Mediclaim vs Health Insurance

Let us understand in detail the difference between mediclaim and a health insurance policy.

Health insurance online is a type of medical coverage that offers financial assistance during medical crises. In exchange for medical coverage, the policyholder needs to pay the premium.

A health insurance policy covers a wide range of medical costs, such as pre and post-hospitalisation, ambulance coverage, AYUSH coverage, etc. These plans can be tailored to specific healthcare requirements, such as individual health insurance and senior citizen health insurance.

Furthermore, to enhance health insurance coverage, you can include add-ons like maternity coverage, critical illness coverage, etc.

Also Read: Best Health Insurance Plans

Comprehensive Financial Protection

One of the benefits of health insurance is that it offers comprehensive financial protection. They offer coverage against a wide range of medical costs outside hospital stays, such as outpatient treatments, diagnostics, critical illness, etc. A health insurance policy helps people get holistic medical coverage in a time of need.

Availability of Riders

Health insurance policies typically include more supplementary riders or add-on plans for individuals requiring better coverage. The add-on extends coverage beyond the base protection limits.

The insurance provider offers enhanced protection tailored (based on the chosen add-on) to the policyholder’s specific medical requirements.

For these add-ons, a normal individual has to pay an additional premium. Some of the most popular add-ons include maternity coverage, critical illness coverage, OPD care, etc.

Also Read: Add-ons in Health Insurance

No Claim Bonus Discounts

Having a health insurance policy helps policyholders avail themselves of a no-claim discount at the time of policy renewal. The no-claim bonus discount is a benefit offered to the policyholder for maintaining their health insurance coverage without filing a claim during the policy tenure.

If you maintain claim-free coverage, the insurer often provides you with discounts at the time of policy renewal.

Tax Benefits

Tax benefits are another common benefit of having health insurance online. Under Section 80D of the Income Tax Act, the policyholder can avail of a tax deduction of ₹25,000 per year on the health insurance premium.

If the policyholder is a senior citizen, then the tax deduction will be up to ₹50,000. This deduction is available on the health insurance premium paid in a year.

Mediclaim is a type of health coverage where the hospitalisation expenses incurred from accidents, surgeries, etc., are covered by the insurance provider. The mediclaim policy only covers the hospitalisation expenses, and all the other expenses are incurred by the policyholder.

These types of health policies come with a pre-defined or limited sum insured. Policyholders need to bear the additional costs out of their pockets for expenses outside the sum insured.

Also Read: Mediclaim Insurance

Easy to Understand

One of the crucial benefits of the mediclaim policy is that it is easy to understand and manage. These plans only cover hospitalisation expenses, making it straightforward.

Policyholders do not have to go through the complexities of add-ons, multiple coverage options, or detailed terms that are often part of comprehensive health insurance plans.

Affordable Premiums

Compared to health insurance plans, the premium of the mediclaim policy is affordable. The plan does not have add-ons and multiple coverage options like health insurance plans, which makes it a cost-effective option.

Due to this, the plan is ideal for students, young professionals, and others who are looking for basic medical coverage.

Focused Hospitalisation Coverage

Another benefit of the mediclaim policy is that it offers focused medical coverage for hospitalisation-related expenses. These expenses include room rent, surgery procedures, doctor’s consultations and medications.

With focused hospitalisation coverage, policyholders can rest assured that their critical medical expenses will be covered in the time of need.

Easy Claim Process

The claim process for the mediclaim policy is straightforward, enabling policyholders to access benefits with minimal hassle. Unlike traditional insurance procedures that often involve extensive paperwork, Mediclaim policies typically require only basic documentation.

Moreover, with a cashless treatment facility, policyholders can avail the medical treatment for hospitalisations without paying any upfront fees, which leads to a smooth claim experience.

The decision to choose health insurance vs a mediclaim policy depends on the individual’s personal preferences and healthcare needs. However, below are some scenarios that can help you choose between the two.

When to Buy Mediclaim Insurance

• If you do not suffer from any chronic health conditions, a mediclaim insurance policy can be a cost-effective choice.

• If you are looking for basic health coverage that aligns with your budget requirements, you can consider opting for a mediclaim policy.

• For young and healthy individuals who are just starting to think about health insurance, mediclaim can be a practical choice to start with.

When to Buy Health Insurance Online

• Health insurance is a suitable option when you need extensive medical coverage for yourself and your loved ones.

• Health insurance is ideal if you are seeking long-term health security. Many plans offer coverage for lifetime renewability, which means you can continue your coverage as you age.

• If you or your family member has critical medical conditions or pre-existing health issues, health insurance provides extensive coverage that includes treatments and medications.

Also Read: Best Health Insurance Plans

Let us understand the difference between health insurance and mediclaim policies through an example. Both policies offer financial protection against medical expenses, but they differ in scope and coverage.

Example of Mediclaim Policy

Rahul, a 26-year-old software professional, has opted for a mediclaim policy with a sum insured of ₹5,00,000. A few months into the policy, Rahul suffered an illness that required hospitalisation.

The hospitalisation expenses included room rent, doctor consultations, diagnostic tests, medicines and treatment procedures, which amounted to ₹2,40,000.

Since all the hospitalisation expenses are within the sum insured limit, Rahul did not have to pay anything out of pocket except for non-medical expenses.

Example of Health Insurance

Rajeev, a 40-year-old banker, has opted for a comprehensive health insurance policy with a sum insured limit of ₹10,00,000. Sometimes, after purchasing a health insurance plan, Rajeev has suffered an illness that requires both outpatient and eventual hospitalisation for treatment.

Initially, he consulted a specialist and underwent diagnostic tests on an outpatient basis. Since his policy covers outpatient department (OPD) expenses, these costs were reimbursed under the policy terms. When his condition worsened, he was admitted to a well-known hospital for treatment.

The policy also covers pre-hospitalisation, including diagnostic tests and consultations conducted within 30 days prior, as well as post-hospitalisation care, which includes medications and follow-up visits within 60 days of discharge.

Furthermore, when purchasing a policy, Rajeev also opted for a daily cash allowance add-on, which provided extra financial support during his recovery.

The comprehensive healthcare protection ensures that Rajeev receives necessary medical care in his time of need without worrying about out-of-pocket expenses.

The following factors must be considered while choosing between health insurance and a mediclaim policy:

Medical Coverage

Mediclaim usually comes with limited medical coverage, while a health insurance policy offers extensive coverage. Depending on your healthcare requirements, it is suitable to choose a plan.

Claim Settlement Process

The claim settlement process helps in understanding how efficiently your claim amount will be processed in case of emergency or planned medical needs.

A smooth and transparent settlement process can make a significant difference in managing healthcare costs. Moreover, a high claim settlement ratio indicates the insurance provider’s reliability and commitment.

Premium Cost

A premium cost is a crucial factor when selecting a mediclaim policy vs. health insurance. It is essential to choose a plan that aligns with your budget.

If you are looking for basic, cost-effective coverage, a mediclaim policy can be an ideal choice. However, if you want more comprehensive medical coverage, investing in health insurance is worth considering.

Critical Illness Coverage

If your family has a history of critical illnesses such as cancer, heart attacks, etc., it is best to look for a medical insurance plan with critical illness coverage. Critical illnesses often require expensive treatments, including hospital stays and surgeries and extended care.

The medical expenses for these conditions can be overwhelming and regular mediclaim or health insurance may not cover all the associated costs. It is best to buy health insurance online that offers critical illness coverage as add-ons.

Waiting Period

Another crucial thing to check while choosing a mediclaim or health policy is the waiting period. Almost every health insurance comes with an initial waiting period.

This is the period during which policyholders can not avail of medical insurance benefits. The longer the waiting period, the longer it will take to claim health insurance benefits.

Policy Customisation

While choosing a health insurance or mediclaim policy, it is best to see if a plan comes with customisation benefits. Typically, mediclaim policies do not offer any customisation options, whereas health insurance policies give you the flexibility to make changes according to your needs.

This flexibility can help you adjust your sum insured, add riders for critical illnesses or maternity benefits and choose a coverage that fits your unique situation.

Future Healthcare Needs

When selecting a health insurance or mediclaim policy, it is crucial to think about your future healthcare needs. Health requirements evolve as you age or as new medical conditions arise. A good insurance plan offers long-term protection and adapts to changes in your health and lifestyle.

Knowing about health insurance vs mediclaim policy is crucial before choosing. A mediclaim policy offers basic coverage and generally covers hospitalisation expenses, while health insurance offers extensive coverage.

If you require comprehensive medical coverage or have a pre-existing condition, it is best to buy health insurance online. However, if you seek basic medical coverage, you can opt for a mediclaim policy.

When it comes to the best health insurance plan, TATA AIG offers plans customised based on your unique healthcare needs. For instance, our health insurance for parents is designed to address the healthcare needs of senior citizens. These plans come with a range of benefits, such as high-end diagnostics, lifetime renewability, restore benefits, etc.

Our health insurance plans also offer cashless facilities in any authorised hospital. Furthermore, we also have a network of 12,000+ hospitals, which makes the cashless treatment process a breeze with minimal paperwork. Secure your loved ones’ health with our affordable and customised health insurance plan now!