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Health Insurance Vs. Mediclaim Policy:          The Difference


Feb 19 2020


Today’s ever-expanding market spoils us for choice. The situation in the health insurance vertical is no different than the rest of the market. With several varieties in policies and subtypes within each policy, it takes effort to get acquainted with the available and make an informed choice. Furthermore, many of us end with purchasing something else instead of what they are looking for. 

Usually, health insurance and medical insurance (commonly known as mediclaim policy) are two different things. But due to being unaware about the technicalities of insurance policies, we usually overlook some crucial aspects. This, however, may lead to severe issues such as claim rejection in the future. To avoid such complications, you must understand the difference between health insurance plans and medical insurance. 

Let’s understand what health insurance and mediclaim policy mean?

Health Insurance Plans

 Health insurance plans cover you fully against surgical as well as medical expenses. Depending on the type of plan, the insurer pays off all the bills directly to the hospital if the policy is cashless, or reimburses the insured incase the amount is paid from his pocket. All you need to do is submit all the bills and documents at the time of making a claim. The health insurance cover is extensive and comes at a higher cost than any mediclaim policy. 

Medical Insurance

Often referred to as mediclaim policy, this type of insurance offers you coverage against specified expenses for health-related issues. Since it not comprehensive, a mediclaim policy covers only hospitalization expenses. Any other expenses such as pre-post hospitalization, outside medical bills are borne by you, and the insurer pays nothing. 

Aspects that Differentiate Health Insurance And Medical Insurance 

Comprehensive health insurance plans cover you against hospitalization, ambulance charges, pathological costs, internal medications and expenses of outer prescriptions along with pre & post-hospitalization. On the other hand, the mediclaim policy provides coverage only against hospitalization in any other pre-defined cases, if any. 
Sum Assured
Usually, health insurance sum insured can be chosen up to Rs. 50 Lakhs, or even more in some cases. However, mediclaim insurance comes with a capping of Rs. 5 Lakhs on the sum insured.
Health insurance policies are comprehensive, hence come at a higher cost than that of medical insurance. 
It is not always necessary to get hospitalized to avail health insurance benefits. You can also choose for day-care procedures or domiciliary treatment instead of getting hospitalized. Well, the mediclaim policy doesn’t allow you to do this. The claim is settled only after providing hospitalization proofs. 
Critical Illness Cover
Comprehensive health insurance covers you against 30+ critical illnesses for which is not covered under any mediclaim policy. 
You can opt for an add-on or a critical illness rider with your health insurance policy whenever necessary. This cover can be availed against accidental disability, maternity, physical and particle disability, and so on. 

Lastly, Both health and medical insurance are advantageous because of their tax benefits.
To conclude, Make sure to arm yourself with all the required information before deciding on buying a health insurance plan. Gaining proper knowledge and purchasing a suitable policy helps you win half of the financial battle before you meet any actual medical event.