Mediclaim And Health Insurance Are Not The Same
By: Anil Sumra
Tags: Mediclaim, Medical Insurance, Insurance, Health Insurance

The terms health insurance and mediclaim are often used for one another but they are not the same. The term mediclaim is limited to hospitalisation expenses. Whereas health insurance has many more services under its umbrella. For example, a health insurance policy in India may include annual health check-ups, OPD expenses, daily hospital cash, and alternative treatments like AYUSH. Thus, mediclaim is one basic part of health insurance.

Mediclaim definition

Mediclaim is a basic health insurance policy that gives you the required financial protection in the times of medical emergency. Your mediclaim takes care of your expenses incurred at times when you are hospitalised because of sudden illness, accident, or surgery in the policy tenure.

There are two types of mediclaim policies:

Cashless type Reimbursement type

You can benefit from cashless mediclaim policy only at select hospitals. Such hospitals have tie-ups with insurance providers and thus they can offer you cashless treatment. Cashless mediclaim policy allows you to avail emergency medical treatments without being worried about the expenses. Your medical bills are settled directly between your insurance provider and hospital within the assured limits under cashless claims.

Cashless mediclaim does not involve any lengthy documentation or paperwork. Therefore it offers you seamless claims.

Alternatively, in reimbursement mediclaim, your insurance company reimburses the expenses incurred to you after the successful claim of medical expenses.

Health insurance definition

Health insurance is a kind of medical insurance cover that offers you complete medical and surgical expenses coverage in case of emergencies. For example, you can opt for a critical illness insurance in India that provides coverage for a variety of diseases such as kidney failure, heart disease, cancer, etc. When you have health insurance, you can either claim for reimbursement or your insurance company will clear your bill directly with the hospital in the case of a cashless facility.

Health insurance vs mediclaim

● Flexibility: Mediclaim policies offer limited coverage. Thus, they are not flexible. But they are useful when it comes to getting coverage for hospitalisation. On the other hand, health insurance plans are flexible. You can customise your plans. For example, you can select your preferred sum-insured amount.

● Ambulance charges: A mediclaim policy does not allow ambulance charges’ reimbursement. On the other hand, in most health insurance policies, ambulance charges are allowed for reimbursement up to a limit. They are reimbursed at a later stage by insurance companies.

● Maternity benefit: Mediclaim covers the cost of hospitalisation for specific illnesses. They do not cover hospitalisation expenses made towards maternity whether it is a caesarean hospitalisation or any other medical treatment for the child. But such maternity benefits are possible to get with a health insurance policy.

● Comprehensive cover assured: Under a mediclaim policy, the coverage is restricted to Rs. 5 lakhs. As the coverage is limited in a mediclaim policy, the expense of the policy is also lower. Nevertheless, with a health insurance policy, you can opt for Sum Insured as much as Rs. 50 lakhs based on your age, location, and other factors. The increase in Sum Insured in turn increases the premium for your health insurance plan. But you sure get a wider coverage.

● Add ons: Mediclaim does not offer any add-ons, that is any additional benefits, that can be added to your base plan. Although, in the case of a health insurance plan, it offers numerous add-ons and riders like maternity benefit, infertility cover, critical illness insurance in India, etc. Any of such additional covers can be added to your base policy.

Benefits of mediclaim

While a health insurance policy can offer a higher and wider coverage, a mediclaim policy has its own benefits.

With mediclaim,

● You get immediate coverage towards medical expenses made when hospitalised

● If you opt for a cashless mediclaim, your insurance company directly pays for the expenses

● If you opt for reimbursement, your money is reimbursed by your insurer

Also, you can opt for specialised policies such as corona kavach policy and corona rakshak policy. Corona kavach policy is an indemnity-based health insurance policy that covers expenses incurred from treatment of Coronavirus disease.