What is the Difference Between Health Insurance and Mediclaim? And Which One is Better and Why?

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Health insurance and mediclaim are both popular terms in the healthcare industry. Although two of them can be used interchangeably, their coverage and benefits are quite different from each other.


However, to analyse which one of them best suits your needs, you should have a clear understanding of their differences.


Health Insurance Vs Mediclaim: What are the Key Differences


In short, mediclaim only offers coverage for hospitalisation and accident-related treatment, while health insurance has wider benefits. For instance, it not only covers hospitalisation costs but also ambulance charges and other associated expenses. This is why health insurance stands way ahead of health insurance.














































Feature



Health Insurance



Mediclaim



Coverage Scope



Wide, including pre- and post-hospitalisation, day care procedures and others



Limited, only for inpatient hospitalisation expenses



Additional Benefits



It can offer add-on benefits to enhance protection, such as critical illness and maternity cover.



Do not offer any add-on coverage.



Flexibility



Highly flexible, allowing policyholders to customise coverage based on their specific needs.



No flexibility in the coverage



Critical Illness Cover



Can provide additional coverage upon diagnosis of 37 critical illnesses, like cancer, heart attack, or stroke.



Do not offer any coverage protection from critical illness.



Hospitalisation



Not necessary, policyholders can get the benefits such as medicine costs, without hospitalisation.



Policyholders can not get the medical benefits without hospitalisation.



Sum Insured



Typically higher, up to ₹2 Crores.



Lower than health insurance, approximately around ₹5 lakh.



Premium



High premium amount due to extensive coverage



Low premium amount due to limited premium amount.



What Should You Choose Between Health Insurance and Mediclaim?



  1. Choose Health Insurance If



  • You need comprehensive protection from a wide range of medical issues, including critical illnesses and long-term treatments.

  • You want to include your family members, as it offers a family floater plan that adapts to evolving health needs under a single sum insured.

  • You are looking for flexibility with higher sum insured options and additional benefits, such as annual health check-ups and maternity coverage.

  • You prefer cashless facilities at the network hospitals and avoid out-of-pocket expenses.



  1. Choose Mediclaim If



  • You are looking for budget-friendly options and a basic option to cover unexpected hospital stays.

  • You are young, generally healthy, and only need an individual plan as a financial safety net for emergencies.

  • You are covered by a group insurance plan from your employer, but want an additional policy for basic inpatient care.


Factors to Consider While Choosing a Mediclaim Policy and Health Insurance



  1. Claim Settlement Ratio: A claim settlement ratio represents how many claims an insurer pays out successfully. This is why you should always choose a provider with a high claim settlement ratio.



  1. No Claim Bonus: No claim bonus is a bonus an insurer provides for a claim-free year. Therefore, the higher percentage of NCB ensures the accumulation of a larger sum insured over time.



  1. Waiting Period: Generally ranging from 24 to 36 months, policyholders with diseases such as high blood pressure, thyroid, or diabetes can not raise a claim at this time.


Conclusion


While health insurance offers better coverage, mediclaim also has its own perks, especially for young adults. Therefore, take your time to assess your healthcare needs and choose the best plan.