Mediclaim and health insurance are highly favored forms of health coverage in India. Despite their similar purpose of safeguarding against hospitalization expenses, they possess notable differences in their structures and coverage. It’s crucial to comprehend these distinctions to make a well-informed decision regarding the most suitable health plan based on individual needs and financial considerations.
Understand Mediclaim
Mediclaim is a type of hospitalization health insurance available in India through public and private insurance companies. It provides financial coverage for medical and surgical expenses arising from hospitalization due to illness or accidents.
Mediclaim plans offer coverage for various expenses incurred during a person’s hospitalization, including room rent, nursing charges, surgeon and anesthetist fees, medical practitioner fees, diagnostic tests, and medicines. Some policies may also cover pre-hospitalization and post-hospitalization expenses for specific periods. However, Mediclaim provides limited coverage and is primarily focused on hospitalization-related costs, excluding outpatient department (OPD) care or fees.
Understand Health Insurance
Health insurance provides financial coverage for medical and surgical expenses, including hospitalization costs. Unlike Mediclaim, which primarily covers hospitalization, health insurance offers broader coverage, encompassing both inpatient and outpatient expenses. This includes reimbursement for various costs related to hospitalization like doctor’s fees, surgery, nursing, daycare treatments, as well as pre-and post-hospitalization expenses. Additionally, health insurance typically covers expenses for outpatient treatments, check-ups, diagnostic tests, medicines, dental care, and even alternative therapies.
What is the difference between Health Insurance and Mediclaim?
A crucial distinction between mediclaim and health insurance lies in their coverage scope. Mediclaim primarily addresses expenses related to hospitalization, while health insurance offers a more extensive coverage, including both inpatient and outpatient medical costs, but let’s understand thoroughly:
Mediclaim provides coverage for hospitalization, accident-related treatment, and pre-existing conditions up to a specific limit. On the other hand, health insurance offers a more comprehensive package, encompassing hospitalization, pre-hospitalization, post-hospitalization, ambulance expenses, and additional benefits like compensation for lost income due to accidents.
While Mediclaim doesn’t include critical illness coverage, health insurance can safeguard against over 30 severe conditions such as cancer, stroke, and kidney failure.
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Unlike Mediclaim, health insurance offers supplementary options like critical illness coverage, personal accident protection, maternity benefits, and more.
In terms of customization, Mediclaim has limited flexibility, whereas health insurance allows for greater tailoring to individual needs.
The premium for Mediclaim depends on the insured sum, with higher coverage resulting in a higher premium. In contrast, health insurance premiums are determined by factors like age, medical history, insured sum, etc., and are generally lower than those of Mediclaim.
Mediclaim typically provides coverage up to INR 5 lakh, while health insurance plans can range from INR 50,000 to INR 6 crore annually.
For new Mediclaim policies, there’s no waiting period, but pre-existing conditions are covered after 4 years. In health insurance, there’s a waiting period of 1-4 years for pre-existing conditions, and specific diseases or procedures may have their own waiting periods.