Health Insurance vs Mediclaim Policy: Understanding the Difference

When you think of getting a financial cover to protect yourselves or your loved ones, it is essential to know the differences in the benefits of Mediclaim vs health insurance, so you choose a suitable policy.

Unfortunately, most individuals believe that that they don’t require medical insurance or a health policy because they think they are healthy. However, with early investments in health insurance plans so you can prevent financial vulnerability in the event of medical emergencies.

Essentially, there are two ways to secure yourself against medical emergencies. One route is investing in Mediclaim policy plans, and the other option is opting for comprehensive health insurance plans.

To help you choose from the two, let us begin with understanding the difference between health insurance vs Mediclaim policy.

What is Mediclaim Policy?

A Mediclaim policy is a type of health insurance policy that covers your health-related expenses. However, Mediclaim policy plans are not comprehensive as they only compensate for hospitalisation expenses. The outside expenses are borne by the policyholder out of their own pocket.

If you are seeking a pocket-friendly health policy to mitigate health emergencies, then you can opt for a Mediclaim policy.

Here are some features of Mediclaim policy plans to better help you understand what it entails:

  • With medical insurance, the policyholder will not have to pay for the hospitalisation expenses or worry about the cost of treatments required for accidents or specific illnesses. For instance, you can opt for health insurance for heart patients wherein you are covered against heart and vascular conditions. Health insurance for heart patients compensates for the treatment cost as well as the associated hospitalisation expenses.
  • The premium of medical insurance is affected by several factors such as the sum insured, age, gender, geographical location, and the duration of the policy chosen.
  • The policyholder can choose a Mediclaim policy just for themselves or opt for a family policy that covers spouse, children, and aged parents along with the policyholder.
  • Policyholders can avail of the tax deductions for the premiums paid for a Mediclaim policy under Section 80D of the Indian Income Tax Act 1961.

What is Health Insurance?

Health insurance offers comprehensive protection that covers the policyholder fully against surgical as well as medical expenses. Depending on the choice of the plan, either the insurer settles all the bills directly with the hospital for a cashless procedure or reimburses the policyholder after the latter submits all the bills.

As health insurance plans are more extensive, they have a higher cost associated with them when compared to a Mediclaim policy. Here are some of the features of a health policy:

  • It offers comprehensive insurance protection against a host of medical emergencies.
  • You can enhance the protection of your health insurance with insurance riders such as the critical illness rider or accidental disability rider.
  • You can get a No Claim Bonus (NCB) at the time of policy renewal if you haven’t made any claims in the previous year.
  • You can opt for the co-payment feature to reduce the cost of the insurance premium payable. With this feature, a part of the medical expense is borne by the insurance provider, whereas the remaining is provided by the insured member out of their own pocket.
  • The policyholder is eligible to receive tax deductions under Section 80D of the Indian Income Tax Act 1961 if they choose a health insurance cover.

Difference Between Mediclaim Vs Health Insurance

The similarity in some of the features of Mediclaim vs health insurance in India can confuse the novice insurance seeker. So, when choosing between health insurance vs Mediclaim policy, a comparative analysis between the two can offer great clarity.

Feature Mediclaim Health Insurance
Coverage offered The coverage is limited to hospitalisation, accident-related treatments, and treatment costs for specific pre-decided illnesses for a certain duration. Compensates for the hospitalisation expenses, pre, and post-hospitalisation charges, as well as ambulance expenses. Some plans also provide income replacement in the event of an accident.
Add-on options There are no add-ons for a Mediclaim policy You can enhance your protection with a critical illness cover, accident cover, disability cover, etc.
Flexibility There is no flexibility with regard to coverage. With health insurance plans, the policyholder can choose to reduce their premium amount after a certain period, change the duration of their policy, and avail of long-term policy benefits.
Sum assured The sum assured for a Mediclaim policy does not exceed ₹5 lakhs The sum assured for health insurance is a lot more extensive and does not exceed ₹6 crores
Claim Under the Mediclaim policy, claims can be made until the total amount assured by the insurance provider is not exhausted Under a health insurance cover, claims made against critical illnesses or accidental disabilities receive a lump sum amount, and these claims can only be made once during the policy tenure. Aside from these, the claims can be made until the policy amount is not exhausted
Hospitalisation policy To avail of the claim, the insured member needs to be hospitalised Hospitalisation is not mandatory to make a claim

To conclude

Knowing the difference between Mediclaim vs health insurance is important for comprehensive protection against medical expenses. With the rising cost of medical treatments, every individual needs to invest in a health insurance policy.

If you are looking for an affordable or targeted health cover, then you can opt for a Mediclaim policy, and if you are seeking comprehensive protection, then a health insurance policy is recommended.

To make the right insurance decision compare the varied offerings of Mediclaim vs health insurance in India.

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