product, its benefits, customer geographical location, insurance company claim process parameters etc. Therefore one shall make their own need as parameter to choose insurance company.

Which is the best Health Insurance product offered by any Insurance Company in India?

Health Insurance Products are offered by almost all General Insurance Companies and Standalone Health Insurance Company in India. Every one’s product differ in only two parameters i.e cost & benefits. Therefore, Best health insurance product may differ for every customer depending upon their need & cost affordability.

What could be the difference in benefits offered by insurance companies?

Every Insurance company offers variety of Health Insurance Products which are majorly varying in terms of Cost and Benefits. Cost is basically  derived from respective Insurance company claims experience, operational, marketing etc cost for that respective product. However Benefits may vary as follows.

  1. Pre-Policy Check up: Insurance Companies have different age bar for conducting pre-policy check up. Some starts conducting pre policy medical check up at above 35 years and some may do above 45 years.
  2. Maximum age for renewal: Some insurers offer life long renewal whereas some offer till 80 years of age.
  3. Entry age: Entry age varies from insurer to insurer. Some Insurance companies offer health insurance to For an example, A customer, 35 years old, will have all insurance companies to offer health insurance policy for him/her whereas if a customer is 55 years  old then only few will offer and so on, Older the age, fewer insurance companies will offer health insurance policy. Once offered, Insurer is bound to renew policy until life or maximum renewal age defined as per insurance contract.
  4. Pre-existing ailment waiting period: Pre-existing ailments are those known/unknown ailment to customer,  which was present in customer before start date of policy. Some Insurers cover such ailments after 3 years of continuous renewal whereas some offer after 4 years.
  5. Day Care Procedures: Day Care procedures are usually surgical in nature and are counted to be those procedures in which 24 hours hospitalization period is not compulsory. Insurance companies usually define list of these day care procedures in their insurance proposal. Longer the list, better is the clarity and coverage.
  6. Room Rent Eligibility: Every Insurance company offers variety of room rent category in their products. Some provide without any restriction, or some with Single AC room or some link it to the coverage amount. Room rent becomes important factor for choosing a health insurance product Because Now a days, Almost every hospital has their entire billing linked to Category of room provided to patient.
    For an Example, If two patients(Patient Name -A and Patient Name – B) are admitted in a hospital for same treatment but at two different room category(let’s says A room rent is 2 times of B room rent) then it is most likely that Patient A bill is going to be approximately double of what Patient B Bill will be.  This because all other services in hospital such as Doctor consultant, Surgeon fees, Medicines, Medical Diagnostic etc are also directly linked to Room rent category.Therefore If room rent cost goes up then all other services cost also go up. Therefore Similarly Insurance companies are also supposed to pay all hospitalization cost as per room rent eligibility as per insurance contract. Therefore, If any Insurance company customer chooses room category of which cost is more than his/her eligibility insurance contract then this customer will be given what could have been his Bill as per his eligible room rent category and any difference in billing will be borne by customer only.
  7. Health Check up Cost: Insurance companies also offer Annual Health Check up on claim free policy year. However, what vary, is content of those health check up. Some Insurance company put a limit on Health Check up cost such as Rs 5000/- or Rs 3000/- per year whereas Some insurance Companies make a compulsory package of medical test for customer to choose.
  8. OPD Coverage: OPD(Out patient Department) Services are those medical services where patient does not required to be hospitalized. Since Health Insurance policies majorly cover 24 hour hospitalization and Day care procedures, therefore few  insurers have started covering OPD Services but within a limited amount.
  9. No Claim Bonus(NCB): No Claim bonus is basically a portion of coverage amount which is kept increasing for certain claim free continuous policy renewals. Portion of coverage which increases, varies from insurance company to insurance company, means Some Insurance company increase 10% of coverage amount for every claim free policy renewal for up to 5 years whereas some insurance company offer 50% of coverage amount for up to 2 years. This is how this coverage varies.
  10. Restore Benefit: Restore was firstly introduced by a Standalone health insurance company almost a decade back.  As per this benefit, If a customer consumes his entire coverage amount due to an ailment/cause then his/her sum insured automatically gets re-instored for that specifically policy year only but not applicable to that previous ailment/cause due to which sum insured has got exhausted. This benefits was vastly appreciated by customers since at least they weren’t have to worried about lack of coverage amount if some other family member or similar member is hospitalized for any other ailment/cause.
  11. Maternity Benefit: Maternity benefit usually extends scope of policy for Hospitalization expenses during Maternity period until Delivery. However, What differs insurance company to insurance company is, Limit of Maternity Benefit allowed in policy and waiting period to cover this benefit in policy.
  12. Other Benefits: There could be other many benefits and their combination becomes a Bouquet, for an insurance company to offer such as Air Ambulance Coverage, Discount on OPD Services at Designated Centers,  Wellness & Reward Programs, Coverage for siblings or extended family etc. Each Benefit could have minimal significance on its own and usability varies from customer to customer.
What Health Insurance Policy does not Cover?

Health Insurance policies also have certain circumstances which are called exclusion under which policy coverage are not extended. Those circumstances are mostly are as below, however Exclusion wording and scope may vary from insurance company to insurance company.

  1. Injury or disease directly or indirectly caused by or arising from or attributable to War, Invasion, Act of Foreign Enemy, War like operations (whether war be declared or not) or by nuclear weapons / materials.
  2. Circumcision (unless necessary for treatment of a disease not excluded here under or as may be necessitated due to any accident), vaccination, inoculation or change of life or cosmetic or of aesthetic treatment of any description, plastic surgery other than as may be necessitated due to an accident or as a part of any illness.
  3. Surgery for correction of eye sight, cost of spectacles, contact lenses, hearing aids etc.
  4. Vaccination and/or inoculation.
  5. Any dental treatment or surgery which is corrective, cosmetic or of aesthetic procedure, filling of cavity, root canal including wear and tear etc unless arising from disease or injury and which requires hospitalization for treatment.
  6. Bodily Injury or Illness due to willful or deliberate exposure to danger (except in an attempt to save human life), intentional self inflicted injury, attempted suicide, arising out of non-adherence to medical advise, Hospitalization discharge against medical advise.
  7. Treatment of any injury or illness arising sustained whilst or as a result of active participation in any hazardous sports of any kind.
  8. Treatment of any injury or illness sustained whilst or as a result of participating in any criminal act.
  9. Expenses incurred at Hospital or Nursing Home primarily for evaluation / diagnostic purposes which is not followed by active treatment for the ailment during the hospitalized period.
  10. Charges incurred at hospital primarily for diagnosis, x-ray or laboratory examinations, or other diagnostic studies not consistent with or incidental to the diagnosis and treatment of positive existence or presence of any illness or injury for which confinement is required at a hospital.
  11. Expenses on vitamins and tonics etc unless forming part of treatment for injury or disease as certified by the attending physician.
  12. Voluntary termination of pregnancy is not covered.
  13. Naturopathy treatment, unproven procedure or treatment, experimental or alternative medicine and related treatment including acupressure, acupuncture, magnetic and such other therapies etc.
  14. Expenses incurred for investigation or treatment irrelevant to the diseases diagnosed during hospitalization or primary reasons for admission. Private nursing charges, Referral fee to family doctors, Out station consultants / Surgeons fees etc.
  15. Genetical disorders and stem cell implantation / surgery.
  16. External and or durable Medical / Non medical equipment of any kind used for diagnosis and or treatment including CPAP, CAPD, Infusion pump etc., Ambulatory devices i.e. walker , Crutches, Belts ,Collars ,Caps , splints, slings, braces ,Stockings etc of any kind, Diabetic foot wear, Glucometer / Thermometer and similar related items etc and also any medical equipment which is subsequently used at home etc.
  17. All non medical expenses including Personal comfort and convenience items or services such as telephone, television, Aya / barber or beauty services, diet charges, baby food, cosmetics, napkins , toiletry items etc, guest services and similar incidental expenses or services etc.
  18. Change of treatment from one pathy to other pathy unless being agreed / allowed and recommended by the consultant under whom the treatment is taken.
  19. Domiciliary hospitalization.
  20. Acupressure, acupuncture, magnetic therapies.
  21. Experimental or unproven treatments/therapies.
  22. Treatment of obesity or condition arising therefrom (including morbid obesity) and any other weight control program, services or supplies etc.
  23. Any treatment required arising from Insured’s participation in any hazardous activity including but not limited to scuba diving, motor racing, parachuting, hang gliding, rock or mountain climbing etc unless specifically agreed by the Insurance Company.
  24. Any treatment received in convalescent home, convalescent hospital, health hydro, nature care clinic or similar establishments.
  25. Any stay in the hospital for any domestic reason or where no active regular treatment is given by the specialist.
  26. Out patient Diagnostic, Medical or Surgical procedures or treatments, non-prescribed drugs and medical supplies, Hormone replacement therapy, Sex change or treatment which results from or is in any way related to sex change.
  27. Massages, Steam bathing, Shirodhara and alike treatment under Ayurvedic treatment.
  28. Any kind of Service charges, Surcharges, Admission fees / Registration charges etc levied by the hospital.
  29. Doctor’s home visit charges, Attendant / Nursing charges during pre and post hospitalisation period.
  30. Convalescence, general debility, “run down” condition or rest cure, congenital external diseases or defects or anomalies, sterility, any fertility, sub-fertility or assisted conception procedure, venereal diseases, intentional self-injury/suicide, all psychiatric and psychosomatic disorders and diseases / accident due to and or use, misuse or abuse of drugs / alcohol or use of intoxicating substances or such abuse or addiction etc.
  31. All expenses arising out of any condition directly or indirectly caused by, or associated with Human T-cell Lymphotropic Virus Type III (HTLD – III) or Lymohadinopathy Associated Virus (LAV) or the Mutants Derivative or Variations Deficiency Syndrome or any Syndrome or condition of similar kind commonly referred to as AIDS, HIV and its complications including sexually transmitted diseases.
  32. Treatment which is continued before hospitalization and continued even after discharge for an ailment / disease / injury different from the one for which hospitalization was necessary
What are non payable expenses?

Every Insurance Company excludes some charges which are consisted of  mostly of hospital administration fees, and consumables & other charges. These charges are standardized by IRDAI and every insurance company is bound to deduct those charges only which are allowed by IRDAI to deduct. You may download list of Non Payable charges under Health Insurance as directed by IRDAI at this link.

What is Cashless Facility under Health Insurance?

Cashless Facility is basically mode of making a claim in Health Insurance under those hospitals which are under empanelment of Insurance Company. Through this facility, Insurance company approves claim amount to hospital for each hospitalization on behalf of customer and customer only needs to pay what is not approved by insurer as per policy contract. Cashless facility not only make financial stable during hospitalization but also saves customer money through negotiated rates between insurance company and hospital.

How does Topup Cover work & why is it beneficial?

Customer usually opts for Rs 5 lakh or maximum Rs 10 lakh to be their coverage amount in General Health Insurance. However, they also wish to cover themselves in rare & expensive contingencies if they or their family is contracted with some ailment or accident where treatment goes for longer period.

So Top up health insurance protects them in such scenarios with affordability option. Top up health insurances are usually very cost effective in comparison to general health insurance with higher coverage amount. With combination of One Health Insurance & One Top up Plan, a Customer can cover his family to any level of contingency.

Top up health insurance Plans are of two categories:

  1. General Top-up: This Policy usually triggers when Claim amount surpasses Deductible in one event of hospitalization or Ailment only.
  2. Super Top-up: This policy triggers immediately when claim amount surpasses deductible irrespective of number of events or ailment.

Exclusion: Top up health insurances also contain same exclusion as normally any general health insurance does.

What is Critical Illness Cover?

Critical illness cover basically empowers customer financially , in case of he/she is diagnosed with Critical illness and survived for specified time period, which is called survival period.  This policy pay coverage immediately upon diagnosis of named illness.

Which critical illness are generally covered in Critical Illness Policy?

List of Critical illness and survival period only, makes every insurance company product different. Below are critical illness generally  covered by insurance companies.

  1. Heart Attack
  2. Stroke
  3. Coronary Artery Disease Requiring Surgery
  4. Cancer
  5. Kidney Failure
  6. Major Organ Transplant
  7. Paralysis
  8. Multiple Sclerosis
  9. Coronary Artery Bypass Surgery
  10. Aorta Graft Surgery
  11. Primary Pulomonary Arterial Hypertension
  12. Heart Valve Replacement
  13. Parkinson’s Disease
  14. Alzheimer’s Disease
  15. End Stage Live Disease
  16. Benign Brain Tumour
  17. Cardiomyopathy
  18. Cabg
  19. Blindness
  20. Chronic Liver Disease
  21. Chronic Lung Disease
  22. Apallic Syndrome
  23. Brain Surgury
  24. Coma
  25. Major Head Trauma
  26. Parkinson Disease
  27. Deafness
  28. Loss Of Limbs
  29. Loss Of Speech
  30. Medullary Cystic Disease
  31. Major Burns
  32. Aplastic Anaemia
  33. Others Major Critical Illness As Defined From Insurer To Insurer

It is also important to understand CRITICAL ILLNESS COVER is not only offered by General Insurance & Standalone Health Insurers, But it is also majorly offered by almost all life insurance companies. Life insurers offering CRITICAL ILLNESS COVER, usually has more illness in their policy scope than GENERAL INSURERS and standalone health insurers.

What are the exclusions under Critical Illness Cover?

Exclusions under this policy are same has general health insurance policies in addition to below exclusions.

  1. Adventure Sports Injuries
  2. Self inflicted injuries
  3. War
  4. Venereal or sexually transmitted diseases
  5. Treatment of obesity or cosmetic surgeries
  6. Other exclusion as per health insurance policies
What is Personal Accidental Insurance?

Personal Accident Insurance basically protects Customers/Family member against financial instability under unfortunate event of Accident. In Personal Accidental Insurance, Insurance Company pays

  1. Agreed Coverage amount to Policy Beneficiary in case of Death
  2. Agreed Coverage amount to Customer in case of Permanent Total Disablement such as Dismember of one leg or boths etc
  3. Agreed Coverage amount to customer in case of Permanent Partial Disablement such as Dismemberment of one finer or one toe etc
  4. Compensating customer against loss of income during recovery period, such event is called as “Temporary Total Disablement” under insurance, also known as Leave Benefit.
  5. Agreed coverage amount against medical expenses
  6. Child Education Benefit in case of death or disablement

This Policy covers customer 24*7 and worldwide.

What are the exclusion under Personal Accidental Insurance?

These exclusion are common but policy wording & scope may vary from insurance company to insurance company.

  1. Intentional self-injury, suicide or attempted suicide,
  2. Whilst under the influence of intoxicating liquor or drugs
  3. Whilst engaging in Aviation or Ballooning whilst mounting into, dismounting from or traveling in any balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world,
  4. Directly or indirectly caused by venereal diseases, AIDS or insanity,
  5. Arising or resulting from the insured person committing any breach of law with criminal intent, by appropriate authority irrespective of whether such an aircraft is privately owned OR chartered OR operated by a regular airline OR whether such an aircraft has a single engine or multi engine.

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OUR LOCATIONSWhere to find us
Registered Office
Orange Capital Insurance Broking Private Limited,
Ground Floor, S-145, Uppal South End
Sohna Road, Sector-49, Gurugram, Haryana-122001

Corporate Office
Second Floor, K-5A/9, DLF Phase-II,
Near Vatika City Point, MG Road,
Gurugram, Haryana-122008

Branch Office
G-02, D-84, Sector-2, Noida,
Uttar pradesh-201301
GET IN TOUCHOrange Capital Social Links
Feel our social presence that seamlessly covers key insurance indicators.

IRDA Registration Number : 704 | CIN : U66000HR2019PTC082383 | Category : Direct Broker (Life & General including Health) | License Period : 17-04-2020 to 16-04-2023

IRDA Registration Number : 704
CIN : U66000HR2019PTC082383
Category : Direct Broker (Life, General, Health)
License Period : 17-04-2020 to 16-04-2023