Know the Difference between Mediclaim Vs. Health Insurance

Health insurance plans and mediclaim insurance are two important financial tools that cover health-related expenses. While both may seem identical, they vary in scope. Understanding the key differences between mediclaim vs. health insurance can help you choose the right fit.

What is Mediclaim Insurance?

Mediclaim insurance is a policy specifically designed to cover hospitalisation-related surgical and medical expenses. It is one of the most affordable ways to mitigate health-related emergencies, but is restricted to hospitalisation costs only and does not cover OPD or outpatient care or fees. Important expenses covered by mediclaim insurance include nursing charges, anaesthetist and surgeon fees, hospital room charges, costs of diagnostic tests, medical practitioner fees and cost of medicines. 

What is Health Insurance?

Health insurance plans are comprehensive coverages that work in two ways.

• First, the cashless mode is where the insurance company settles the entire bill directly with the network hospital.
• Second, the insured individual pays the medical bill upfront and is later reimbursed by the insurance company.

It involves paying a specific premium amount to the insurance company, which then offers coverage for daycare procedures, hospitalisation, ambulance charges, post-hospitalisation expenditures, preventive care and medication, etc.

A health insurance claim may also cover OPD treatment-related expenses and the costs incurred on check-ups, diagnostic tests, dental treatments, medicines and alternative therapies.  

Mediclaim vs.Health Insurance: Points of Difference

Here’s a breakdown of the key areas where mediclaim and health insurance differ:

Mediclaim

• Covers hospitalisation, pre-existing diseases and accident-related treatment up to the specified limit
• Plan features may vary according to the chosen insurance company
• Excludes critical illness cover
• The sum insured depends on the type of plan chosen
• No add-ons
• Limited customisation options
• No flexibility in coverage
• The insured can file several claims until the total insured amount is exhausted

Health Insurance

• Covers hospitalisation, pre-hospitalisation and post-hospitalisation expenses, ambulance charges and compensates for loss of income
• General plan features are the same regardless of the insurer
• Covers several severe conditions like stroke, cancer and kidney failure
• The sum insured may go up to ₹6 crores per year and vary according to the plan
• Provides several add-on covers, such as COVID care, OPD cover, global coverage, and international second opinion
• Customisation options tailored to individual requirements
• Highly flexible
• The insured can file claims on a reimbursement or cashless basis.

How to Choose a Plan for Medical Coverage?

• Consider adequate sum insured to avoid all financial burdens arising out of an ailment, mild or severe.
• Choose an affordable health plan that you can extend later for improved coverage.
• Look for co-payments to decrease insurance premiums as a specific percentage of treatment cost is paid by you and the remaining by the insurer. 

Mediclaim vs. Health Insurance: Which One to Buy in India?

Consider your specific needs and preferences to find the best health insurance plan. Health insurance offers more extensive coverage than Mediclaim, so it is highly recommended. If your budget and needs are restricted to just hospitalisation benefits, you can still consider mediclaim plans to start your insured journey. However, before choosing, insurers should be evaluated based on their claim settlement ratio, network hospitals, etc., to avoid any surprises.

Key Takeaways

Mediclaim and health insurance are two different ways to cover your health-related expenditures. Choose health insurance for limited coverage needs and mediclaim for wide coverage. For all-inclusive coverage with guaranteed benefits and affordable premiums, contact PhonePe now! Access policy details and secure your health by getting a plan within minutes.