What is the difference between Health Insurance and Mediclaim?

While a lot of people use the terms ‘health insurance’ and ‘Mediclaim’ interchangeably, these two types of health insurance policies are rather different from one another. The most important difference between the two is that a Mediclaim provides coverage, but is limited to hospitalization expenses. Meanwhile, health insurance provides a much more complete coverage that extends further than just hospitalization expenses.

A health insurance policy is a comprehensive policy that, apart from hospitalization charges, also provides coverage for pre and post hospitalization expenses, compensation for lost income, etc. There are several types of health insurance plans available in India, including:

• Individual Insurance Plans – provides coverage to individuals against various illnesses
• Family Floater Plans – provides coverage to your family under a single policy
• Surgery and Critical Illness Plans – can be taken as an add-on cover or as a standalone policy
• Pre-existing Disease Cover – an add-on cover to provide coverage for diseases an individual had before taking the health insurance
• Senior Citizen Plans
• Preventative Healthcare – preventive care treatments like regular checkups

A complete health insurance policy is full of a number of features, including:

• Cashless Facility – Every health insurance company has a number of hospitals in its network, which means that the people who are covered by this company can get admitted to the network hospitals and avail the cashless facility. This means that the insured will not have to pay money from their own pocket and the payment details will be handled by the hospital and the insurer.
• Pre and Post Hospitalization Expenses – Depending on the plan that you purchase, from 30 to 60 days before and after your hospitalization, any charges related to your treatment are also covered by the policy.
• Ambulance charges – With this feature, ambulance charges up to a certain amount are covered by the insurance company.
• No Claim Bonus – For every claim-free policy year, you can avail this no claim bonus, either as an increase in the total sum assured or as a discount in the premium.
• Medical Checkup – A number of insurance companies provide free medical checkups with their health insurance plans.
• Tax Benefits – According to Section 80D of the Income Tax Act, people paying premiums are liable for a tax refund.

The key feature of the Mediclaim is that it provides the insured with coverage for hospitalization because of an accident or a pre-specified illness, for a specified amount of money. Meant for settling the hospitalization expenses that are incurred when a person is admitted to a hospital, this policy reimburses the actual medical expenses.

There are two types of claims under a Mediclaim policy:

This, like health insurance, requires the insured to get admitted to a network hospital. At the hospital’s insurance desk, the pre-authorization form must be filled and sent to the insurance company. The company then verifies the details and sends a fax to the hospital, informing them of the amount that has been approved.

In reimbursement claims, the insured must inform the insurer that the hospitalization has happened or is about to. Then, all the relevant documents like the payment receipts, bills, etc. must be sent to the insurance company.

If you consider the breadth of the diseases covered, the benefits offered, etc., a health insurance policy is quite well-rounded as an insurance product. While your Mediclaim will provide you coverage up to a certain limit, it will be the health insurance that will prove to be more helpful in the more expensive medical emergencies.