Difference Between Mediclaim and Health Insurance
The unpredictable nature of a medical contingency makes it highly challenging. You never know when and how it will strike. Gone are the days when aged people or those with co-morbidities were vulnerable to ailments and needed hospitalisation. Given the sedentary lifestyle we live, even the seemingly fittest person may require urgent medical attention.
While the emotional stress during such periods can take time to heal, you can overcome the financial burden with two potent weapons in your arsenal – mediclaim and health insurance. Though they may look the same, there are considerable differences between them. Knowing them is essential for making an informed choice and being financially prepared to deal with the situation.
What is Mediclaim?
Mediclaims are health insurance plans offering financial protection during hospitalisation due to illness or accident. Mediclaim strictly covers hospitalisation costs while you’ve to bear other medical expenses. In a mediclaim policy, you can’t add any add-ons, unlike health insurance plans; therefore, its coverage scope is limited.
What are Health Insurance Plans?
Health insurance plans offer more comprehensive coverage. With health insurance, you can claim reimbursement for medical costs not only during hospitalisation but also before and after admission and discharge up to a certain number of days as per the policy’s terms and conditions. Several health insurance plans also cover expenses incurred on OPD treatments, diagnostic tests, medicines and alternative therapies.
Difference Between Mediclaim and Health Insurance
The table captures key differences between mediclaim and health insurance on several vital aspects:
Aspect | Mediclaim | Health Insurance |
Coverage offered | Coverage is limited only to hospitalisation expenses and nothing beyond that. | Offers coverage beyond hospitalisation, including pre- and post-hospitalisation expenses, OPD costs, ambulance expenditures, and other medical expenses, among others. Some health insurance plans also offer compensation for lost income. |
Add-on Covers | Non-availability of add-on covers limits the scope of a mediclaim policy. Add-on covers enhance the scope of coverage and have their individual sum insured on top of the coverage provided by the base policy. | Health insurance plans offer various add-ons that you can opt for. Some of these include critical illness, personal accident, maternity cover, etc. Opting for these add-ons further enhances coverage. However, you need to pay some additional premiums to add them to your base policy. |
Sum Insured | The maximum sum insured in a mediclaim policy is generally Rs 5 lakh. | The sum insured offered by health insurance plans is much higher. Today, you can get a health insurance plan providing coverage of up to Rs 1 crore. A higher sum insured widens your financial cushion significantly. |
Customisation | Flexibility for customisation is less in mediclaim. In other words, tailoring it as per your needs is difficult. | Health insurance plans offer more flexibility in terms of customisation. You can tailor it as per your needs in terms of the sum insured and add-on covers. |
Should You Buy Mediclaim or Health Insurance?
This is a tricky choice. While it’s essential to have mediclaim and health insurance for a financial cushion in the event of a medical emergency, these factors should guide your choice:
- Coverage Needed
If you need relatively less coverage at a not-so-expensive price point, you can opt for mediclaim. It can be a good starting point towards securing your finances against a medical emergency. On the other hand, health insurance is a better choice if you need more comprehensive coverage for yourself and your family.
Family health insurance plans are available through which you can cover all members of your family. Known as floater plans, they help you cover every family member.
- Budget
Consider your budget and the premiums associated with mediclaim and health insurance. As coverage is less, with no options for add-ons and limited flexibility, premiums are less for mediclaim. On the other hand, health insurance plans may command a higher premium due to the coverage and flexibility on offer.
That said, premiums are low for health insurance plans if you buy them when you are young and healthy. Premiums rise with age, and the body becomes vulnerable to several ailments.
- Cost of treatment where you reside
This is an important consideration. The cost of treatment differs across locations and is comparatively higher in metros compared to tier II and tier III cities. If you feel your medical needs can be covered within a few lakh of rupees, you can opt for mediclaim. If not, research about various health insurance plans and choose the one that meets your needs.
- Short and long-term needs
If you are planning for the short-term, you can opt for mediclaim. On the other hand, health insurance is a better choice for long-term needs.
- Your family members’ age and life stage
If your family members are young and healthy, they are less likely to incur hospitalisation. In such a scenario, you can opt for mediclaim. On the other hand, if they are elderly, they might require more extensive coverage due to age-related issues. Health insurance is more apt then.
Summing it Up
Both mediclaim and health insurance shields you from rising medical inflation. Whether you buy either of them, ensure you do your homework and read the policy’s fine print. Know your insurer’s exclusions, the waiting period for pre-existing ailments and claim settlement ratio to make a prudent choice. You can compare different plans online before making a choice.
Disclaimer: This article is part of sponsored content programme. The Tribune is not responsible for the content including the data in the text and has no role in its selection.
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