There is a common misunderstanding that a Mediclaim policy and health insurance are the same things. Well, no, they are not. They are rather two sides of the same coin. While a Mediclaim policy is limited to hospital expenses, a health insurance plan offers widespread coverage. Before deciding on one of these two options, it is necessary to compare them.
Before we compare the two options, let’s have a look at the concepts of these two options in detail.
What is a Mediclaim policy?
A Mediclaim policy is a policy that covers you against the hospitalization expenses and expenses incurred for specific treatments and ailments during the hospitalization. The aim of a Mediclaim policy or Mediclaim insurance is to reduce your monetary risk occurring due to the hefty hospitalization charges. You can avail a Mediclaim policy for sum insured amount that is pre-specified and enjoy tax benefits under Section 80D of Income Tax Act that is available on premiums paid for a Mediclaim policy for yourself as well as your family members.
What is Health Insurance?
Health insurance is a type of medical insurance that either reimburses you for the cost of hospitalization or offers a cashless facility that is the direct settlement of the bill if the hospital comes under its list of network hospitals. By opting for a health insurance policy, you get a wider coverage than that provided by a simple Mediclaim policy. With a health insurance policy, you can also avail coverage for critical illnesses like cancer, cardiac issues, etc. However, coverage for such illnesses is to be added to the basic policy by opting for specific add-ons that come by paying an extra amount on premiums.
Health insurance policies come with either a deductible clause or a co-payment option. A deductible clause is where the customer must bear a specific pre-decided amount at the time of claim. The option of co-payment is where the insurer must pay a specific percentage of the claim.
Now you must have realised that a Mediclaim policy is different than a health insurance policy. Let’s see the differences in detail.
| Factors | Mediclaim Policy | Health Insurance |
| Basic Definition | A Mediclaim policy is a type of insurance that offers coverage only against expenses related to hospitalization for a specified time period | Health insurance is a type of insurance that offers all-inclusive coverage for medical and surgical expenses along with basic hospitalization |
| Coverage | Provides cover for domiciliary care and cost of hospitalization incurred due to surgery, illness, or accident | Offers comprehensive coverage for various expenses like Ambulance, Maternity Expenses, Diagnostic Tests, OPD Expenses, Critical Illnesses, Day Care Treatments, Alternative Treatment, Pre and Post-Hospitalization etc. |
| Add-on cover | There are no add-ons offered on a Mediclaim policy. | Health insurance offers add-on covers for various medical conditions like diabetes, hypertension, maternity, and OPD |
| Sum Insured | The sum insured for hospitalization under Mediclaim policy is limited up to ₹5,00,000 | The sum insured for medical expenses under a health insurance policy can rise to six crores per year. The amount is decided based on factors like age, city, members insured of the policyholder |
| Number of Claims | A Mediclaim policyholder can file claims until the total amount is consumed completely | For a few health insurance plans like critical illness cover, the sum insured is to be paid in a lump sum and can be claimed only once during the entire duration of the policy. For other health insurance plans, one can keep claiming until the total amount is completely consumed |
| Hospitalisation Cover | Benefits of a Mediclaim policy can be availed on if the policyholder is hospitalized | A health insurance policy holder can gets cover for daycare, regular check-ups, pre-natal expenses, etc. along with hospitalization expenses |
| Flexibility | Due to confined coverage, mediclaim policies can’t be called flexible policies. However, they prove to be beneficial for facing hospitalization expenses | Health insurance plans are flexible as they offer various options to customize the plan and choose add-ons with sum insured amount |
