What Are The Differences Between Mediclaim Policies & How Do They Work?


Healthcare costs have been skyrocketing in India. Whether a simple medical procedure or a major surgery, any kind of treatment can drill a hole in your pocket, especially if a viable Mediclaim policy doesn’t support it. Investing in a comprehensive health insurance policy can save you from unnecessary expenses. 

With many health insurance plans available today, selecting the most befitting one can sometimes become challenging. However, a better understanding between the different policies and your specific needs can enable you to conveniently choose a Mediclaim policy that provides complete coverage for your healthcare needs. 

Health insurance plan vs a mediclaim policy 

A Mediclaim policy is a type of insurance plan offering specific financial protection against health-related expenses. Mostly limited to hospitalisation, this is a pocket-friendly form of mitigating any health-related financial emergency. A health insurance policy, on the other hand, has broader coverage. It covers the cost of medical and surgical expenses for the policyholder. 

Here’s a look at the broad differences.

  1. In the case of a health insurance policy, the policyholder can pay for the incurr expenses out-of-pocket and subsequently claim it from the insurance provider, or the insurance company settles the bills directly with the eligible hospitals listed in their network. Health insurance policies are comparatively more expensive than a mediclaim policy.  
  1. Most Mediclaim policies don’t offer add-on covers or coverage for critical illness and are less flexible than health insurance policies. The sum insure for a Mediclaim may have a specific limit but allows policyholders to file multiple claims until the insured claim amount is exhaust. For any kind of claim under the Mediclaim benefits, it is essential to get hospitalise.  

On the other hand, a health insurance plan allows policyholders to select from multiple add-on covers, including critical illness, personal accident covers and maternity covers, among many others. 

  1. A health insurance policy is flexible and will enable policyholders to adjust their coverage needs per their requirements. So, you can either enhance or reduce your coverage by changing the policy’s duration. 

Some more differences

For instance, you can look for long-term policies that offer premiums and discounts. Most health insurance policies from top-rate insurance providers may provide coverage for over 30 critical diseases, including cancer, stroke, and kidney failure, depending on the policy. Moreover, the sum insure for health insurance schemes could go up to Rs 6 Cr/yr.  You cannot customise a mediclaim policy.

  1. In health insurance, the policyholder can claim the insurance sum as long as it isn’t exhaust. When it comes to cover relate to critical illness or disability caused by accident, the provider will pay the assured sum in a lump sum. But such claims can be made only once during the policy tenure. Some insurers can have a limited number of claims in mediclaim.
  2. In a health insurance scheme, the policyholder can avail of benefits such as daycare procedures without getting hospitalise. Mediclaim pays only in case of hospitalisation.

The different types of Mediclaim policies that you can avail

Healthcare policies come in various forms offering different types of coverage.

Individual Health Insurance 

Individual health plans are design to cover your individual health needs. However, these plans also allow policyholders to add other members, such as their spouse, children, parents, etc., on the payment of an extra premium amount. This insurance form usually charges the premium based on the individual’s age, medical history, and respective sum insured. 

Also, individual health policies claimed by one member don’t affect the sum insured by the other. The premium is slightly higher than a family floater plan owing to the comprehensive coverage and the offered sum. 

Family Floater Health Insurance 

In a family floater plan, the coverage is offer to family members, including anyone from spouse and children to parents and other dependent members. It is provided at a single premium based on the family’s eldest member. All family members in this plan are cover under a single assure sum. 

Critical Illness Insurance Policy

This policy covers life-threatening diseases such as cancer, kidney failure, paralysis, stroke, etc. As the cost of treatment of such ailments is quite high and may call for frequent hospital visits over long periods, the critical illness plans provide for various expenses, including doctor consultations, chemotherapy and more other than hospitalisation. 

The insure sum is paid in a lump sum and can be use to cover total medical costs. The policyholder must check the illnesses covered when buying the policy, as mentioned in the policy document. Some plans also offer compensation for loss of income emanating from a diagnosis of a life-threatening health condition. 

Senior Citizens Insurance

The Health insurance for senior citizens is design for people above 60. If you have elderly parents who are vulnerable to severe illnesses, it is best to invest in a senior citizen plan as it can ensure adequate medical coverage in their years of post-retirement. Although the premium is usually higher in these plans, it also offers tax benefits under Section 80D on the premium paid. 

In conclusion

You can select a health insurance policy that suits your health needs and preferences. Your decision will depend on your financial condition, required plan flexibility, add-on covers and benefits and the premium amount; it is best to keep these factors in mind when choosing a mediclaim policy. 

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