Difference between Mediclaim and Health Insurance

• Written by Nidhi Goyal

  Reviewed by Munmi Sharma

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How is Health Insurance Different from Mediclaim Policy

Most of the people tend to use the terms medical and health insurance interchangeably. Though these two insurance policies refer to the coverage for medical expenses,  they still remain different. If this happens to you as well, this blog will help you find the key differences between mediclaim and health insurance policies. Hence, enabling you to make well-informed decisions regarding which policy to buy.

What is a Health Insurance Policy?

A health insurance policy is an indemnity-based insurance plan offering comprehensive coverage for emergency or planned hospitalisation and several distinct benefits. It includes in-patient hospitalisation, ambulance costs, pre and post-hospitalisation expenses, daycare treatments, OPD expenses, COVID-19 hospitalisation, and more. Additionally, the policy coverage includes no claim bonus, lifelong renewability, automatic recharge, annual health check-up, organ donor cover, second opinion, etc.. 

A cashless claim facility at network hospitals is one of the seamless benefits of a health insurance policy. Moreover, reimbursement claim settlement can be claimed from non-network hospitals. You can also increase the policy coverage with exclusive add-ons like a reduction in wait period, co-payment waiver, international second opinion, OPD cover etc.  There are different types of plans including  individual plans,  family floater plans, senior citizen plans, maternity plans etc. to choose from as per your needs. that you can choose as per your and your family's healthcare needs. You can get these plans at a low premium with special online discounts.

What is Mediclaim Policy?

A mediclaim policy is a health insurance policy that offers coverage for expenses incurred by a person during a medical emergency, including hospitalisation and treatment due to critical illness, surgery, or accident. However, its premium is slightly higher, but it provides lifelong coverage for various life-threatening diseases, including cancer., It  also covers the expenses for chemotherapy, radiotherapy, and organ donor cover. These plans are available monthly and quarterly on installments with 2 or 3 years of tenure.

You can earn the reward of no claim bonus (NCB) for every claim-free year. Cashless hospitalisation and reimbursement claim settlement are available under the mediclaim as per the policyholder's preference. Individuals who have a history of diseases like cancer, heart attack, etc., should opt for mediclaim.  Moreover, you can also get it as an additional health cover to stay protected from the exorbitant treatment costs of critical illnesses.

To summarise, a mediclaim policy limits itself to hospitalisation expenses. In contrast, health insurance is an all-inclusive policy that offers a wide range of coverage and value-added benefits, along with in-patient, pre and post hospitalisation coverage.

Mediclaim Vs Health Insurance

Here are a few main points of comparison between health insurance and Mediclaim policy:

How Does Health Insurance Score Over Mediclaim Policies?

Mediclaim policies are often very restrictive but can be useful during emergencies like hospitalisation due to accidents or ailments. However, since health insurance offers 360-degree coverage, most experts recommend having a health insurance plan. Such plans are designed to keep an individual's healthcare requirements in mind. They accommodate coverage from the very start of any health issue. So, when assessing the benefits of mediclaim vs. health insurance plans, it is clear that a health plan has many added benefits and features, some of which are listed below:

• Domiciliary Hospitalisation: If required or suggested by the doctor, you can go for domiciliary hospitalisation, which is covered by health insurance but not by  mediclaim.
• Annual Health Check-ups: The best part of health insurance is that you can go for an annual health check-up once right from the first year. But in mediclaim, it starts from the second year of the policy. 
• Coverage: The amount of coverage or sum insured is less in mediclaim. In contrast, s, with health insurance, you can choose up to 6 crore sum insured. 
• COVID-19 Cover: Health insurance covers coronavirus hospitalisation and treatment costs. Mediclaim does not cover COVID-19 treatment expenses.
• Add-Ons: You can increase the coverage of your health insurance policy by opting for add-ons. For example, with Care Health Insurance, you have add-on benefits like global coverage, international second opinion, Care Shield, reduction in PED wait period, no claim bonus super, etc.
• Daily Allowance: Health insurance also offers a daily allowance add-on in which you will get coverage for non-medical expenses such as food, transportation, etc., which you will not get in mediclaim.
• Co-payment Waiver: If the insured member is 61 years or older, you can opt for this add-on to eliminate the 20% co-payment. It is not applicable in mediclaim.  

Insurance suppositions can differ. An insurance plan that works for one family might not work for another. For this very purpose, many plans can be tailored to suit different people with different health problems. There is a significant difference between health insurance and mediclaim, where one can customise a health plan according to individual needs. 

Care Health Insurance resolves to offer a solution for customers from all walks of life. Our comprehensive Health Insurance provides the exclusive benefits and features that help policyholders to avail of the best possible treatment during a medical emergency.

Cashless Mediclaim Policy for Family in India

Mediclaim offers its customers two claim settlement options - reimbursement and cashless. Policyholders can avail of the cashless treatment across any hospital empaneled in the insurer's network. Simply put, a cashless Mediclaim policy is one where the expenses are directly settled with the healthcare institution, subject to policy terms and conditions. It is beneficial, as it reduces the direct financial load on that individual during hospitalisation. For the customer, this is highly convenient. For a hassle-free experience, one should inform the insurer post-admission within the specified time, which is 24 hours in case of emergency hospitalisation. Apart from this, one should read all key policy terms and conditions and keep their health card handy as it must be presented in the hospital.

However, if an individual wishes to proceed with treatment in a hospital that is not on the insurance company's list at the time of an emergency, they can still claim. In this case, they will have to pay the hospital expenses out of their own pocket and file for reimbursement after being discharged.

How Does Mediclaim and Health Insurance in India Work?

Though mediclaim policies are beneficial for meeting hospitalisation expenses, health insurance policies have the edge over mediclaim plans, given the wide range of features available. The following features are unique to a mediclaim policy and define how  it works in India.

• Coverage Offered: Mediclaim policies offer specific coverage, such as hospitalisation expenses for accident-related treatment and certain diseases.
• Group Mediclaim: Just like Health Insurance, a Mediclaim policy also offers a family health insurance plan, which means one could cover multiple family members like parents, spouses, and children in a single policy. A Group Mediclaim is a type of Mediclaim policy wherein the coverage is extended to a group of people, for example, employees of an organization.
• Premium and Sum Insured: Mediclaim policies usually have a predefined sum insured. The policy premium is calculated based on factors such as the sum insured, gender, proposer’s age, treatment location, and policy duration.
• Claim: The claim settlement generally reimburses the insurance company's hospitalisation expenses.
• Tax Advantages: Such plans offer a tax rebate on the premium paid under section 80D of the Income Tax Act.
  Health insurance plans are the most widely preferred insurance plans in India owing to the comprehensive nature of coverage offered by them. Listed below are some exclusive features that explain how they work in India:
• Cover Offered: Health policies offer complete coverage for various medical exigencies, such as critical illness and pre-existing diseases.
• Family Cover: Family floater plans offer health insurance coverage for the entire family parents, spouse, and children.
• Tax Benefits: Health insurance buyers can get tax deductions under section 80D of the Income Tax Act on the premium they pay for a policy.
• Cashless Hospitalisation: This feature enables an insured person to avail of cashless Mediclaim treatment in any of the insurer's network hospitals, thus providing a high level of convenience.
• Co-payment Option: Some senior citizen health insurance plans have a co-payment option, requiring the policyholder to bear some medical costs. Buyers can expect lower premiums.
• Discounts and no-claim bonus: Health plans offer various additional benefits, generally offered during policy renewal in the form of premium discounts and a higher sum insured as a bonus for a claim-free year.

Which Policy Should You Buy, Health Insurance or Mediclaim?

Mediclaim and health insurance policies both cover unexpected hospitalisation costs that may arise due to sudden injuries, accidents, or illnesses. But consider these factors before you decide which policy you should buy:

• Choose the policy as per your financials so that the premium won't burden you later
• Pick the policy as per your family's past medical history or pre-existing disease
• Duration of the policy, whether it should be for 1/2/3 years
• Customisation available in the coverage as per the healthcare needs
• Add-on benefits to increase the policy coverage
• Coverage for COVID-19 hospitalisation and treatment expenses 
• Check the eligibility of buying the policy with lifelong renewability 

>> Read More : Benefits of Unlimited Automatic Recharge in Mediclaim

Takeaway

Given the marked difference and benefits of mediclaim vs health insurance, it might be confusing when deciding between buying a mediclaim and opting for a health insurance policy. The best way to know which health coverage is best for you and your family is to assess your healthcare needs. Some factors to remember include financial situation, the required coverage amount, any ailment you or a family member may be suffering from, age, lifestyle, etc. 

If you are clear about what a mediclaim policy is, you will see that it works best for satisfying your hospitalisation-related needs. However, if you have a family, including a spouse, dependent children, and parents, it is advisable to go for a family floater health insurance with benefits that offer much more than hospitalisation coverage.

Disclaimer: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.