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Is Mediclaim Policy and Health Insurance Same?

Updated On Jan 04, 2022

Mediclaim and health insurance, though used interchangeably are different from each other. Mediclaim policy covers the hospitalisation expenses, whereas health insurance provides more comprehensive coverage.

Accurate and reliable health insurance can facilitate relief from paying high cost while being hospitalised during illness or critical disease. It covers not only hospitalisation and related expenses, but also provides coverage for pre and post hospitalisation charges, cost of the ambulance, compensation for loss of income, and so forth.

Let’s have a better understanding of these two terms:

Mediclaim Policy: A mediclaim policy provides coverage against health-related expenses. The coverage is limited to hospitalisation. All other costs are meant to be borne by the insured.

Health Insurance: Health insurance plan, on the other hand, provides coverage against medical and surgical expenses. There are two ways of payment. There is either cashless coverage or the other way is that the insured at first is to pay out-of-pocket and is later reimbursed by the insurance company. The coverage though expensive is definitely more extensive as compared to mediclaim policy.

Highlights of Mediclaim Insurance versus Health Insurance Plan:

1. Coverage: In mediclaim insurance, there is coverage against expenses related to hospitalisation and treatment due to specific diseases and accident. In health insurance, there is extensive coverage, including critical illness. There is coverage against hospitalisation expenses, pre and post hospitalisation expenses, ambulance expenses, and sometimes even compensation for loss of income.
2. Add-on Coverage: Mediclaim insurance comes with no add-on coverage. Health insurance, on the other hand, offers coverage for critical illness, personal accident, maternity, and accidental disability coverage. You can also avail these health insurance benefits not only under an individual plan but also under a health insurance for family.
3. Sum Assured: In a mediclaim policy, there is the pre-decided sum assured. For health insurance, there can be extensive coverage.
4. Flexibility: There is no coverage flexibility in mediclaim insurance. Health insurance plans have the flexibility of reducing the health insurance premium amount after a specified period or even changing the policy duration.
5. Hospitalisation: Mediclaim benefits can be availed only after hospitalisation. Health insurance benefits can also be availed for daycare procedures, which does not require hospitalisation.
6. Benefits: Different health insurance companies tend to offer different types of insurance coverage. The features and benefits of health insurance for a particular sum assured remains the same over most of the health insurance companies. There are various health insurance types available in the market with different health insurance benefits.
7. Renewal Discounts: Health insurance comes with a benefit of No Claim Bonus after the end of a claim-free year. This benefit can be availed at health insurance renewal.
8. Claim Filing: Mediclaim insurance has the benefit of filing claims until there is the exhaustion of the total amount assured. In health insurance, the sum assured is paid in a lump sum in case of critical illness/accidental disability. There are also plans in health insurance, which can be claimed only once during the policy tenure. Apart from it, an insured can also file a claim for health insurance as long as the insured sum has not exhausted.

Different people have different insurance expectations. The difference between the mediclaim and health insurance plan will help you in making the choice as to which health insurance is best that fits all your health-related needs. If you are looking for extensive coverage, then go for health insurance, but if the coverage is needed for hospitalisation, then mediclaim is the best choice. Both the instruments are for mitigating risk related to health issues. One can take the decision depending on the kind of coverage needed, medical history, financial situation, etc.

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