Mediclaim vs Health Insurance: Know the Key Differences

2024-08-02

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Table of Content

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What is Mediclaim?

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What is Health Insurance?

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What is the Difference Between Mediclaim

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Things to Consider Before Buying Medicla

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Make the Right Choice Today

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FAQ’s

Keep scrolling through to understand the difference between mediclaim & health insurance.

What is Mediclaim?

Mediclaim insurance policy is a type of health insurance policy that offers financial protection at the time of medical emergencies. The policy is designed to help individuals and families manage the financial burden of healthcare costs by reimbursing them for eligible medical expenses.

Features of Mediclaim

Coverage under the mediclaim policy differs from one policy to another. Below listed are some of the basic features it offers:

Hospitalisation Coverage: Mediclaim covers all the expenses that are incurred during the hospitalisation, like OT charges, room rent, blood reports, x-rays, and much more.
Pre and Post-Hospitalisation Expenses: The insured's expenses for 30 to 60 days prior to admission and up to 60 to 90 days of discharge are covered under the mediclaim policy.
Cashless Settlement: One of the best features of a mediclaim insurance policy is that it offers a cashless settlement service for the policyholder's convenience. During difficult times, the individual does not have to worry about making payments to the hospital and can easily avail hospitalisation services.
Reimbursement Option: In cases where cashless hospitalisation is not possible, policyholders can reimburse expenses by submitting bills and medical records to the insurance company.

Importance of Buying Mediclaim

Mediclaim insurance serves as a crucial financial safety net, offering a range of benefits that go beyond just covering medical bills.

Reduces Financial Burden: Medical treatments can be expensive, and unexpected health emergencies can lead to significant financial stress. A mediclaim policy helps reduce this financial burden by covering various medical expenses.
Provides Certainty: It can offer peace of mind about managing healthcare costs in times of need.
Cost-Effective: While you pay regular premiums for your mediclaim policy, it is generally more cost-effective than paying for huge medical expenses out of pocket. You will know the monthly premium amount you have to pay towards the policy, making it easier to maintain your budget.
Tax Benefits: It offers tax benefits under the Income Tax Act. Policyholders can avail of deductions on premiums paid and claim tax benefits under Section 80D, thereby reducing their taxable income.
Access to Quality Healthcare: Having a mediclaim insurance policy often provides access to a broader network of hospitals and healthcare providers. You can choose quality medical service from a list of network hospitals where the insurance provider has tie-ups.

Check our Health Plan and its benefits: Health First Plan

What is Health Insurance?

Health insurance is a vital financial protection plan designed to safeguard individuals and families from the financial burdens associated with medical expenses.

Features of Health Insurance

A health insurance policy offers unique features that help the policyholder during unexpected times. Here are some of the features of the policy:

Coverage for Medical Expenses: Health insurance policies cover numerous medical expenses, including hospitalisation, doctor's fees, surgical procedures, diagnostic tests, prescription medications, and more. This comprehensive coverage ensures that policyholders have financial support when facing unforeseen medical bills.
Network of Healthcare Providers: These plans have a network of preferred healthcare providers, including hospitals, clinics, and doctors. It results in lower out-of-pocket expenses, making quality healthcare more affordable.
Premiums: Policyholders pay regular premiums that may vary based on factors like age, health status, coverage level, and the insurance provider.
Emergency Care: Health insurance plans commonly include coverage for emergency medical care. Whether it's an accident or a sudden illness, policyholders can seek immediate medical attention without worrying about the exorbitant costs associated with emergency services.

Importance of Buying a Health Insurance Policy

Health insurance is quite important because the cost of good medical facilities can be financially stressful. Let us understand in detail the importance of buying a health insurance policy.

Financial Protection: It shields individuals and families from the potentially crippling costs of medical treatment.
Access to Quality Healthcare: It often comes with access to a network of quality healthcare providers. This ensures that policyholders receive timely and appropriate medical care from reputable hospitals and doctors.
Preventive Care: Having an insurance policy encourages individuals to prioritise preventive healthcare. Regular check-ups and screenings can help in the early detection and prevention of health issues, reducing the need for costly treatments.
Peace of Mind: Knowing that you have health insurance coverage provides peace of mind. You will not have to worry about digging a hole in your pocket in the event of a medical emergency or a chronic illness diagnosis.
Legal Requirement: In some countries, having health insurance is a legal requirement. Failing to have coverage may result in penalties or limited access to certain healthcare services.

What is the Difference Between Mediclaim and Health Insurance?

Now that you know what a mediclaim and health insurance policy is and what features these policies offer, let’s move forward to understand mediclaim vs. health insurance to help you make an informed decision.

Basis	Mehiclaim	Health Insurance
Coverage	A mediclaim policy only covers the hospitalisation cost.	Health insurance policy offers medical coverage against hospitalisation charges, pre-hospitalisation charges, and much more. It also offers compensation to policyholders in case of loss of income that arises due to the accident.
Add-On Covers	This policy does not offer any additional cover.	It offers multiple add-on covers like critical illness cover, personal accident cover, etc.
Flexibility	The mediclaim policy does not offer the flexibility of making any change to the policy.	Flexibility is offered to enhance or reduce the coverage of policyholders.
Critical IIlness Cover	It does not offer critical illness coverage.	To help the policyholder stay stress-free during medical emergencies, generally, the policy offers critical illness cover.
Sum Insured	The sum insured of the mediclaim policy does not exceed ₹ 5 lakhs.	The sum insured varies from ₹ 50,000 to ₹ 6 crore per year.
Claims	The policyholder can claim until the total insured amount is exhausted.	Policyholders can file claims until their coverage limit is reached. However, for critical illness or accidental disability coverage, the entire assured sum is paid as a lump sum, and this type of claim can only be made once throughout the policy duration.
Hospitalisation	Only in the case of hospitalisation, the benefits can be used by the insured.	Under the health insurance policy, you don’t have to get hospitalised to take advantage of the benefits.
Change in Benefits	Under this policy, you can make adjustments in premiums, modify the list of medical services, and shift in co-payments.	These modifications can include adjustments to premiums, coverage limits, deductibles, co-payments, policy exclusions, and the introduction of new features.
Premium Charge	It typically offers limited coverage for specific medical expenses at a lower premium.	It provides comprehensive coverage for a broader range of healthcare needs, often resulting in higher premiums.

Things to Consider Before Buying Mediclaim and Health Insurance in India

When considering buying a mediclaim vs health insurance in India, several crucial factors should be carefully evaluated to ensure you choose the right policy for your needs.

Listed below are a few factors you must take into account while choosing to buy any of the policies:

Sum Insured

For comprehensive coverage and to protect against rising healthcare costs, you must apply for a higher sum insured. To find the exact amount, assess your healthcare needs based on factors like your family size, age, and any existing medical conditions.

Premium Affecting Factors

While buying the policy, you must understand different factors that can impact your premium. Some of the factors that may impact the premium are age, medical history, lifestyle habits (like smoking or drinking), and the coverage amount. Furthermore, to get the best option, you must compare premiums from different insurers to find the best one that aligns with your financial goals.

Claim Settlement History

You must check the claim settlement history of the insurance provider. Claim Settlement Ratio is the percentage of claims settled by an insurance provider out of the total number of claims made in a year. Always choose an insurance company that has a high claim settlement ratio.

Tax Exemption

Understand the tax benefits that you will be getting in with the policy you will buy.

Renewal Discounts

Look for policies that offer renewal discounts for claim-free years. These discounts can help reduce your future premiums.

Co-payments

Co-payment refers to the portion of medical expenses that you must pay out of pocket while the insurer covers the rest. You must evaluate the co-payment percentage and how it may affect your overall out-of-pocket expenses.

Also Read: What is a Co-Pay in Health Insurance?

Make the Right Choice Today!

Mediclaim and health insurance are two different instruments that help mitigate the health-related risk. Both these policies help to meet the insurance need. Now that you know the difference between mediclaim vs health insurance policy, you can choose one that best suits your needs.

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