Mediclaim vs Health Insurance
In healthcare finance, two terms - "Mediclaim" and "Health Insurance" - are often used. While they may seem similar, they have distinct roles in safeguarding health and finances against medical expenses.
Here, we clarify the difference between Mediclaim and Health Insurance, shedding light on their importance in healthcare coverage.
Understanding Mediclaim Insurance
Mediclaim is a form of health insurance policy that provides coverage for medical expenses incurred from illnesses or injuries. It covers a variety of expenses and costs associated with medical treatments. These plans reimburse the policyholder with costs of medical expenses up to the assured sum.
The policyholder will have to submit the medical bills that detail the actual expenses, and a successful claim can be made. This claim can either be made directly to the healthcare provider or as a repayment to the policyholder.
Advantages of Mediclaim
- Hospitalisation Protection: Mediclaim shields you from the financial strain of hospitalisation expenses due to illness or injury, ensuring you get necessary care without financial worry.
- Family Coverage: It often covers your entire family, including spouse, children, and sometimes dependent parents, simplifying healthcare for your loved ones.
- Cashless Hospitalisation: Many policies offer cashless treatment at network hospitals, sparing you from upfront payments and streamlining the process during medical emergencies.
- Tax Benefits: Mediclaim premiums are tax-deductible in many countries, reducing your annual tax burden and making healthcare more affordable.
Understanding Health Insurance
Health Insurance is a complete financial plan that offers coverage for a vast range of medical expenses and healthcare services.
Individuals and families obtain these insurance policies by making regular premium payments to an insurance company. In exchange, the insurer takes on the responsibility of covering various healthcare expenses, which can include doctor's visits, hospital stays, surgeries, preventive care, prescription medications, and more, depending on the details of the selected plan.
Advantages of Health Insurance
- Comprehensive Financial Protection: Health Insurance shields you from major medical costs, covering hospitalisation, daycare procedures, home-based care, and ambulance fees, ensuring you can focus on recovery without financial worries.
- Critical Illness Coverage: Critical illness plans, available as standalone policies or add-ons, protect against severe conditions like kidney failure, limb loss, bone marrow transplants, strokes, and more, providing financial security during critical health challenges.
- Hassle-Free Claims: Many insurers offer cashless claim services, sparing you upfront payments. Your insurer handles hospitalisation expenses and related costs directly, easing the financial burden during medical emergencies.
- Tax Advantages: Health insurance premiums qualify for tax exemptions under Section 80D of the Income Tax Act, 1961. This not only ensures vital health coverage but also offers tax benefits, reducing your overall financial obligations.
Difference Between Mediclaim and Health Insurance
Here are the key difference between Mediclaim and Health Insurance:
|
Parameters -Mediclaim vs Health Insurance |
Mediclaim |
Health Insurance |
|
Scope of Coverage |
A Mediclaim policy is a form of insurance plan offering specified financial protection against health-related expenses. |
Health Insurance offers broader coverage, including hospitalisation, outpatient care, diagnostics, maternity, preventive care, and more. |
|
Policy Term |
Mediclaim Insurance is often available as an annual policy that needs to be renewed regularly. |
Health Insurance policies can involve both annual and long-term policies, providing continuous coverage for an extended period. |
|
Premiums |
Premiums for Mediclaims are generally more affordable as they offer limited coverage. |
Premiums for Health Insurance may be higher due to the comprehensive coverage offered. |
|
Claim Process |
Mediclaim typically involves reimbursement, which means that the insured pays the bills and then claims a refund from the insurer. |
Health Insurance allows for cashless claims, where the insurer settles medical bills directly with the healthcare provider. |
|
Sum Insured |
Mediclaim often offers lower sum insured options compared to health insurance policies. |
Health Insurance provides a range of sum insured options, allowing for higher coverage limits. |
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Pre-existing Conditions |
Mediclaim Insurance may have a waiting period or exclusions for pre-existing conditions. |
Health Insurance policies often have waiting periods for pre-existing conditions, but coverage is available after a waiting period. |
|
Policy Flexibility |
Mediclaim offers less flexibility in customising coverage. |
Health Insurance offers greater flexibility to tailor coverage to specific needs through riders and add-ons. |
|
Additional Benefits |
Mediclaim policies may offer limited additional benefits, such as critical illness coverage or accidental death benefits. |
A wide array of additional benefits like wellness programs, maternity coverage, and more, may be offered by Health Insurance policies. |
Things to Consider When Deciding Between Mediclaim and Health Insurance
When deciding between Mediclaim and Health Insurance, there are several crucial factors to consider. These include:
- Extent of Coverage: Assess the scope of coverage offered by each option. Health Insurance typically provides broader coverage, including hospitalisation, critical illnesses, preventive care, and more. Mediclaim, on the other hand, often focuses on specific medical expenses.
- Family Needs: Consider your family's healthcare needs. Health Insurance policies often allow you to include your spouse, children, and sometimes even dependent parents under a single plan, providing comprehensive coverage for your entire family. Mediclaim may not offer such extensive family coverage.
- Premium Costs: Compare the premium costs associated with both options. Health Insurance premiums are usually higher due to their broader coverage, while Mediclaim premiums tend to be lower.
- Cashless Services: Check if both options offer cashless hospitalisation services. Many Health Insurance policies provide this convenience, allowing you to avoid upfront payments during hospitalisation. Some Mediclaim policies may also offer cashless services.
- Critical Illness Coverage: If you are concerned about protection against critical illnesses like cancer or heart disease, consider whether you need a policy that specifically covers these conditions.
- Tax Benefits: Evaluate the tax benefits associated with each option.
- Network Hospitals: If you prefer receiving medical care at specific hospitals or healthcare providers, check whether these facilities are part of the network for your chosen insurance. This can affect the convenience and cost-effectiveness of your healthcare.
- Future Needs: Think about your long-term healthcare needs. Consider how your choice of insurance aligns with your future healthcare requirements and whether it allows for flexibility.