Hey there, health-savvy policyholder! Wondering about the differences between health
insurance and mediclaim insurance and which to choose? Are they the same thing, or do they
serve different purposes? Then you are at the right place!
Welcome to our comprehensive guide on understanding the distinctions between health
insurance and mediclaim insurance.
1. Definitions
Health insurance is a financial protection plan that covers various healthcare services in
return for a premium. From hospitalisation costs to diagnostic tests and medications, it
provides comprehensive protection against unexpected health crises.
Mediclaim insurance, often misunderstood as health insurance, narrowly focuses on
hospitalisation expenses, leaving the insured to cover the rest. These policies operate on an
indemnity basis, reimbursing the policyholder for expenses up to the sum assured.
2. What are the benefits?
Benefits of Health insurance :
● Coverage Extent: Health insurance provides broader coverage, encompassing pre and
post-hospitalization costs and sometimes even alternative treatments like Ayurveda.
● Customisable Plans: Plans tailored to individuals' needs allow them flexibility in
coverage and add-ons.
● Long-Term Protection: Health insurance typically offers long-term coverage,
providing continuous protection against health risks.
Benefits of Mediclaim :
● Affordability: Affordability over comprehensive health insurance plans makes them
accessible to individuals seeking basic coverage against hospitalisation costs.
● Simple Claim settlements: Claims are straightforward, with the policyholder
submitting hospital bills detailing the incurred expenses for reimbursement.
● Focused Coverage: Mediclaims are suitable for individuals needing focused coverage
specifically for hospitalisation expenses.
So, which one to choose? Let us look at some key differences-
| S. NO. | HEALTH INSURANCE | MEDICLAIM INSURANCE |
| 1 |
Comprehensive coverage above hospitalisation. |
Exclusively covers hospitalisation expenses. |
| 2 | Includes various Pre-and post-hospitalisation expenses, even covering loss of income due to accidents. | Includes treatments related to accidents and specified diseases to a limit. |
| 3 | Offers a range of add-ons and riders such as maternity benefits, disability cover, critical illness cover etc. | No additional covers, riders or add-ons. |
| 4 |
Higher premiums due to broader coverage and benefits. |
Lower premiums due to limited coverage. |
| 5 | Offers flexibility regarding the coverage and customisation options. | Offers relatively less or no coverage flexibility. |
| 6 | The sum insured can be significantly higher and may vary based on age, lifestyle, and the number of covered members. | The sum insured is limited, typically around 5 Lakh rupees only, but may vary depending on the insurer. |
| 7 | There is no compulsion for hospitalisation to avail health insurance benefits. | Mediclaims can only be claimed if the insured was hospitalised. |
| 8 | Claims can be filed as long as their sum insured is not exhausted. However, in the event of claims related to critical illness or accidental disability cover, the assured sum is paid as a lump sum and typically limited to once during the entire policy duration. |
Multiple claims are allowed during a year til the sum assured gets exhausted. |
3. Which is better?
Mediclaim and health insurance plans both provide tax benefits under Section 80D of the
Income Tax Act. However, a health insurance plan is favoured by most due to its more
extensive insurance coverage.
Everyone's needs are different, so the best plan for you depends on what you're after and what
you can afford. There's no one-size-fits-all "perfect" mediclaim plan or health policy. It all
depends on your lifestyle, your health, and what you can manage financially.
In Summary
Understanding coverages, the services offered, the perks you get, and how much the plans
cost can help, especially when choosing between mediclaims and health insurance policies.
Knowing what you are getting into helps avoid disappointments and claim rejections.
Contact a subject matter expert to help understand your needs or claim rejection services if
needed. It'll save you a lot of headaches down the road!
