Hurry Up!Mediclaim vs. Health Insurance: Which One Should You Choose?
To sustain expenses from health and medical treatments, you must rely on a plan that provides proper health coverage. The key issue is that the difference between “mediclaim” and “health insurance” is unclear to many people.
Are they the same thing?
Which one works the best for you?
This article focuses on mediclaim vs. health insurance policies so that you can make an informed decision.
Understanding the Importance of Medical Coverage
Doctors never call asking to be paid, but medical emergencies can strike at any time and, to a large extent, dismantle financial plans.
For this reason, you have to save in advance for a wide range of health issues that might arise. These days, an ordinary sickness could mean a very long and expensive hospital stay.
With a comprehensive medical coverage plan, you do not have to worry about using savings or falling into debt for bills as you get better. You can take comfort in knowing that managing medical bills will not keep you in a state of anxiety nor deplete you of the funds you depend on for security.
Overview of Mediclaim and Health Insurance
Mediclaim and health insurance are conceptually the same in as much as both intend to offer monetary assistance during treatment. Still, the scope, items insured, and value-added features differ greatly, so it is imperative to know them before picking a plan.
What is Mediclaim?
A Mediclaim policy is an essential insurance product for health restricted to inpatient care only. The patient is covered for the cost of treatment during hospitalisation arising out of sickness, injury, or surgery, but only up to the sum insured. This policy is very popular as it is simple and easy to understand for people looking for basic healthcare coverage.
Key Features of Mediclaim Policies
- Covers Hospitalization Expense: Mediclaim policies cover medical expenses for services rendered during the patient's treatment in a hospital, such as hospital room rent, physicians’ charges, and medicines.
- Individual and Family Floater Option: Individual mediclaims and family floaters are available, the latter provides cover to more than one family member on a single policy.
- Cashless Treatment: Several Mediclaim policies provide cashless treatment in hospitals that have an established relationship with the insurer, eliminating the payment requirement at the time of service.
- Reimbursement Facility: If a policyholder works out of the area, they can go to any hospital and submit bills for the services rendered and will be reimbursed for all covered expenses.
Advantages and Limitations of Mediclaim
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Advantages |
Limitations |
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Lower Premiums: For most policyholders, Mediclaim policies are cheaper than other types of policies and, therefore, are best for those on a budget. |
Limited Coverage Scope: Mediclaim policies only provide coverage for the cost of hospitalisation, and do not provide coverage for outpatient treatments or diagnostic tests. |
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Simple Policy Structure: Mediclaim policies do not require the policyholder to read through large volumes of complicated documents. |
No Pre- and Post-Hospitalization Coverage: Costs related to the period before and after the actual admission to the hospital are generally excluded. |
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Essential Coverage: These policies help pay for the costs that arise from hospitalisation. |
Fixed Sum Insured: The sum insured is set at a limit that may not be sufficient for critical medical situations. |
What is Health Insurance?
Health insurance is an entrenched plan that seeks to address all possible medical expenses. Covering miscellaneous expenses beyond hospitalisation, it further includes outpatient treatments, diagnostic procedures, critical illnesses, and even wellness programs that vary by plan. Thus, health insurance plans acts as a comprehensive financial safeguard for every medical need.
Key Features of Health Insurance Plans
- Extensive Coverage: Health insurance covers hospitalisation, outpatient treatments, and all related pre- and post-hospitalization expenses.
- Customisation Options: Additional options like maternity leaves, cover for critical illnesses, and personal accident cover further aid in the customisation of the plan.
- Higher Sum Insured: These policies have a higher limit on the sum insured to aid with critical medical situations and emergencies.
- Cashless and Reimbursement Options: Health insurance plans allow cashless treatment in network hospitals as well as reimbursement for treatment in other hospitals.
Advantages and Limitations of Health Insurance
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Advantages |
Limitations |
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Comprehensive Coverage: Broad spectrum of health insurance that provides maximum coverage. |
Higher Premiums: Users have to pay a higher premium for comprehensive policies. |
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Preventive Care and Wellness Benefits: A multitude of health insurance plans offer health screening and wellness services on an annual basis. |
Complexity: The features and options may appear to be excessive and burdensome to a new user. |
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Flexibility: Policy coverage can be enhanced through additional covers, riders, and endorsements, which boost the basic coverage according to the individual’s requirements. |
Key Differences Between Mediclaim and Health Insurance
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Basis |
Mediclaim |
Health Insurance |
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Coverage Scope |
Over and above meeting the basic medical needs during an emergency, there is a specific focus on hospitalization-only expenditures |
Includes outpatient services, diagnostic tests, and covering major diseases. |
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Sum Insured Limits |
Allows for a lower sum insured limit, which is largely accepted, but restricts the amount to which one can medically spend. |
Greater flexibility, along with more money, ensures that the insured is financially much better off. |
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Claim Settlement Process |
Submission of bills to the hospital under a certain network of hospitals for reimbursement or cashless treatment. |
The hassle of submitting claims is much less with this option. Cashless claims or reimbursement claims are more openly accepted. |
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Extra covers cannot be purchased, and there are no options available. Only one plan of coverage is provided. |
Self-customization through add-ons is immediately available, such as maternity benefits, personal accident cover, and critical illness coverage. |
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Costs and Premiums |
Ideal for users with constrained finances due to its lower cost and basic coverage. |
Premiums are higher, but they bring value with extensive coverage and benefits. |
Things to Think About Before Selecting Between Mediclaim and Health Insurance
- Personal Health Requirements: Assess how healthy you are and the treatment risk levels. If you have existing ailments that need treatment regularly, you should opt for a health insurance plan. Young Mediclaim should be sufficient for young and healthy people.
- Financial Limitations: Think of your budget and financial situation. It is easier to pay for Mediclaim policies, while spending on health insurance can pay off in the long run through the elimination of several more expenses.
- Family Circumstances: A comprehensive health insurance plan that covers the whole family can secure medical treatment expenses for all family members.
- Future Healthcare Needs: Buy health insurance with a higher sum insured and critical illness health insurance in order to take care of rising health problems and health expenses in the future.
Pros and Cons of Mediclaim
- Pros of Mediclaim
- Reasonable Monthly Payments: Great option for an individual or family who has limited funds.
- Easy To Understand Policy: Very straightforward and simple.
- Fundamental Coverage: Offers coverage sufficient enough for basic hospitalisation expenses.
Drawbacks of Mediclaim
- Insufficient Coverage: Accommodation only extends to hospitalisation claims.
- Absence of Other Benefits: This does not include outpatient treatment, wellness programs, and severe illnesses.
Advantages and Disadvantages of Health Insurance
Benefits of Health Insurance
- Broad Scope: Covers outpatient procedures and even treatments before getting ill.
- High-Value Benefit Limits: Provides more coverage and financial reimbursement during major medical issues.
- Flexibility: Extra benefits and riders may increase coverage.
Challenges of Health Insurance
- High Premiums: This is expensive for a person with a limited financial budget.
- Complicated: It may require a lot of time and analysis to find the most economical plan.
Myths and Misconceptions
Health Insurance is the Same as Mediclaim
This is untrue. They both work on the concept of covering medical expenditure; however, their mode of operation, features, and benefits differ significantly. Mediclaim is limited to hospitalization-based claims, while health insurance is from a broader perspective.
Employer-Provided Coverage is Enough
Most people tend to depend exclusively on employer-provided health cover schemes, which is unwise. Such policies are extremely portable and have lower sum insured limits, so with most job switches, you end up losing insurance coverage. For total peace of mind, a personal health insurance policy is highly recommended.
Conclusion
It is important to consider your specific health requirements, costs, and long-term goals when choosing between Mediclaim and health insurance. While basic coverage is offered by mediclaim policies, health insurance plans offer more advanced coverage. Your future health concerns are extremely important to consider as risks to make an informed choice.
