Choosing an appropriate health coverage helps manage medical costs along with financial assistance during unforeseen circumstances. Mediclaim and health insurance are two different types of health coverage plans that are used interchangeably but differ in their policy features and scope of coverage. While mediclaim mainly focuses on hospitalisation expenses, a health insurance plan generally has a broader scope, which includes pre- and post-hospitalisation expenses, ambulance charges, day care procedures, etc. Understanding the differences between Mediclaim Vs Health Insurance will help you make an informed decision and choose an appropriate plan that best suits your needs.
What is Mediclaim Policy?
Mediclaim insurance is a kind of health insurance plan that mainly includes hospitalisation expenses, providing financial protection against medical emergencies. It allows policyholders to manage their hospitalisation bills without any significant financial stress. This policy may cover both planned and unplanned admissions, including room rent, medical expenses, medical fees, etc., up to an applicable sum insured and policy limits.
What is Health Insurance?
Health insurance is a broad term that not only includes hospitalisation but also a wide range of medical costs, which may include pre- and post-hospitalisation expenses, diagnostic tests, outpatient consultations, preventive health check-ups, etc. These plans can be customised according to specific healthcare requirements, such as individual, family floater, senior citizen, and top-up health plans.
Mediclaim Vs Health Insurance
Though both mediclaim and health insurance plans are meant to offer financial protection to the policyholder in case of any medical emergencies, their costs, benefits and coverage might differ. The main differences can be understood through the below-mentioned parameters:
| Parameters | Mediclaim Insurance | Health Insurance |
| Coverage | Its coverage generally focuses on eligible hospitalisation expenses only, subject to applicable terms and conditions. | It is a comprehensive plan that covers medical expenses over and above hospitalisation costs. |
| Customisation Facility | This plan offers limited customisation in the existing plan. | These plans are more flexible, allowing policyholders to choose the coverage required depending on the budget and healthcare needs. |
| Sum Insured | The amount of sum insured remains fixed, and the maximum coverage amount may vary from one insurance company to another, subject to applicable terms and conditions. | The amount of sum insured is dependent on the plan chosen, which may vary across different insurance companies. This plan also allows higher coverage, depending on the insurance company and applicable terms and conditions. |
| Cost | The cost of this plan may vary depending on factors such as age, product terms, and applicable terms and conditions. | The cost of this plan may vary depending on factors such as sum insured, age, plan features, and applicable terms and conditions. |
| Add-On benefit | This plan offers limited add-on benefits, depending on the insurance company and respective policy. | This plan offers add-on facilities, such as personal accident coverage, critical illness coverage, daily hospital cash facility, accidental disability, etc., depending on the policy. |
| Floater Coverage | Floater coverage may be allowed depending on the insurance company. | Floater coverage may be allowed by the insurance companies, which includes multiple family members under a single plan, hence offering affordable coverage. |
| Hospitalisation-related expenses | Ambulance charges may not be included under all mediclaim plans, subject to applicable terms and conditions. | Some of the insurance companies offer reimbursement against ambulance expenses up to a certain limit, subject to applicable terms and conditions. |
| Premium | Due to limited coverage, the premium amount may be comparatively lower depending on the coverage and policy features. | Due to extensive coverage, the premium amount may be higher depending on the coverage and policy features. |
Key Factors to Consider When Choosing Between Mediclaim and Health Insurance
While choosing between mediclaim and health insurance, one should consider the following factors:
- Coverage Requirements: Evaluate the healthcare needs to determine the type of coverage required. If comprehensive coverage is needed, a health insurance plan may be considered.
- Sum Insured: Evaluate the potential medical costs to choose an appropriate sum insured that will offer financial protection during unforeseen emergencies.
- Affordability: Evaluate your budget before choosing between a mediclaim and a health insurance. Compare them based on coverage, premium and benefits offered while choosing a plan that provides appropriate coverage within an affordable budget.
How Can a BMR Calculator Help You Understand Your Health Needs?
A BMR Calculator is used to calculate the calories our body requires to perform its essential functions while at rest. The inputs required to estimate the metabolic rate include age, height, gender, and weight. Assessing BMR helps evaluate daily calorie requirements, hence letting you make an informed decision with respect to physical workouts and dietary needs. It is just a factor considered while evaluating overall health and cannot be considered as a medical assessment.
Mediclaim Vs Health Insurance: Which One is Suitable for You?
Both mediclaim and health insurance offer financial protection against unforeseen medical expenses; the decision-making depends on coverage amount, healthcare requirements, and budget.
Consider mediclaim if:
- Specific requirements:
If only specific medical expenses are to be covered for hospitalisation purposes without any comprehensive features.
- Budget-friendly:
If you are low on budget and looking just for basic hospitalisation.
- Basic Hospitalisation Needs:
If coverage is needed for eligible hospitalisation needs without comprehensive features.
Consider health insurance if:
- Customisation: If you are looking for a flexible plan where you can add riders and customise the plan according to your needs.
- High sum insured: If high coverage is required to meet major health problems and treatments.
- Extensive Coverage: If comprehensive coverage is required to meet medical costs, such as outpatient services, critical illnesses, etc.
- Long-Term Security: If you want long-term coverage along with access to a wide network of hospitals.
FAQs
- Is AYUSH coverage included in mediclaim?
AYUSH coverage may be included in mediclaim or health insurance plans, subject to applicable terms and conditions.
- Are maternity benefits included?
Many mediclaim plans do not cover maternity unless it is mentioned. But some health insurance plans may include maternity benefits.
Conclusion
Selecting an appropriate plan between mediclaim and health plan depends on the desired coverage, healthcare needs, and budget. Though mediclaim, on the one hand, best suits when basic hospitalisation is needed, health insurance may offer a wide coverage scope. Also, compare the coverage, features, premium, and sum insured before choosing the plan that best suits your needs.
