MedCare360Health Insurance Guide
Understand your coverage, navigate claims, and make informed decisions — before you need to.
About Insurance
Common questions answered plainly — no jargon.
What's Covered
Standard coverage across most comprehensive health plans — and what's typically excluded.
Covered
- Hospitalisation for 24 hours or more
- ICU and critical care charges
- Surgeon, anaesthetist, and specialist fees
- Pre-hospitalisation (30–60 days before admission)
- Post-hospitalisation (60–90 days after discharge)
- Daycare procedures — cataract, dialysis, chemotherapy
- Ambulance charges
- Diagnostic tests and scans during hospitalisation
- Organ donor expenses
Exclusions
- Pre-existing diseases during waiting period (2–4 years)
- Cosmetic and aesthetic procedures
- Dental treatment — unless caused by accident
- Experimental or unproven treatments
- Self-inflicted injuries or substance abuse
- War, terrorism, or nuclear incidents
- Maternity — unless a specific add-on is purchased
- OPD / outpatient consultations — unless add-on
- Weight loss, fertility, or hormone treatments
Types of Insurance
Choose the plan that matches your situation and health profile.
Individual Health Plan
Best for: Singles, young professionals
The full sum insured applies solely to the policyholder. Lower premium, personal benefit.
Family Floater
Best for: Families with low individual risk
One shared sum insured for the whole family. Cost-effective, but one large claim can exhaust the pool for everyone.
Corporate / Group Insurance
Best for: Salaried employees
Provided by employers. Usually covers pre-existing conditions from day one — but coverage ends with employment.
Senior Citizen Plan
Best for: Individuals aged 60+
Higher premiums, mandatory co-payment, and pre-existing conditions covered after a waiting period.
Ayushman Bharat – PMJAY
Best for: Below poverty line families
Free hospitalisation up to ₹5 lakh/year for eligible BPL families at 1,900+ empanelled hospitals.
Critical Illness Policy
Best for: High-risk individuals
Pays a lump sum on diagnosis of specified conditions — cancer, stroke, heart attack. Separate from regular health cover.
Cashless vs Reimbursement
Most people only discover the difference when they're already at the hospital. Know it now.
Cashless
Reimbursement
Payment at hospital
₹0 — insurer settles directly
You pay the full bill upfront
Hospital choice
Network hospitals only
Any hospital, network or not
Pre-authorisation
Required before treatment
Not required
Documentation burden
Minimal — hospital handles most
Extensive — you collect & submit all originals
Claim settlement
Immediate — at discharge
7–21 working days after submission
Submission deadline
N/A
15–30 days from discharge — strict
Risk of shortfall
Only non-approved amounts
Full amount at risk if claim rejected
Best for
Planned surgery, known conditions
Emergencies, travel, non-network hospitals
Accepted Insurance Providers
Most top hospitals work with all major insurers — but not every hospital accepts every provider. Confirm cashless coverage on the hospital's empanelment list before you book.
Private Insurers
- •Star Health & Allied Insurance
- •HDFC ERGO Health Insurance
- •ICICI Lombard
- •Bajaj Allianz Health
- •Niva Bupa (Max Bupa)
- •Aditya Birla Health
- •Care Health Insurance
- •ManipalCigna Health
Government Insurers
- •Ayushman Bharat – PMJAY
- •ESIC
- •CGHS
- •New India Assurance
- •United India Insurance
- •National Insurance Co.
International Insurers
- •BUPA Global
- •Cigna Global
- •Allianz Care
- •AXA International
- •Aetna International
Cashless Claim Process
How cashless hospitalisation works — step by step.
Choose a network hospital
Verify your insurer's empanelled hospital list before admission. Non-network hospitals cannot offer cashless.
Inform your insurer
Call the helpline or use the app to initiate cashless hospitalisation at least 48 hours before planned admission.
Share your insurance details
Present your health card, Aadhaar, and policy number at the hospital's insurance desk on arrival.
Pre-authorisation request
The hospital submits a pre-auth request to the insurer with the diagnosis, treatment plan, and estimated cost.
Insurer approval
The insurer reviews and approves (or queries) within a few hours. An approval letter is issued to the hospital.
Treatment & cashless discharge
Treatment proceeds. At discharge, the insurer settles the approved amount directly. You pay only non-covered items.
Reimbursement Guide
For when you paid upfront and need to claim the amount back.
Pay upfront at the hospital
Settle all bills and collect every original document. Do not accept photocopies from the hospital.
Collect all documents
Discharge summary, itemised bills, prescriptions, diagnostic reports, and doctor's certificate.
Fill the claim form
Download and complete your insurer's reimbursement claim form accurately. Errors here cause most delays.
Submit within the deadline
Most insurers require submission within 15–30 days of discharge. Missing this is the most common avoidable rejection.
Respond to insurer queries
The claims team may ask for clarifications or additional documents. Respond promptly to avoid delays.
Reimbursement credited
Approved amount is transferred to your registered bank account within 7–21 working days of final approval.
Documents Required for Reimbursement Claim
These are the documents you need after discharge. Missing even one can delay or reject your claim.
- •Duly filled and signed claim form
- •Discharge summary — original, stamped by hospital
- •All original bills, receipts, and payment invoices
- •Doctor's prescriptions and referral letters
- •Diagnostic reports — blood tests, scans, X-rays
- •Operation notes (for any surgical claim)
- •FIR copy — if claim is accident-related
- •Cancelled cheque or bank passbook copy
- •Health insurance card or policy document copy
- •Government-issued photo ID (Aadhaar or PAN)
Common Mistakes
Most claim rejections are avoidable. Know the pitfalls before you're in a hospital.
Not reading your policy document
Most claim rejections happen because of conditions the policyholder never read. Sub-limits, co-pay clauses, and exclusion lists are buried in the fine print.
Admitting to a non-network hospital
Cashless is unavailable. Reimbursement payouts for non-network hospitals are often lower or subject to additional scrutiny.
Missing the claim submission window
Most insurers require all documents within 15–30 days of discharge. Delay is one of the most common — and entirely avoidable — rejection reasons.
Submitting incomplete documents
Missing prescriptions, unsigned forms, or photocopies instead of originals are standard grounds for rejection.
Not disclosing pre-existing conditions
Non-disclosure is grounds for policy cancellation and claim rejection — even for unrelated conditions — at any point during the policy term.
Claiming during the waiting period
Filing a claim for a condition within its waiting period will always be rejected. Know your waiting periods before planning any treatment.
Frequently Asked Questions
Disease, cost, and coverage questions — answered clearly.
Support & Assistance
We help you navigate your insurance — not just your medical care.
Lost in the fine print? We'll decode it for you.
Sign in to upload your policy — our insurance specialists will check what's covered for your treatment, flag hidden exclusions, and walk you through pre-authorisation. Completely free.
Contents
No Insurance? Check Government Schemes
Ayushman Bharat (PM-JAY)
₹5 lakh cover/year for 50 crore+ beneficiaries
Central Government Health Scheme (CGHS)
For central govt. employees & pensioners
Employees' State Insurance (ESIC)
For organised sector workers earning under ₹21,000/mo