Mediclaim vs. Health Insurance: Which One to Choose?
People often get confused between mediclaim and health insurance while purchasing a health insurance plan. A major misconception is that health insurance is synonymous with mediclaim. That’s not the case. A health insurance policy is quite different from a mediclaim.
This post lists out the main differences between Mediclaim and Health Insurance, their features and benefits and which one to choose depending on your requirement. Read on!
What is Mediclaim?
Mediclaim is an insurance policy that offers financial assistance for medical expenses. You can mitigate health-related emergencies through this pocket-friendly plan. The only flipside is, Mediclaim only covers your hospitalisation expenses. For other medical costs, you need to pay from your pocket.
What is Health Insurance?
Health insurance covers surgical and medical costs that an insured incurs. An insurance provider can directly settle your bills with the concerned network hospital. However, at times, you might have to pay for the hospital expenses and your insurer will reimburse the amount later. These policies offer extensive coverage that goes beyond hospitalisation expenses and hence, is somewhat costlier than mediclaim policies.
Mediclaim vs. Health Insurance
The following chart will help you understand how mediclaim is different from health insurance:
| Factors | Health Insurance | Mediclaim |
| Hospitalisation | You can avail of medical insurance benefits without getting hospitalised. Such plans cover expenses for daycare procedures that do not require hospitalisation. | You can avail of mediclaim policy benefits only after being hospitalised. |
| Claims | Under a health insurance policy, you can file claims until the sum insured is exhausted. However, when claims concerning accidental disability/critical illness cover arise, you’ll get the assured amount in a lump sum. You can raise this claim only once in the entire policy tenure. | In a mediclaim policy, you can file numerous claims until the sum insured gets exhausted. |
| Amount insured | Amount insured may range between Rs. 50,000 to Rs. 6 crores every year. | Amount insured generally does not go above Rs. 5 lakh. |
| Critical illness cover | It facilitates coverage for over 30 critical illnesses, namely kidney failure, stroke and cancer, based on your plan. | It doesn’t offer coverage for critical diseases. |
| Flexibility | You can easily reduce or enhance your health insurance coverage. By altering your policy duration, you can minimise the amount of premium after certain tenure. Additionally, long term plans give discounts on your premiums. | There is no flexibility in the policy coverage. |
| Add-on covers | It includes various add-on covers such as maternity cover, personal accident cover and critical illness cover. | It doesn’t come with add-on covers. |
| Basic coverage | It provides comprehensive coverage comprising ambulance expenses, pre and post hospitalisation charges and hospitalisation expenses. | It only offers coverage for hospitalisation. Pre-existing diseases and accident-related treatments get coverage up to a pre-mentioned limit. |
Features and Benefits of Mediclaim Policy
Following are the merits of a mediclaim plan:
- After hospitalisation, you will get instant coverage for your medical expenses.
- In the case of a cashless plan, the insurance provider directly pays your bills.
- You can protect yourself and your family through this policy.
- As per Section 80D of the Income Tax Act, these plans qualify for tax exemption.
- It offers cost-effective medical facilities.
Features and Benefits of Health Insurance Policy
Following are the advantages of availing a medical insurance plan:
- Cashless claim settlement is applicable.
- It offers extensive coverage with multiple add-ons such as restoration benefits, maternity benefits and outpatient benefits.
- A family floater health insurance policy provides numerous benefits under one umbrella.
- Special senior citizen medical plans are available for older individuals.
- According to Section 80D of the Income Tax Act, you can claim tax deductions for your health insurance policy.
Insurers such as Navi Health Insurance provide substantial coverage of Rs. 2 lakh to Rs. 1 crore with cashless benefits and paperless claim settlement. Its claim settlement ratio stands at 97% and you can get a claim settled in 20 minutes across 400+ locations and 10,000+ network hospitals in India. To avail of these benefits, download the Navi App on Android or iOS now!
Also Read: Cashless Health Insurance Policy: All You Need To Know
Health Insurance or Mediclaim: Which to Choose?
Keep the following points in mind while deciding to opt for a health insurance plan or mediclaim:
- Opt for a policy that suits your medical condition, life stage and age
- Consider whether you want to pay a low or a high premium
- Understand whether you require add-on benefits and cover
- Know whether you require a flexible health policy or not
- Choose a policy as per your financial stability
- Take a decision after considering the health issues of you and your family members
- Find out whether you need a short term or long term policy
The above-mentioned parameters will help you to make the right decision. Meanwhile, every health policy is unique in its offerings and features. So, choose as per your requirements.
Also Read: What to Keep in Mind when Buying a Health Insurance Policy
Final Word
Health insurance and mediclaim are two separate options for financing health emergencies. Both have been successful in satisfying the urgent needs of policyholders. So, you should compare the multiple medical policies of the insurance companies on the basis of their premium, benefits, services and coverage. All the best!
FAQs on Mediclaim vs Health Insurance
Ans: Claim settlement ratio acts as a credible metric to decide whether an insurer and a certain policy is the correct choice for a person. So, you must always check your prospective insurer’s CSR before opting for a plan.
Ans: A family floater medical insurance denotes a health insurance policy that covers you and your family under one plan. Through this, you and your loved ones will share the amount insured and the insurance premium. It’s a cost-effective option.
Ans: A group medical insurance plan is designed for the employees of a company or a business organisation. Hence, a person who owns a corporate house or a start-up can purchase such policies for their employees.
Ans: Yes, individuals above 60 years of age can opt for a dedicatedly designed senior citizen medical insurance policy. It offers wide coverage for expenses incurred for pre and post hospitalisation, medical expenses, critical illnesses, accidents, psychiatric benefits and domiciliary hospitalisation.
Ans: There has been a gradual rise in lifestyle-related illnesses over the years. Insurers have designed critical illness insurance policies to cover expenses for treating multiple sclerosis, pulmonary arterial hypertension, paralysis, kidney failure, stroke, cancer and coronary artery bypass surgery and others.
Before you go…
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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