scorecardresearchDifference between Mediclaim and Health Insurance?

Difference between Mediclaim and Health Insurance?

Updated: 12 Apr 2022, 10:05 AM IST

Both mediclaim and health insurance are intended to cover an individual's medical expenses. They each have their own set of benefits, as well as the expenditures they cover. The coverage provided, your budget, and other criteria will all influence your selection. Continue reading to have a thorough understanding of it.

Both mediclaim and health insurance are designed to meet the health expenditure of an individual.

Both mediclaim and health insurance are designed to meet the health expenditure of an individual.

With the advancements in medical sciences, it has become very convenient to detect and cure almost all diseases and ailments. However, the cost of the same can be very heavy on the pocket. In order to ensure the well-being of all at the best price possible, mediclaims and health insurances come in handy.

What is a Mediclaim?

Mediclaim insurance offers financial protection against health expenses. Even though it is pocket friendly, it is very limited in its scope of coverage. It must be noted that the coverage under a mediclaim is limited to hospitalisation whereas the additional expenses are borne by the insured himself. It is not very flexible in nature.

What is Health Insurance?

Health insurance has a wider scope of coverage. The surgical and medical expenses are reimbursed by the health insurance policy. Health insurance is more expensive than a mediclaim owing to its wider scope of coverage and other differences that are listed below.

The difference between mediclaim and health insurance

In order to choose the right assistance between a mediclaim and health insurance, it is very important to understand how they are different from each other. Listed below are few categories where they can be differentiated and chosen as per the requirement.

Number of claims

A policyholder can claim multiple claims until the total amount that is assured is exhausted. On the other hand, a policyholder is paid the assured lump sum whenever a medical emergency arises. Usually, only one claim can be made in a year in the case of health insurance.

Ambulance charges

There is no provision of reimbursement for the ambulance facility in case of mediclaim. Whereas, health insurance has a provision of allowing the reimbursement of ambulance charges to a certain limit.

Coverage and benefits

Mediclaims are restricted in their scope of coverage. Claims under a mediclaim plan can be provided only in the case of hospitalisation, accident-related treatment and pre-decided diseases but only up to a pre-specified limit. The coverage under mediclaim is generally restricted to Rs. 5 lakh without any scope of add-on coverage.

On the other hand, health insurance is more flexible in terms of coverage. Health insurance offers comprehensive coverage against pre-hospitalization, post-hospitalization, ambulance, etc. in addition to hospitalisation expenses. 

There are numerous add on coverages available in health insurance, like personal accident coverage, maternity coverage, etc. Health insurance plans are more flexible and offer the options of changing the policy duration, reducing their premium, etc.

The coverage under health insurance is comparatively higher and varies with the kind of policy purchased along with the size of the premium. However, the assured amount cannot exceed Rs. 6 crores per year.

What is the Best Option?

Your decision will depend on various factors such as the coverage offered, your budget, the kind of health issues faced by you and your family, is it a long term plan or a short term plan, the need for flexibility in your plan, etc. However, it can be concluded that the benefits of a health insurance plan surpass those of mediclaim.

Apart from offering pre and post hospitalisation facilities, health insurance also provides you with an option of critical illness cover. Such options are missing in mediclaims. Thus, health insurance plans are more comprehensive and flexible in nature.

All in all, both mediclaim and health insurance are designed to meet the health expenditure of an individual. They come with different sets of advantages and they differ in the expenses they cover. 

One should make a choice only after considering his/her risk appetite, the number of elderly people at home and the presence or absence of a genetic disease/ailment or otherwise. It goes without saying that the financial condition is the most important factor in determining.

First Published: 12 Apr 2022, 10:05 AM IST