Mediclaim is the first thing that comes to mind when thinking of family health insurance. Most people are under the misconception that they are the same, but they are not. It’s critical to understand the difference between mediclaim & health insurance so that you can choose the best policy for you and your family.
What is the definition of a health insurance policy?
Health insurance is a broad term that refers to various policies that provide complete coverage. A health insurance policy can cover pre-hospitalization, post-hospitalization, critical illness, and other things, depending on the coverage chosen and the terms and circumstances that apply.
What is Mediclaim, and how does it work?
A mediclaim policy reimburses only hospitalization expenditures incurred during the policy period. The policyholder bears all other expenses. Mediclaim insurance also offers cashless or reimbursement options for settling claims.
The terms “health insurance” and “mediclaim” are frequently interchanged. They are not, however, the same. Purchasing an insurance policy is not the same as purchasing mediclaim coverage. Understanding the differences between these two policies can help you in making a sound decision. What is the distinction between this insurance & mediclaim, though? This guide will assist you.
- Expenses incurred before and after hospitalisation
A mediclaim policy fully covers the expense of hospitalisation. To a certain extent, it may also cover the treatment of specific illnesses. On the other hand, a Health Insurance policy covers a wider range of possibilities. It comprises expenses incurred over days before and following hospitalisation, such as diagnostic costs, doctor’s consultation fees, and so on. A standard mediclaim coverage does not cover these expenses.
- Charges for ambulance services
Ambulance fees are not covered under a mediclaim policy. On the other hand, most health insurance policies allow ambulance expenditures up to a certain amount in the insurance claim. The insurance company reimburses these charges.
- Daycare practises and maternity benefits
Mediclaim requires the person to be hospitalised. In most cases, a mediclaim covers hospitalisation expenses for specific illnesses. They do not include any maternity expenses, such as caesarean sections or medical treatment for the child. Therefore, childcare operations that do not require hospitalisation are naturally excluded. These items may be included in a family health insurance claim.
- Benefits and costs
Because mediclaim coverage is limited, the cost of the policy is also lower than that of a health insurance policy. The amount of coverage is usually limited to just Rs. 5 lakhs. On the other hand, a Health Insurance policy is comprehensive with many additional benefits, increasing the premium cost while also increasing the sum assured.
- Amount of claims
A mediclaim policy allows several claims to be submitted during the year if the assured maximum sum is not exhausted. The insured can only make one claim per year under health insurance coverage in most cases.
Difference between Mediclaim and Health Insurance
| Mediclaim | Health Insurance |
| Mediclaim only covers hospitalisation expenditures, thus you can only file a claim if you’ve been admitted to the hospital. | Health insurance provides comprehensive coverage that goes beyond hospitalisation costs. Annual health exams, daily hospital payments, OPD expenses, & alternative treatments such as AYUSH are just a few of many aspects covered. |
| Mediclaim does not offer any further coverage. | There are a variety of add-on coverage available, including Critical Illness Cover, Maternity Benefit, and Infertility Cover, among others. |
| Mediclaim’s hospitalisation coverage is limited, and in most cases it does not exceed Rs 5 lakh. | A family health insurance coverage is extensive, and it is determined by factors such as age, location, and the number of participants in a single plan. |
| Mediclaim isn’t very adaptable. | Health insurance policies are adaptable and customisable. |
Mediclaim and Health Insurance Benefits
Mediclaim Advantages
- When you are hospitalized, you can acquire urgent medical expenditure coverage.
- If you choose Cashless Mediclaim insurance, your insurer will cover all your hospitalisation costs.
- If you choose reimbursement, the insurance will reimburse your money.
The Advantages of Health Insurance
- You can choose a Family Health Insurance plan to cover all your family members under a single policy.
- Expenses incurred before and following hospitalisation are covered.
- Allows you to choose between a Critical Illness and a Non-Critical Illness policy.
- You can choose from various advantages, including outpatient, maternity, and restoration.
Should you get Mediclaim or Health Insurance?
Several factors will influence your decision, including:
- Your current financial situation
- If you and your family are coping with health concerns.
- Whether you believe in long-term or short-term planning,
- Whether or not you require flexibility in your health plan
- Whether or not you’ll require additional coverage and benefits
On the surface, the differences between mediclaim and health insurance are minor, but an insurance policy covers more and provides more security when getting claims reimbursed. A mediclaim, on the other hand, is quite affordable, making it a popular choice. So, whether it’s mediclaim or health insurance, choose the one that you can afford and that will provide your family with the best protection. If health insurance coverage is out of your price range, consider a mediclaim policy to start with, and as your income grows, you can even graduate to a comprehensive health insurance plan.