What is the difference between mediclaim and health insurance

The most popular question that comes to mind when people purchase medical cover is: What is the difference between Mediclaim and health insurance? They might seem similar at first, but this is not the case, and you can only avoid unnecessary costs in the future once you know the difference.

The easier one is Mediclaim. It will only cover hospitalisation, whether due to illness, surgery, or an accident. Health insurance, in its turn, is wider. This is inclusive of hospital stays, not to mention pre- and post-hospitalisation costs, maternity, critical illnesses, and preventive check-ups.

Therefore, are Mediclaim and health insurance similar? No. They are used for various purposes, and the appropriate option will depend on the level of protection you desire, either to protect yourself or to protect your family.

This blog will elaborate on mediclaim vs health insurance and bring out the differences between the two, and make you understand the type of plan that might suit you.

 

What is Mediclaim?

The simplest health coverage in India is Mediclaim. It is meant to compensate for the hospitalisation cost that can occur as a result of sickness, surgery, or accidents. The policy covers payments of the hospital bills up to the amount insured by the policy, either through cashless treatment or reimbursement at a network hospital.

Mediclaim is limited in scope. It only puts into consideration the costs that are directly related to hospitalisation, which include:

• Room fee and nursing fees.
• Hospital stay, doctor fees.
• Charges in the surgery and operation theatre.
• Drugs taken on admission.

Mediclaim does not include such expenses as preventive health check-ups and outpatient consultations, maternity, and treatment of critical illnesses. This is the key difference between Mediclaim and health insurance: while health insurance offers comprehensive protection, Mediclaim is limited to hospital stays.

Considering an example, when an individual undergoes dengue hospitalisation or surgery due to an accident, the Mediclaim will cater to the hospital bills. However, when the same individual needs subsequent tests, prolonged therapy, or wishes to be covered in case of such illnesses as cancer or heart disease, then Mediclaim will not suffice.

It is due to this that most people pose the question: Is Mediclaim and health insurance the same? The response is negative; mediclaim and health insurance are different.

 

What is Health Insurance?

Health insurance has more coverage than Mediclaim. Whereas Mediclaim is limited to bills on hospitalisation, health insurance extends to cover several other medical bills besides the hospitalisation. This expanded coverage is what makes it fit the criteria of anyone and their family who requires complete financial assistance in the event of a need related to health.

A normal health insurance scheme typically encompasses:

• Hospitalisation (room rent, surgery, doctor fees).
• Tests and follow-up visits (pre-hospitalisation and post-hospitalisation costs).
• Critical illnesses such as cancer, kidney failure, or heart disease are also covered.
• Maternity and newborn costs.
• Preventive health check-ups.
• Additional benefits like OPD cover or wellness benefits are optional.

Health insurance includes some of the following:

• Maternity coverage can be of benefit to a young couple intending to have a child.
• A client who has a family history of critical illness can cover long-term treatment expenses.
• Follow-up tests and consultations are also covered for working professionals who are not able to afford the lack of treatment during the periods.

When comparing health insurance vs medical insurance, the terms are often used interchangeably. Nevertheless, the overall advantages of health insurance underscore the reason why it is regarded as more appropriate for long-term healthcare planning as compared to Mediclaim on its own.

 

Key Differences Between Mediclaim and Health Insurance

One should know the distinction between interests in Mediclaim and health insurance since they address two distinct sets of needs. Although they are used interchangeably, the benefits, coverage, and suitability of each are not identical:

Coverage Scope

• Mediclaim: This is restricted to hospitalisation costs like room rent, surgery, and medicines in the process of admission.
• Health Insurance: It is a much broader coverage that covers hospitalisation, pre and post-hospitalisation, maternity, preventive check-ups, as well as critical illness cover.

Premium Differences

• Mediclaim: It is normally less expensive due to its limited coverage for hospitalisation.
• Health Insurance: It is more expensive in terms of premiums, but it covers a wider range of benefits.

Claim Process

• Mediclaim: This is a simple procedure where only hospitalisation bills are claimed.
• Health Insurance: It provides coverage of various types of claims- hospitalisation, daycare procedures, and add-on benefits. Claims can be considered to have a wider range of documents.

Flexibility and Add-On Benefits.

• Mediclaim: Cap and trade. No or minimal customisation opportunities.
• Health Insurance: Flexible with additional covers such as wellness benefits, OPD cover, personal accident cover, and top-ups to boost the sum insured.

Suitable Audience

• Mediclaim: This is appropriate when one is seeking the simplest cover with minimal cost, like young people or employees who are already covered by a group policy.
• Health Insurance: Health insurance is better taken by families, the elderly, or by anyone who desires to be covered by various medical risks over a longer period of time.

Factor	Mediclaim	Health Insurance
Coverage	Hospitalization only	Hospitalisation + pre/post care + critical illness + maternity + preventive check-ups
Premiums	Lower	Higher, due to wider coverage
Claims	Only for hospital stays	For hospitalisation, daycare, add-ons, etc.
Flexibility	Limited	Customisable with add-ons and riders
Best Suited For	Individuals seeking low-cost, basic cover	Families, seniors, or those planning long-term healthcare needs

 

Which One Should You Choose?

The dilemma between Mediclaim and health insurance is highly dependent on your age, duty, and economic ambitions. They are both right in their own way; however, the correct choice depends on the individual.

• To those who are only beginning, i.e., young, healthy, and need only to be covered in case of an emergency, a simple Mediclaim plan may be sufficient. It provides low-cost coverage in case of sudden hospitalisation costs.
• In the case of families, health insurance is normally more appropriate. It not only pays for hospital stays but also for maternity and newborn care as well as long-term treatments. A family floater health plan makes coverage available to all members of the family.
• To corporate workers: Mediclaim, in many instances, is also included in the group benefits offered by employers. Although this aids in basic hospital payments, the coverage in most cases is terminated upon termination of employment. The continuity and extended coverage can be ensured by the addition of personal health insurance.
• In the case of elderly people or those with predisposing factors, Health insurance is more appropriate since it covers critical ailments, continuous treatments, and preventive treatments, which Mediclaim does not.

 

Common Misconceptions

The most frequently asked question by people is: Is Mediclaim and health insurance the same? It is natural confusion, both of which cover medical expenses. However, the fact is that their range of coverage and advantages is very dissimilar. The following are the most widespread myths:

Myth 1: Health Insurance and Mediclaim are the same.

Mediclaim is restricted to the hospitalisation expenses. The protection is broader because health insurance covers pre- and post-hospitalisation, maternity, check-ups, and even critical illnesses.

Myth 2: The Mediclaim provided by employers suffices.

Employer Group Mediclaim is normally basic in nature, and has a fixed limit. It also ceases upon a change of occupation. Personal health insurance offers more extensive protection that is uninterrupted.

Myth 3: Mediclaim is less expensive, and therefore it is better.

Fewer benefits are a result of lower premiums. Health insurance can be more expensive, yet it is much more comprehensive, addressing a broad range of healthcare requirements and becoming more secure in terms of finances.

These arguments explain why Mediclaim and health insurance are not one and why it is needed to understand the difference between them before deciding on a policy.

 

FAQs

Is mediclaim the same as health insurance?

No. Mediclaim only covers hospitalisation expenses, while health insurance offers wider benefits like pre- and post-hospitalisation care, maternity, critical illness, and preventive check-ups.

Which is better: mediclaim or health Insurance?

Neither is "better" in absolute terms. If you only want low-cost protection for hospital stays, Mediclaim is enough. If you need comprehensive coverage, health insurance is the better option.

Can I have both?

Yes, you can hold a Mediclaim policy and a health insurance plan at the same time. However, most people prefer upgrading to health insurance instead of maintaining both.

Does mediclaim cover OPD or preventive check-ups?

No, mediclaim does not cover outpatient consultations, diagnostics, or routine health check-ups. Health insurance policies often include these.

What is the premium difference?

Mediclaim premiums are usually lower because the scope is limited. Health insurance premiums are higher, but they reflect the broader protection offered.

Can I convert mediclaim to health insurance?

There is no direct conversion. You would need to purchase a separate health insurance policy for wider coverage.

 

Conclusion

Whether to have health insurance or medical insurance is a question of making the right financial decision, as far as your health and the future of your family are concerned. Mediclaim only provides basic hospitalisation cover, whereas health insurance offers you a wider safety net, which includes critical illnesses, maternity, preventive care, and long-term coverage.

The correct decision is based on your needs, life stage, and the budget. All they need is a basic Mediclaim. To the majority, having an all-inclusive health insurance plan brings a lot of peace of mind.

At ManipalCigna , we offer health insurance solutions designed to cover not only emergencies but also evolving healthcare needs. Contact us to know more!