Mediclaim vs Health Insurance : What Is The Difference Between Mediclaim Policy And Health Insurance Policy?

Mediclaim policy and Health Insurance policy are the two terms that are often confused with each other. In layman’s words, they are both related to medical insurance that provides financial coverage to the policyholders at the time of a medical emergency. Despite this resemblance, some major factors highlight the differences between them. Let us compare mediclaim vs health insurance.

What is a Mediclaim Policy? 

A Mediclaim Policy is a kind of health insurance that covers the insured members, financially in case a medical emergency arises. The policyholders can either choose for reimbursement or direct bill settlement of the expenses incurred on the hospitalization due to accident, critical illnesses, or surgeries. 

Benefits of a Mediclaim Policy

  1. In the case of hospitalization, the expenses incurred can be claimed immediately. 
  2. Direct bill Settlement facility is available on cashless policies by the mediclaim insurance company. 
  3. A reimbursement facility is available according to the type of plan you choose. 
  4. Affordable premiums are applicable in comparison to health insurance policies.

What is a Health Insurance Policy?

Health insurance meaning is an insurance policy that provides wider coverage to its policyholders when he/she is stuck in a medical emergency. The comprehensive coverage offered under a health insurance policy can include much more than just hospitalization expenses, like coverage for critical illnesses, alternative treatments, daycare procedures, and others. 

Benefits of a Health Insurance Policy

  1. The policy offers comprehensive coverage with several add-ons. 
  2. Covers the pre-and-post hospitalization charges of the insured, apart from the hospitalization costs.
  3. Numerous policies are available to suit the requirements of all, be it senior citizens or your entire family. 
  4. The policy allows you to choose for extra coverage regarding maternity benefits, outpatient benefits, and critical illness coverage.

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Mediclaim vs Health insurance : Mediclaim And Health Insurance Policy Difference

Let’s see this table to understand the difference between Mediclaim and Health insurance policy:

Difference In
Mediclaim 
Health Insurance
Coverage 
Provides coverage on hospitalization charges of the insured. Can also cover critical illnesses up to a certain limit.
Provides comprehensive coverage to the insured and bears the expenses of in-patient hospitalization, outpatient charges, medical tests, etc.
Pre & Post hospitalization charges
Does not cover.
It covers the expenses, depending on the type of plan chosen.
Ambulance charges 
Does not cover
It Covers ambulance expenses up to a certain limit.
Daycare procedure
Does not cover

 

(Mediclaim only covers for the hospitalization charges, thus will not bear the charges of daycare procedures)

Covers for the patient’s daycare treatments like cataract surgeries, maternity-related treatments, diagnosis, etc.
Co-payment facility 
Not permitted 
Permitted 
Cost and Benefits 
With lesser benefits offered, Mediclaims are available at low costs. Mediclaims generally provide coverage up to INR 5 lakhs. 
Health Insurances offer wider coverage under comprehensive plans and demand higher premiums with increased S.I options.
Number of Claims allowed 
Under a Mediclaim policy, you can make numerous claims in one policy year until the limit of sum assured, exhausts.
Generally, a Health Insurance policy allows you to make only one claim per year.
Flexibility 
Rigid plans with almost no variety or customization 
Numerous health insurance plans are offered to suit the requirements of all with additional features and extra benefits.

 

What should I invest in Mediclaim Insurance or Health Insurance?

You have now seen that both Mediclaim Insurance and Health Insurance have their own pros and cons. Therefore, you should analyze your budget, requirements and the number of members to be insured, before investing in either of them. 

If you are someone who cannot spend much on premiums but also does not want to overlook your family’s health, then opting for a Mediclaim can be a good choice. However, if you want wider coverage for your loved ones and afford the premium costs, then you should go for a suitable Health insurance policy. So, apart from your financial condition, there are certainly other factors that you can keep in mind before making a choice:

  1. If your and your family’s medical history  has been healthy, you may consider a Mediclaim 
  2. Also, keep in mind their age and stage. Elderly people, women planning a family, individuals working in a risky environment would need better coverage
  3. Whether you wish to make a short term or long term investment
  4. Flexibility and freedom to customize is available only in a health insurance policy
  5. Mediclaim policies have a lower premium

Conclusion

Mediclaim vs Health Insurance

Should You Purchase Health Insurance or a Mediclaim Policy in India? Insurance professionals advise choosing a health insurance plan even though both mediclaim and health insurance plans qualify for tax benefits under Section 80D of the Income Tax Act. This is so because health insurance plans provide extensive insurance protection.

A medical insurance policy will only pay for inpatient care. Up to a certain extent, it might cover the treatment of particular illnesses. Contrarily, a health insurance policy has a wider scope.

Protection from medical debt is offered by Mediclaim insurance. At network hospitals, you can use the cashless payment option. Both individuals and families are eligible for Mediclaim. On the yearly premium, it offers tax advantages.

Additionally, the cost of healthcare has generally been increasing at a rate of 15% per year. Therefore, having mediclaim insurance to cover any unforeseen or anticipated medical needs is essential, as purchasing a health cover is always a lot less expensive than blowing through all of one's savings on treatment.

Author Bio

Paybima Team

Paybima is an Indian insurance aggregator on a mission to make insurance simple for people. Paybima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. Paybima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

Over to You

Care Health Supreme and HDFC ERGO Optima Restore are among the best health insurance policies in India today. It is a matter of your priority, coverage depth over cost effectiveness. Here’s a quick recap for you to make an informed decision.

Both offer coverage of up to ₹1 crore; Optima Restore starts at ₹3L, Care Supreme at ₹7L. Supreme offers unlimited recharge; Optima Restore offers 100% once a year, after a claim is made. Care includes OPD + unlimited e-consults; Optima lacks OPD, allows one consultation/year. Care gives a 30% discount + 500% bonus; Optima offers 8% discount + 50% bonus. Care Supreme is costlier but has more features. Optima suits budget buyers; Care fits those needing wider, long-term coverage.

Whichever health insurance plan you choose, ensure to read the policy wordings and seek advice from an expert before you make the purchase. The best health insurance is the one that covers you the way you want to be covered.
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