A health emergency can occur unexpectedly, depleting your savings with hefty medical bills and hospitalisation expenses. Therefore, you must have adequate health coverage or a health insurance plan to cope with unforeseen health emergencies.
Health insurance plans are categorised into mediclaim and medical insurance based on the scope and comprehensiveness of coverage they offer.
This article will guide you through the fundamental differences between mediclaim and medical insurance and their features. Before that, you must know the meaning of health insurance.
What is health insurance?
Health insurance is a contract where an individual pays a premium to a health insurance provider, and the insurer agrees to cover some or all of their medical expenses. This protects against high medical costs due to illness or injury.
You will now learn about what is health insurance and differences between the two main types of health insurance: mediclaim and medical insurance
Eight differences between mediclaim and medical insurance
Mediclaim is a basic health insurance policy, covering hospitalisation expenses, while medical insurance provides a more comprehensive range of benefits and higher coverage amounts.
Although both these terms are often used interchangeably, there are subtle differences between mediclaim and medical Insurance. Below are eight key differences between mediclaim and medical insurance:
S.No. | Feature | Mediclaim | Medical Insurance |
Scope | Essential coverage for hospitalisation expenses | Comprehensive coverage, including hospitalisation, OPD, critical illness, etc. | |
Coverage amount | Generally, a lower sum insured | Higher sum insured options available | |
Claim basis | Indemnity-based, reimburses actual hospitalisation expenses | Can be indemnity or benefit-based (lump sum for specific illnesses) | |
Purpose | Primarily for hospitalisation due to illness or injury | Broader financial protection against various health risks | |
OPD coverage | Limited or no OPD coverage | Often includes OPD expenses, diagnostics, consultations | |
Additional benefits | Fewer additional benefits | This may consist of maternity benefits, critical illness coverage, etc. | |
Cost | Generally lower premiums | Higher premiums due to broader coverage | |
Renewal | Renewal is subject to terms and conditions | Renewal is subject to terms and conditions |
As shown above, mediclaim is a basic health insurance plan, whereas medical insurance offers more extensive coverage and financial protection. While a mediclaim policy primarily covers hospitalisation expenses due to illness or injury, a medical insurance plan provides more comprehensive health coverage.
In addition to understanding the basic features of mediclaim and medical insurance plans, it is also important to know the limitations and exclusions of a mediclaim policy.
15 Standard exclusions to a mediclaim policy
The following are fifteen standard exclusions found in mediclaim insurance policies:
- Pre-existing diseases: Conditions diagnosed or treated within a specified period (e.g., 2-4 years) before the policy start date.
- Waiting periods: Specific illnesses, such as cataracts, hernias, and joint replacements, have waiting periods (e.g., 1-2 years).
- Maternity benefits: These often have a more extended waiting period (e.g., 2-4 years).
- Specific treatments and Procedures: Cosmetic surgery, dental treatments (unless due to an accident), and weight control procedures.
- Alternative treatments: acupuncture, acupressure, homoeopathy, and naturopathy (unless specified).
- Injuries Due to Risky Activities: Injuries from adventure sports, racing, or other hazardous activities.
- Self-Inflicted Injuries: Suicide attempts or intentional self-harm.
- Alcohol and Drug Abuse: Treatment for conditions related to alcohol or drug abuse.
- HIV/AIDS: Treatment related to HIV/AIDS and sexually transmitted diseases.
- War and Nuclear Perils: Treatment of injuries due to war, invasion, acts of foreign enemies, hostilities, or nuclear weapons.
- Outpatient Department (OPD) Treatment: OPD expenses might be excluded unless specifically covered.
- Non-Allopathic Treatment: Treatments other than allopathy might be excluded unless specified.
- Congenital Diseases: External congenital diseases might be excluded.
- Unproven Treatments: Experimental or unproven treatments.
- Diagnostic Expenses: Expenses related to diagnostic tests without hospitalisation might be excluded.
Note: It is always essential to read the policy document carefully to understand the specific exclusions and terms of your mediclaim insurance.
Which one is better– mediclaim or medical insurance?
Both mediclaim and medical insurance plans have their uses and limitations. They are not directly comparable. Whether you buy a Mediclaim policy or a medical insurance plan depends on your specific needs and budget.
- Mediclaim is a basic plan with lower premiums, while medical insurance has higher premiums due to its more extensive benefits.
- A mediclaim policy is suitable for those seeking protection primarily for hospitalisation costs, whereas a medical insurance plan offers more extensive coverage, including OPD and critical illnesses, but with higher premiums.
- Additionally, mediclaim policies offer faster claim processing and cashless benefits, while medical insurance plans provide a more comprehensive and broader scope of coverage.
Accordingly, you must choose the appropriate type of health insurance to fulfil your immediate medical needs.
Wrapping Up!
With that, you are now thoroughly familiar with the fundamental differences and the technicalities of mediclaim and medical insurance plans. Based on their scopes of coverage and other benefits, you can choose either of the two types of health coverage plans according to your family's healthcare needs. Besides, you can even choose a comprehensive health coverage plan that offers you the benefit of both mediclaim and medical insurance. Moreover, you can also opt for additional plan benefits such as instant cover benefits or a reduction in waiting periods.
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