If you’re looking for financial safety during medical emergencies, most people are often seen asking this question: Is Mediclaim and health insurance the same? Of course, both offer the purpose of giving financial aid during health emergencies, but they differ in their benefits, costs and coverage. Here is a proper difference between mediclaim & health insurance to help you choose which one serves your purpose well.
What is Mediclaim Insurance?
It is a health insurance coverage plan where the hospitalization costs taken place for accidents, illness and surgeries are reimbursed by the insurance company. It works on an indemnity basis, stating the insurance company covers the complete medical expenses as per the sum insured. It majorly focuses on hospitalization and covers expenses like rent of the room, fees of the doctor and diagnostic tests while admitted.
Usually, these plans have a pre-defined sum insured limit and claims are only made till the limit. It is a good alternative for those looking for basic coverage for health emergencies.
What is Health Insurance?
It is a comprehensive financial aid that covers a wide range of medical expenses, such as pre and post-hospitalization expenditures, ambulance charges, day-care expenses and critical illnesses. As per the policy, you can also avail of benefits like annual health checkups, maternity services and cashless treatment. Health Insurance policies also provides the options of riders like critical illness cover and personal accident cover
Key Differences Between Mediclaim and Health Insurance
Coverage Scope
While mediclaim only covers hospitalization costs and may not include other medical expenses like pre- or post-hospitalization, preventive care, or outpatient treatments, health insurance offers an all-inclusive coverage that covers more than hospitalization. It includes day-care procedures, maternity benefits, and even wellness programs, according to the policy.
Pre and Post-Hospitalization
Mediclaim policies generally do not cover expenses incurred before or after hospitalization. For example, consultation with the doctor, follow-up treatments, and medicines outside the hospital stay are not included.
Instead, health insurance plans cover both pre- and post-hospitalization expenses for a specific period, ensuring that the insured individual gets full financial help for their health treatment.
Sum Insured Limit
Mediclaim policies have a fixed sum insured limit, often determined by the premium paid. This cap restricts claims to the actual hospitalization expenses up to the pre-set limit.
Health insurance policies usually offer higher sum insured amounts, and some also offer restoration benefits, where the insured amount is restocked if exhausted during the policy term. This allows consistent coverage for several claims.
Additional Benefits
Mediclaim plans focus mainly on hospitalization, offering no add-ons or wellness services.
However, health insurance policies offer many extra facilities, such as critical illness coverage, personal accident coverage, health check-ups and maternity coverage. These add-ons make health insurance a flexible financial aid for handling your healthcare necessities.
Premium Costs
When comparing Mediclaim vs health insurance costs, Mediclaim policies are generally more affordable due to their limited coverage. They are ideal for individuals seeking basic protection against hospitalization expenses.
Compared to this, the premium for health insurance plans is higher because they offer broad coverage and additional benefits, depending on aspects like age and the type of coverage desired and medical history.
Claims
Mediclaim plans to support only hospitalization expense claims, either via repayment or cashless settlement. The claims process is straightforward but restricted to the sum insured.
Health insurance claims are more flexible, covering expenses including day-care treatments and critical illnesses. Additionally, these plans offer a cashless claim option, allowing seamless treatment at network health facilities.
Critical Illness Cover
Diseases like cancer, heart disease, or kidney failure do not come under Mediclaim policies as benefit cover.
However, health insurance often includes a critical illness rider or a separate cover, offering an amount upon diagnosis. This offers financial stability during lengthy or costly treatments.
When to Choose Mediclaim or Health Insurance?
Understanding your healthcare needs and financial situation is key to deciding between Mediclaim or health insurance:
- Go for mediclaim if you need basic and affordable coverage for your hospitalization during health emergencies.
- Choose health insurance if you need something comprehensive, such as pre and post-hospitalization, add-ons and critical illness cover.
Aspects like family size, age, medical history and budget can impact your decision. Compare the policies available, assess their benefits and choose which is better- mediclaim or health insurance.
Conclusion
In the end, the difference between Mediclaim and health insurance is seen in the coverage provided, advantages, and pricing. While Mediclaim focuses on hospitalization expenditures, health insurance offers a wider protection net with additional benefits like critical illness and preventive care.
Eventually, the choice depends on your personal needs and monetary goals. If you are looking for basic coverage at a reasonable price, opt for mediclaim. However, if you need comprehensive protection against rising healthcare expenses, choose a health insurance plan. Knowing the benefits of buying health insurance and understanding how to choose a health insurance plan will help you safeguard your future and enjoy peace of mind during health emergencies.
FAQ
You can shift from mediclaim to health insurance. Most insurance firms allow policyholders to upgrade their coverage during renewal. Using portability, the insured person can transfer their mediclaim policy to health insurance with the same insurance company or another firm.
Yes, a few health insurance policies offer outpatient treatment coverage as additional benefits or in specialized policies. It includes consultation with a doctor, tests, and medicines without the need for hospitalization.
You need medical checkups for health insurance policies, precisely if you are above a specific age or with a pre-existing illness. Mediclaim plans may also need checkups but commonly for a higher coverage amount.
Timely renewal is needed for both, but health insurance sometimes offers additional features, better coverage and additional benefits during renewal, while Mediclaim renewals only offer basic coverage continuation.
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