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Difference between Health Insurance and Mediclaim

One must have knowledge and information about the difference between mediclaim and health insurance before you go to buy a health insurance plan. No matter even if you’re aiming to buy the best plan from the best health insurance company but unless you are well aware of the details you will not be able to make the right decision for you or your family. 

Often people assume that mediclaim is similar to or same as health insurance. But this is completely incorrect and so we have listed down the necessary details for you to understand the difference between the two.  

What is Mediclaim Insurance?

Mediclaim insurance is an insurance that provides specific monetary protection against health expenses. It does save you from the financial crises of a health-related emergency but the coverage is only applicable for hospitalization and all the other costs are on the individual himself.

How Does Mediclaim Insurance Plan Work in India?

Here are the key elements of Mediclaim Insurance Plan.

1. Coverage – Insurance coverage against treatment expenses in case of an accident, hospitalization expenses and specifically defined diseases.

2. Sum Assured – In most cases it has a pre-decided sum assured.

3. Premium Affecting Factors – The premium of a mediclaim insurance is decided on the following bases like proposer’s age, gender, sum insured, geographical location and the duration of the plan.

4.  Claim Settlement - A mediclaim claim is given as reimbursement or in the form of cashless treatment.

5.  Plan Basis - The plan can be availed by a single person or in the form of a family floater. In case of a family floater plan, it secures self, dependent children, spouse, and dependent parents.

6. Tax Exemption - Tax benefits are as per Section 80D of IT Act 1961.

What is Health Insurance?

Health insurance is a broader policy that provides you cover against the cost of medical as well as surgical expenses. The insured is required to pay these expenses from his/her pocket or in other cases is reimbursed later by the insurer. In some cases, the insurance company may also decide to settle the expenses with the hospital. The benefits are subject to the terms and conditions mentioned in the policy. The cover is more expensive as compared to a Mediclaim Policy.

How does Health Insurance Plan Work in India?

Here are the elements of the Health Insurance Plan.

1. Coverage- Health insurance plan provides a rather elaborate coverage, which includes critical illness cover for more than 30 illnesses.
Note - Critical illness is not inclusive of a basic health plan.

2. Renewal Discounts- In most cases, health insurance has a benefit at the time of renewal post the claim-free year. This benefit is called No Claim Bonus.

3. Co-payment- Some health insurance policies come with a co-payment option. It helps to lower the insurance premium as a particular sum of the treatment expense is borne by the insured and the remaining is remunerated/paid by the insurance company.

4. Tax Benefits- Covered in Section 80 D of the income tax act. The plan offers tax benefits.

 Difference between Mediclaim Insurance and Health Insurance

S. No.

Basis

Mediclaim

Health Insurance

  1.  

Offered Coverage

Insurance coverage against treatment expenses in case of an accident, hospitalization expenses, and specifically defined diseases.

 

Health insurance plan provides a rather elaborate coverage, which includes critical illness cover for more than 30 illnesses.
It further provides additional monetary support for income loss because of accident

  1.  

Add on coverage

No add on coverage

Critical illness coverage, maternity coverage, accidental disability coverage, personal accident coverage etc.

  1.  

Flexibility

No flexibility in coverage

Offers extensive flexibility. Insurance buyers can decrease their health insurance premium sum after a particular period. They also have the option of changing the duration of their policy.

  1.  

Plan Features

Different mediclaim insurance companies provide different insurance coverage.

In most cases, the features of a health insurance plan for a specific sum is the same for all insurance providers.

  1.  

Cover for critical illness

No cover for critical illnesses.

Health insurance plan provides a rather elaborate coverage, which includes critical illness cover for more than 30 illnesses.

  1.  

Assured Sum

The sum assured does not exceed 5 Lakhs

The sum assured doesn’t exceed 6 crores/per year. Thus providing extensive coverage.

  1.  

Claims

In the case of mediclaim, one can file claims until the total sum assured is worn out.

In the case of claims related to accidental disability coverage/ critical illness, the total amount assured is paid as a whole.

Such claims can be made only once in the complete policy length or once during the policy term.

Apart from this, one can file claims until the total sum assured is worn out.

 

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