While browsing through health insurance plans, you might have also come across the term Mediclaim. Often, health insurance and Mediclaim are used as synonyms for each other. In a way, these two do have several similarities, the primary one being that they can help you access quality treatment during a medical emergency. However, there are many features that distinguish a Mediclaim policy from a health insurance policy. In this article, we guide you through these differences so that you may know which form of coverage suits you better.
The major difference lies in the coverage
The biggest difference between health insurance and Mediclaim lies in the kind of coverage offered. A Mediclaim policy only pays for your treatment under the condition of hospitalization due to accidents or specific illnesses only. You cannot raise a claim on your Mediclaim policy unless you are hospitalized. It does not pay for any pre- or post-hospitalization expenses either.
Health insurance, on the other hand, is a comprehensive policy that offers financial protection against a variety of illnesses, medical procedures, and health issues. Besides paying for pre- and post-hospitalization expenses, it also offers cover for annual health check-ups and alternative healing methods such as AYUSH. You do not have to be hospitalized to make claims on your health insurance as it also covers out-patient treatment.
The option of add-ons
Add-ons are extra plans or coverage that you are offered to increase the protection for the insured.
Mediclaim policies do not offer the option of add-ons.
Health insurance policies offer several add-ons that may be helpful to you depending on your needs. A critical illness cover add-on may provide you protection against up to 25 critical illnesses, while a personal accident cover add-on may prove to be helpful to you in case of accidents that lead to disabilities and loss of income.
Sum insured limitations
The sum insured for a Mediclaim policy is limited to a maximum of Rs 5 lakhs.
The maximum sum insured of health insurance policies has a higher limit than Mediclaim and depends upon the insurance providers.
Claims and payment
One can raise claims on their Mediclaim policy until the sum insured is exhausted. The payment for the claims is done either by reimbursing the policyholder or by paying the hospital directly under the cashless facility.
The payment of the claims in health insurance depends upon the policy chosen. If it is an indemnity-based plan, the policyholder can opt for reimbursement or cashless treatment. If the policy happens to be a benefit-based plan or cover, the policyholder will receive lumpsum payments that they may use according to their needs.
Flexibility
A Mediclaim policy does not offer much flexibility in terms of premiums, coverage, or duration.
Under health insurance plans, one can reduce or increase their premium according to their needs. They can opt for a shorter duration or a long-term policy, or add more coverage as they may deem fit.
Premium affordability
Mediclaim is considered to be an affordable way of getting financial support during medical emergencies. Since the coverage is limited, the premium you would have to pay for a Mediclaim policy would be low as compared to health insurance.
Since health insurance offers extensive coverage, the premium you might incur for a health insurance policy will possibly be higher as compared to Mediclaim. However, you get a better safety net of coverage.
Do bear in mind that the features and terms and conditions of health insurance policies differ between insurers. Kindly read the policy documents carefully before signing anything.
We hope this article has increased your understanding of the differences between Mediclaim and health insurance.
