Difference Between Mediclaim and Health Insurance Explained
Do you think you are healthy? Well, if yes, we are happy for you. But are you 100% sure you will be healthy in the future too? No, none of us are. It is better to plan for yourself and your loved ones and be stress-free in the future.
If you are confused about where to start, then don’t worry. We are here to help you😊
There are two ways to get the best benefits in case of medical emergencies: Mediclaim and a health insurance plan. In this article, we will explain you the major difference between the two i.e., Mediclaim vs Health insurance and help you evaluate what you must opt for.
What is Mediclaim?
A Mediclaim insurance policy gives you specified financial protection at the time of a medical emergency. It takes care of all the following expenses when hospitalized:
- In case of an accident
- In case of sudden illness or surgery
- In case of any surgery during the policy tenure
It pays the policyholder's medical bills from the hospital stay, room charges, doctor’s visits, prescription drugs, and other inpatient hospital-related expenditures.
What is Health Insurance?
Health insurance is an insurance cover that gives you complete coverage for medical and surgical expenses in case of emergencies.
A health insurance policy provides coverage for various healthcare services, such as hospitalization, daycare treatments, pre and post-hospitalization expenditures, ambulance charges, medicines, preventative care, etc.
Both sounds similar right? But you will be surprised to know the differences between the two.
Difference Between Mediclaim and Health Insurance
Mediclaim and Health Insurance both provide financial support during medical emergencies but both are different in coverage and scope. Let’s understand the main difference between mediclaim and health insurance depending on certain factors:
Benefits of Mediclaim and Health Insurance
Mediclaim and Health Insurance are your financial superheroes in times of medical emergencies. They ensure that you are protected from unexpected medical expenses, but they provide different benefits when needed. Let’s find out:
Benefits of Mediclaim
- You can get immediate coverage for medical expenses when you are hospitalized.
- If you opt for a Cashless Mediclaim policy, your insurer directly pays for the expense.s
- If you opt for Reimbursement, your money will be reimbursed by the insurer.
- You can lower your tax deduction through a mediclaim policy under section 80D.
Benefits of Health insurance
- It gives you comprehensive coverage, including hospitalisation expenses, outpatient treatments, diagnostics, maternity benefits, etc.
- It provides you with numerous add-ons such as Critical Illness cover, pre-existing disease, etc.
- You can opt for a Family Floater Health Insurance plan to cover all family members under one collective health insurance policy.
- Pre and Post hospitalization expenses are covered
- You can opt for a specific senior citizen health plan for your parents
- Cashless claims and reimbursement claims are available
Mediclaim Insurance vs Health Insurance: Which One is Better?
Deciding what is better in Mediclaim vs Health Insurance can be tough but here are certain factors that will help you decide which one is better for you:
- Your financial condition
- Health issues you and your loved ones are dealing with
- Whether you believe in long-term or short-term planning
- Whether you need flexibility in your health plan or not
- Whether you would need add-on covers and benefits
- Willing to pay high or low premium
- Keep in mind your or your family members' age, life stage, medical condition
Choosing one out of the two is not difficult if you know what will be best for you and your loved ones, keeping all the factors mentioned above in mind.
If you need more information, get in touch with us! We are always ready to help you.
Things to Know Before Buying a Mediclaim and Health Insurance Plan in India
Now, you must be clear about the differences between health insurance and Mediclaim, but here are certain things you must know before buying either Mediclaim or health insurance:
- Coverage: The coverage provided under both differs widely. You can extend your coverage based on your health insurance needs.
- Sum Insured: Generally, both mediclaim and health insurance come with a predetermined sum insured that cannot be altered before renewal.
- Premium: The plan's premium is determined by the insured's age, gender, location, and chosen length of the policy coverage.
- Claim Settlement: The claim request is handled through cashless treatment and reimbursement.
- Tax Exemption: The plan provides tax benefits on premiums paid under Section 80D of the Income Tax Act of 1961.
- Renewability: Typically, health insurance offers a No Claim Bonus benefit when the policy is renewed after each year without a claim. This benefit may lower renewal premiums.
- Co-payment: Certain plans may require a co-payment in which the insured pays a certain part of the treatment costs, and the insurance company pays the remaining sum. This helps lower the insurance premium.
In the battle between mediclaim and health insurance, there is nothing perfect winner that suits everyone. Mediclaim is for hospitalization coverage, whereas health insurance is for wider coverage.
Assess your health risks and financial goals and choose the best that suits your needs.
FAQs about Mediclaim vs Health Insurance
Is a Mediclaim policy the same as health insurance?
No, a mediclaim policy is not the same as health insurance. The mediclaim usually covers only the hospitalization expenses, whereas, in health insurance, the policyholder provides coverage against preventive care, pre-hospitalization and post-hospitalization expenses.
What are the differences between Mediclaim and health insurance policies?
A mediclaim and a health insurance policy depends on several factors:
- Mediclaim: It provides coverage against any hospitalization expenses incurred due to an accident or sudden illness.
- Health Insurance: It provides wider coverage along with hospitalization, such as preventive care, ambulance coverage, pre & post-hospitalization coverage, etc.
Is it better to take Mediclaim or health insurance?
When it comes to choosing the best for yourself, health insurance is superior to mediclaim as it covers outpatient procedures, preventive care, and pre-existing diseases.
However, decide what suits your needs the most regarding your financial and health conditions.
What are the advantages of Mediclaim insurance?
The mediclaim has several advantages, including the coverage provided for room charges, doctor’s fees, medication, and other sanctioned costs while you are hospitalized for treatment or surgery.
What is covered under a Mediclaim policy?
A mediclaim covers the hospitalization costs related to accidents, surgery or illness. It covers the cost of room, treatment, diagnostic tests, and consultation fees only when you are hospitalised.
What are the key benefits of health insurance?
The key benefits of health insurance include:
- It provides wider coverage and financial security during accidents, illness or surgery
- Helps to undergo cashless treatment at the hospital
- Provides tax benefits on the premiums paid under section 80D
- Rewards with no claim bonus every year if you don't file any claim in a policy year
- It has several add-on options to provide complete coverage
Are pre-existing conditions covered under Mediclaim or health insurance policies?
Yes, the pre-existing diseases are covered only under the health insurance policy. You must disclose your pre-existing disease to your insurer at the time of policy purchase to get the coverage.
Pre-existing diseases include Diabetes, Asthma, Thyroid problems, High Blood Pressure, Arthritis, Heart Conditions, Kidney Problems, etc.
How do the claim processes differ between Mediclaim and health insurance?
The claim process for mediclaim and health insurance are almost the same.
You can opt for cashless claims or reimbursement claims as per your requirements. For a cashless claim, you can connect with the TPA at the network hospital or apply for a reimbursement claim directly on the website.
Are there tax benefits associated with Mediclaim or health insurance premiums?
Yes, you can claim tax benefits with mediclaim and health insurance premiums under article 80D of income tax. You can save up to ₹25,000 yearly for yourself and ₹25,000 for your senior parents under a health insurance policy.
How does the premium for Mediclaim compare to that of health insurance?
The premium paid for mediclaim is generally low when compared with health insurance. This is because health insurance provides a wider coverage than a mediclaim and thus, the price is slightly higher in health insurance.
What factors should you consider before choosing between Mediclaim and health insurance?
You must consider certain important factors before choosing between mediclaim and health insurance. It includes the coverage, financial condition, sum insured, premiums paid, network hospitals, policy duration, etc.
What are co-payments and deductibles in Mediclaim and health insurance?
The co-payment and deductibles are differently defined in mediclaim and health insurance:
- Co-payment: This is the set sum that a policyholder must pay for a particular medical treatment, such as a prescription drug or doctor's visit. The insurance company covers the rest of the cost. Co-payment can be applied directly or after a deductible.
- Deductibles: This is the fixed amount a policyholder must pay out of pocket before the insurance provider pays for medical expenses.
What are the common exclusions in Mediclaim and health insurance policies?
Certain common exclusions that are not covered under mediclaim and health insurance policies include cosmetic surgery, self-harm injuries (suicide attempts), ART procedures (IVF, IUI), etc.
Can Mediclaim and health insurance policies be customized to meet individual needs?
Yes, mediclaim and health insurance policies can be customised as per your needs and on the mutual agreement of you and your insurance company.
Are there waiting periods for coverage in Mediclaim and health insurance policies?
Yes, there are waiting periods for coverage in both, mediclaim and health insurance policies. The waiting period differs from policy to policy:
- Initial Waiting Period - 30 days
- Pre-existing Disease Waiting Period - 1 to 4 years
- Specific Disease Waiting Period - 1 to 2 years
- Accidents - No waiting period in Mediclaim or health insurance
Do Mediclaim and health insurance policies cover preventive health check-ups?
Only a health insurance policy covers the cost of preventive health check-ups. Mediclaim doesn't.
What should I do if I cannot afford health insurance?
If you cannot afford health insurance, you can modify your plan’s coverage to decrease the cost of premiums. You can opt for health insurance that is easily affordable and within your budget.
Is it worth buying Mediclaim insurance?
Despite the distinction between health insurance and mediclaim policies, a mediclaim plan may also be worthwhile based on your particular requirements. It covers the expenses related to hospitalisation during accident and any illness.
If you want more coverage than a mediclaim provides, go for health insurance.
Does Health Insurance mean Mediclaim?
No, Mediclaim is not the same as health insurance. Both terms vary depending on coverage, duration, premiums, sum insured, hospitalisation, etc.