What are the differences between Health Insurance and Traditional Mediclaim?
I am sure, you first reaction will be “is there any differences? Most of the people using these two words “Health Insurance” and “Mediclaim” interchangeably but through this post I will try to clear dust on the issue and helps you learn the basic differences between health insurance and mediclaim.
Features of Traditional Mediclaim Policy
Mediclaim is policy under which you will get the claim only on hospitalisation and related expense, under this policy, you will not get any claim on outdoor medical treatment. Once you admitted in a hospital and you have fulfilled the conditions in your mediclaim policy then only you are eligible for claim under such policy. The claim under such policy includes hospital charges, some test charges conducted during hospitalisation, doctor fee and medicine fees etc. No claim accepted under mediclaim policy for pre-post hospitalisation.
Under mediclaim policy, maximum sum assured is generally less than 10 lakh. In this policy you may get cover for yourself and your family for hospitalisation expenses. In policy term your sum assured will be reduced by the amount claimed by you.
Suppose A person have taken a mediclaim policy for sum assured of Rs:500000./- and he has filed and received a claim of Rs 200000/- for medical treatment ,in such case, next time he will get maximum Rs 300000/- as claim(Total sum assured minus claim already received )
Features of the Health Insurance
Health insurance is much broader concept and comprehensive and wider scope of coverage for medical treatment. It not only covers claim for inpatient medical expense but also covers outpatient expenses. Further you may take policy extensions covering critical illness & hospital cash benefits. In health insurance policy you can take cover for yourself and your family. Higher sum assured than mediclaim policy can be availed under this policy. Further, if you have taken health insurance policy along with critical illness cover under health insurance then full sum assured will be given as a claim on diagnosing of diseases covered under your policy.
Suppose a person has taken a critical illness cover for cancer with a sum assured of Rs 20 lakh and unfortunately, he has been diagnosed with cancer, in such case full Rs 20 lakh will be paid to him immediately under critical illness cover and there will be no need to show any bill for medical treatment expenses for claim.
Differences between Health insurance and Traditional Mediclaim
1. Coverage: Mediclaim provide coverage for hospitalisation only whereas health insurance covered includes pre and post hospitalisation expenses also.
2. Sum assured: Traditionally you can take maximum 10 lakh coverage under this Mediclaim, whereas under health insurance you can take up to crore according to your income levels.
3. Add on: In mediclaim policy traditionally no adds are available, however under health insurance you can also take additional add on like critical illness cover, hospital cash etc…..
4. Claim: Claim is paid on actual expenses basis under Mediclaim plan, whereas under health plan with appropriate riders you may claim full sum assured on diagnosis of the disease.
Need of the Health Insurance Plan
Though one may take preventive measures and take utmost care to avoid bad medical conditions, yet One cannot predict good health all the time and must spend money on treatment and expense which sometime may spoil your financial planning altogether. So, it is must for everybody to have a decent health insurance cover for you and your family. Type of insurance policies available in India are Individual plan, family floater, preventive health care, critical illness covers and special plan for senior citizens also provided by insurance companies.
Main Benefits of health insurance includes cashless treatment which includes pre and post treatment expense, critical illness cover, free medical check-ups at designated centres tied up with insurance company. Further you may end up with no claim bonus or return of premium, if you have no claim during tenure of health insurance policy cover. Moreover, tax benefit under section 80D is available for senior citizens and others. Same additional benefit can be claimed for payment of health insurance for parents.
At the end, as explained above, Health insurance is more comprehensive term than Mediclaim, but which is better for a particular person depends upon the needs and circumstances of that specific person and accordingly he may choose either for Mediclaim policy or Health insurance or mix of two.