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Mediclaim and Insurance

Healthcare insurance or ‘mediclaim’ is an important method of paying for your child’s surgery. There are many pointers such as grade of surgery, class of admission, nature of surgery etc that you need to look at while claiming insurance.

Before you decide on the hospital where your child will be operated upon, here are a few things that you need to look into –

  1. Surgery suggested
    1. The name of the surgery will be written on the advise letter from us.
    2. If there are options for minimally invasive (Laparoscopic or Robotic). These usually cost extra and you must be aware of those costs.
  2. Cost of surgery
    1. This has two important components
      1. Grade of surgery – this is decided by the complexity of the surgery
      2. Class of admission
        1. General or Multibed
        2. Sharing – twin or triple, or Higher second class
        3. Single – Deluxe or Super deluxe or Suite
      3. Whether the surgery is covered by your insurance policy?
        1. Many policies do not cover ‘congenital’ anomalies ie. Defects present from birth. These are usually individual policies taken by you or your family members.
        2. Corporate policies such as those given by your company are generally more liberal and cover all operations.
        3. Almost always all emergency operations are covered by your policy
      4. The total coverage by your policy
        1. Total cost covered. This affects what class of admission you will get benefits under. ie. A policy of Rs. 2 lakhs will usually allow a daily bed charge of Rs. 2,000. If the class you have chosen is higher than this then you will usually be required to pay the difference over the entire bill amount and not just bed charges. ie. A bill of Rs. 3 lakhs, will need a bed class of Rs. 3,000. But since your policy allows only Rs. 2,000 you will get only 2000 ÷ 3000 x 100 = 66% of the total bill amount.
        2. There are other charges such as OPD fees, investigations, follow-up charges etc. which your policy may allow for which you will need to submit receipts.
      5. ‘Cashless’ surgery
        1. If your policy allows, then at certain hospitals, a ‘Cashless’ surgery may be done. The procedure for this requires prior planning and cannot be done at the last minute. If you are keen on getting treated under ‘cashless’ method then you will need to tell us before the surgery is booked.
        2. The hospital where surgery is to be done will help you with all the paperwork for submitting a ‘cashless’ claim.


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