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Difference Between Mediclaim and Health Insurance

Oct 14, 2019 | 4 months ago | Read Time: 3 minutes | By iKnowledge Team
Difference Between Mediclaim and Health Insurance


Aneesh had invested in a mediclaim insurance policy and when he was hospitalized after injuring himself in an accident, he duly made a claim to the insurance company. He also considered the amount he paid to the ambulance, and post hospitalization physical rehabilitation expenses. To his dismay, the insurance company disallowed these expenses and only paid him a portion of the hospitalization expenses he had incurred. He picked up his policy document and studied it in detail and realized he had invested in a mediclaim health insurance policy and not in a health insurance policy.

To many people, the difference between mediclaim and health insurance policy is not too large. But when it comes to making a claim for an illness, these small differences can play a big role in the payout received.

What is a mediclaim policy?

A mediclaim policy covers the cost of hospitalization and treatment of specific illnesses up to the specified sum assured. Under the mediclaim policy, the policyholder can claim multiple times till the limit is reached. Under mediclaim, the hospitalization amount can either be paid cashless directly by the insurance company to the hospital, or it can be reimbursed to the policyholder. One can get a tax benefit under Section 80D of the Income Tax Act, 1961, for investing in a mediclaim policy.

What is a health insurance policy?

A health insurance policy is more comprehensive than a mediclaim policy. Also, the payout in health insurance policies is much larger. Health insurance products also include treatment for critical illnesses. These critical illness policies are offered as a rider to traditional health insurance policies. On diagnosis of critical illnesses, the entire amount is paid to the policyholder. Most health insurance policies also include maternity benefits as well. One can get a deduction under Section 80D for investing in a health insurance policy.

Differences between a mediclaim and a health insurance policy:

Following are the differences between a Mediclaim and a Health insurance policy:-

  1. A mediclaim only includes hospitalization expenses. A health insurance policy includes pre-and post-hospitalization expenses up to the specified duration.
  2. Ambulance charges are not included in a mediclaim. They are included up to the specified limit in a health insurance policy.
  3. Maternity benefits are not included in a mediclaim policy. Specified maternity costs such as hospitalization, vaccination for newborns and additional coverage are included in health insurance policies.
  4. To claim benefits under a mediclaim policy, it is necessary for the policyholder to be hospitalized. Health insurance policies cover diagnosis of illnesses and the resulting expenses, and include day procedures such as cataract operations where no hospitalization is necessary.
  5. Under mediclaim, the policyholder can make claims several times till the sum assured is exhausted. For example, if a family floater mediclaim is purchased, there can be several claims made till the sum assured is exhausted. In a health insurance policy, there can be only one claim during the policy period, i.e. a year.
  6. The policy amount under mediclaim is usually up to Rs. 5 lakhs. A health insurance policy is more comprehensive and provides a greater sum assured.

Take for example, Aegon Life and Royal Sundaram’s Life n’ Health Protect Combi plan. This is a combination of a health insurance plan and a term insurance plan. The health insurance plan provides a comprehensive coverage against different diseases as well as critical illnesses. Depending on the type of plan chosen i.e. classic, supreme, and elite, the benefits under the plan increase. For example, for maternity benefits and coverage, the Elite plan is to be selected. If you want a comprehensive plan against hospitalization and different illnesses, you can opt for the classic and the supreme plan. The Life and Health Protect Combi Plan provides for hospitalization expenses, pre-and post-hospitalization expenses, ambulance charges, and even provides for alternate treatment expenses. This makes it a comprehensive and affordable health insurance plan.

These differences are minor, but because of the additional options provided in a health insurance policy, it is preferred. However, the additional benefits in the health insurance policy also translate to a higher insurance premium. Mediclaim policies have a lower premium because of a restricted and limited coverage. In case you can’t afford a health insurance policy, then it is better to opt for a mediclaim because any amount of coverage is better than having no coverage. Given the sharp increase in medical treatment costs every year, it is better to have some form of coverage that covers hospitalization expenses.

Before you opt for a health insurance policy, examine the features and inclusions of the policy and the exclusions. Check the premium for the policy and pick up one that provides the best features for the premium paid. Have you picked up your health insurance policy yet? To know about Aegon Life’s life insurance products like term insurance and other products, visit our home page.


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