Mediclaim VS Health Insurance

It is a misconception that Health Insurance and Mediclaim can be used interchangeably. Although they do have some similar characteristics, they are quite different in terms of their function. Health Insurance covers a wide range of expenses, including pre and post-hospitalisation, cost of treatment, transportation costs and maternity-related costs. Some policies even cover outpatient expenses and surgeries. Mediclaim provides limited coverage that is restricted to hospitalisation and the treatment of certain diseases. 

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are to decide on the request for cashless claims within 1 hour of receiving the request. Also, the final claim is to be granted within 3 hours after the policyholder’s discharge from the hospital. Insurers have been directed by IRDAI to establish necessary systems and procedures for this process by July 31, 2024. The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

What is Health Insurance?

Health insurance is the best way to keep yourself financially secure in the event of medical emergencies. Under this plan, medical and surgical costs are incurred by the insured. Moreover, the policyholder can also pay these costs out of pocket and then receive reimbursement from the insurer, or the insurance provider pays the network hospital directly. The coverage is typically broader than hospitalisation costs, hence it is typically more expensive than mediclaim insurance.

What is Mediclaim Insurance? 

Mediclaim insurance is a form of insurance that provides specific financial protection against medical bills. It is a cost-effective technique to deal with any health-related crisis. However, mediclaim insurance coverage is restricted to hospitalisation, and the insured is responsible for all additional medical expenditures.

Differences Between Mediclaim and Health Insurance

Let’s understand the differences between mediclaim and health insurance with the help of this table given below:

Benefits of Health & Mediclaim Insurance

1. Advantages of Mediclaim

• When you are hospitalised, you might receive instant coverage for medical bills.

• If you choose a Cashless Mediclaim coverage, your insurer will pay the costs immediately.

• If you choose reimbursement, the insurance company will return your money.

2. Health Insurance Advantages

• Gives you complete protection

• Offers you a variety of add-ons

• To cover everyone in your family under a single family-wide health insurance plan, you can choose a Family Floater Health Insurance plan.

• The costs of both pre and post hospitalisation are covered.

• It allows you to choose a critical illness cover

• Benefits including outpatient, maternity, restoration, and other options are available.

• You can select a special senior citizen health plan for your parents.

• There are cashless claims accessible.

Things to Know Before Buying a Mediclaim or Health Insurance Plan in India

Here are some important things that you need to consider before buying a mediclaim policy or health insurance for yourself or your loved ones: 

• Sum Insured 

Sum insured refers to the maximum amount of medical coverage you are eligible to receive through your mediclaim/health insurance plan. You should try to pick a plan that offers the higher sum insured at reasonable rates. 

• Type of Plan 

It’s also important to consider which type of mediclaim/health plan you should buy. There are a variety of plans available such as individual health insurance plans, family health plans, and senior citizen health plans that you can choose from. 

• Extent of Coverage

While you’re deciding the amount of coverage, it is also a good idea to take the extent of coverage that you want into account as well. While some may want more comprehensive coverage that includes pre-hospitalisation costs and ambulance costs, others may want to just take care of the hospitalisation part of the expenses. Deciding the extent of coverage beforehand can allow you to better customise the insurance plan according to your needs.

• Policy Duration 

This is another major factor that you should be aware of before deciding to purchase an insurance policy. Usually, most health insurance plans are offered for only a year. However, there are plans that are offered for a tenor of 2 or more years as well. The longer the tenor you opt for, the better, as you would effectively be shielded from any unexpected premium increases.

• Network Hospitals 

Finally, before making your purchase decision, remember to check the network hospitals supported by the insurance plan. The more the number of hospitals in the network, the better, as it would allow you to opt for cashless claims, which can significantly reduce your financial burden.

Should You Buy a Mediclaim Policy or a Health Insurance in India?

The ultimate decision of whether you should purchase a mediclaim policy or a health insurance plan lies with you. If extensive and comprehensive coverage for almost all kinds of medical expenses is what you seek, a health insurance plan will serve you well. On the other hand, if you’re only looking to cover hospitalisation expenses and treatment costs for certain specified diseases, a mediclaim policy should be enough for you. Before you make a purchase decision, make sure to take your needs and requirements into account.