Health insurance vs Mediclaim policy: Know these nine points

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We have all heard about health insurance and Mediclaim policies. But most of us are not sure about the difference between the two. While they have many similarities, there are crucial differences too. Here’s a look:

Health insurance policy

Health insurance is a comprehensive policy which takes care of your medical, hospitalisation and surgical expenses. The settlement is either done between the insurance company and the hospital authority or between the insurer and the insurance company. This takes care of all your medical expense and slightly costlier than a Mediclaim policy.

Mediclaim policy

Mediclaim policy is a specific financial assistance against hospitalisation of a person. It is pocket friendly, and the insurer does not have to worry about as the final settlement in this generally done between the insurance company and the hospital authority. But this is not a comprehensive plan for health-related issue.

Nine important points

Coverage: In a Mediclaim policy only hospitalisation cost of planned, sudden or pre-decided decease are generally covered. Pre or post hospitalisation costs are not included in this policy.

A health insurance plan is a comprehensive plan including pre and post hospitalisation cost, ambulance expense, OPD expense and even pathological expenses. Additionally, it also offers compensation in case of loss of income as a result of an accident.

Premium: For same coverage the premium of a Mediclaim policy is a bit cheaper. Consider a health insurance of a 30-year old with sum assured of Rs 5 lakh. The standard premium rate varies between Rs 6,100 and Rs 6,600.

On the other hand, if you go for a Mediclaim policy then it generally varies between Rs 4,900 and Rs 5,500. These rates are excluding GST and other variable charges.

Add on coverage: Mediclaim policy offers a couple of additional or optional benefits like non-deductible, room rent modification, pregnancy and cataract coverage under strict guidelines.

In a health policy add-on features like OPD charges, Covid care, global coverage can be obtained. It also offers critical illness coverage, personal accident and accidental disability coverage as well. Maternity and other benefits are there also.

Flexibility: In Mediclaim it is not possible to change the policy or the tenure in the middle of the year. It is not considered as a flexible policy.

On the other hand, one can change the coverage limit after a specific period in a health insurance. A person can change the duration of the policy as well as add some add-on benefits. It gives policyholders the opportunity to customise the policy according to their need.

Sum assured: In Mediclaim sum assured generally goes up to Rs 50-60 lakh, on the other hand in health insurance the sum assured can go up to Rs 6 crore. That is almost 10 times more than the Mediclaim policy. That is why health insurance is called comprehensive health coverage.

Claims: Both in Mediclaim and health insurance policy insurer can placed a claim unless and until he/she has exhausted the limit. But in health insurance scheme one can claim for an accidental disability or critical illness coverage, though this can be claimed once in policy duration. Both claims can be adjusted either through cashless or through reimbursement method.

Critical illness cover: In Mediclaim the insurer does not get any critical illness cover, on the other hand a health insurance provides critical insurance cover once in the policy tenure. Lump sum amount will be given to the insurer after the claim has been submitted. 30 critical diseases like cancer, lung, kidney, liver or heart related ailment are enlisted under a health insurance policy.

Hospitalisation and other benefits: In Mediclaim facility the insurer must get hospitalised, unless hospitalisation takes place Mediclaim benefits cannot be obtained. On the other hand, health insurance policy can cover pre and post hospitalisation cost, day care cost and others.

In both the cases regular health check-up benefits are there, but for Mediclaim it starts after two claimless years and for health insurance after a single claimless year.

Daily allowance: In health insurance policy one may get daily add-on allowances of non-medical expenses like food, transportation cost, attendant cost etc. On the other hand, in Mediclaim these types of facility are not available at all.

End point: Both health insurance and Mediclaim policy are important. Experts advise to avail a health insurance policy as this is more comprehensive one. If you do not have any cover, go for Medicalim at least. If you have a family, family floater health insurance scheme might be suitable for you.