Do you consider yourself healthy? Well, if yes, then it is good. Can you guarantee to maintain this health status in future? Probably not. None of us can do that. We need to keep ourselves and our family members healthy and safe from ailments, by ensuring proper maintenance of health insurance. This is essential to safeguard and ensure proper maintenance of your savings and finances while coping with medical inflation. Either you need to possess a mediclaim or a health insurance plan for effective practical management of your financial status and health together. Here, we will discuss all the relevant aspects related to mediclaim and health insurance plans, making a comparative analysis for better understanding.
What is Mediclaim?
Mediclaim is referred to as a health insurance plan that provides speculated medical protection during medical emergencies. In case of hospitalisation, it takes care of the following expenses:
- During health damages due to any accidental circumstances
- During any unprecedented surgery or ailment
- During any surgery in case of the policy term
Depending on the nature of finance management and transaction, mediclaim can be broadly classified into two categories: reimbursement and cashless.
In case of reimbursement, you need to make all the necessary payments during the course of treatment after which you need to make a health insurance claim, authenticating it with proper documentation. In the case of cashless health insurance treatment, you need not have to pay for the ongoing treatment, up to the maximum limit of the insurance. Under both circumstances, you have to ensure that the treatments are done exclusively in the network hospitals, mentioned by the concerned insurance company.
Read more - All That You Need to Know About Mediclaim Policy in India
What is Health Insurance?
Health insurance is a protective insurance cover that offers entire coverage for surgical and medical expenses in case of sudden medical emergencies like health insurance for heart patients, health insurance for surgery, personal accident insurance cover, critical illness insurance, etc. In case you possess health insurance, you need to either pay the entire treatment cost out of your pocket which gets later reimbursed by the concerned insurance provider or the insurance company directly settles the bill with the hospital authorities.
Differences Between Health Insurance and Mediclaim
| Focal Point | Mediclaim | Health Insurance |
| Coverage | Mediclaim offers coverage only against hospitalization expenses. No other form of treatment costs is covered under the plan. | Offers comprehensive coverage extending further than hospitalization costs. Some of these expenses include health insurance with OPD cover, preventive health check-ups, air ambulance cover, hospital cash insurance, and alternative medical treatments like homoeopathy, AYUSH, etc. |
| Riders | No riders are available with mediclaim. | Depending on the plan, several health insurance riders are available: maternity rider, critical illness rider, personal accident rider, hospital cash rider, room rent waiver, etc. |
| Limitations | The hospitalisation coverage for mediclaim remains limited and never exceeds INR 5 lakh. | The health insurance plan is far more extensive and gets determined by age, location, the total number of members involved in a single plan, etc. |
| Flexibility | Mediclaim lacks flexibility | Health insurance plans are comparatively far more flexible and can even be customised according to requirements. |
| Ambulance Charges | Never allows for payment or reimbursement of ambulance charges. | Generally, allows ambulance charge payment up to a certain extent. |
| Daycare Procedures and Maternity Benefits | It does not include maternity benefits or the costs of treatment of the child. Cataract surgery costs are also not covered since it does not include hospitalisation | Includes maternity benefits and daycare costs along with other relevant expense coverage. |
| Cost and Benefits | Since mediclaim coverage is limited to up to INR 5 lakhs, the premium value is also comparatively low. | Being a comprehensive plan, its scope is much extensive. |
| Number of Claims | Allows multiple claims till the sum insured gets exhausted. | Unlimited number of claims can be made based on the coverage & sum insured limit. |
Benefits of Mediclaim and Health Insurance
Benefits of Mediclaim
- Being able to receive immediate coverage from all medical expenses in case of hospitalisation.
- In the case of a cashless facility, the insurance provider settles the claim directly with the authorities of the concerned network hospital.
- In case you choose the reimbursement option, your money will be automatically reimbursed by the concerned insurance provider/company.
Benefits of Health Insurance
- Offers a concrete comprehensive coverage.
- Offers you different types of rider facilities to choose from depending on the circumstances and your personal requirement.
- You can even avail of the family floater health insurance to ensure insurance coverage for all the family members, depending on the policy terms, under one single insurance plan.
- It covers pre-and-post-hospitalisation costs.
- Offers you the option to choose the critical illness health cover.
- You can enjoy a variety of benefits like maternity benefits, restoration benefits, outpatient benefits, etc.
- Depending on the circumstances, you can separately buy senior citizens health insurance for aged parents.
- You can also avail of cashless treatment facilities.
Which One is More Feasible for Buying: Mediclaim or Health Insurance?
This is a tricky question and you need to consider several factors before making the decision. Before choosing, you must carefully consider several factors like:
- Your current financial condition
- Pre-existing and current health issues that you and other family members included in the plan are dealing with.
- Whether you are planning for short-term or long-term
- Whether you are in a position to enjoy a flexible health plan or not
- Whether you will be requiring additional benefits and riders
- The amount of premium you are eligible to pay depending on your current financial status and considering the rising medical inflation.
- Considering the type of medical requirements that you might need depending on the existing health status, life stage, age, lifestyle of all the potential family members to be involved in the plan.
Conclusion
The above discussion has essentially highlighted all the major differences between mediclaim and health insurance. You can now easily compare health insurance plans online and mediclaim plans and settle for the one best suited for your purpose.
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