WHAT IS THE DIFFERENCE IN MEDICLAIM AND HEALTH INSURANCE

Health is our priority whether you secure it by using health insurance or consider any mediclaim. Usually, people secure their health with insurance benefits, and buying a mediclaim policy means protecting your health against healthcare expenses or health emergencies. Mediclaim vs Health Insurance policies are both financially secured instruments designed to cover medical expenses incurred due to illness or injury. However, they differ in their scope and coverage.

 

WHAT IS THE DIFFERENCE IN MEDICLAIM AND HEALTH INSURANCE

 

According to the recent Healthcare Sectors stats; “The Healthcare Insurance field is growing fast because more people are getting medical care, the services are improving, and both the government and private companies are spending more money on it. In the budget for 2023-24, the Ministry of Health and Family Welfare got INR 89,155 crore, which is 3.43% more than what they got in the previous year, which was INR 86,200.65 crore.”

 

What is Mediclaim?

Mediclaim is a type of health insurance policy specifically planned to cover all hospitalization expenses in specific hospitalization along with medical benefits. It typically reimburses the insured costs of hospitalization, surgery, and medical procedures up to a predetermined limit you have claimed. Mediclaim policies are usually more focused and offer coverage for specific medical concerns.

What is Health Insurance?

On the other hand, Health insurance is a broader term encompassing numerous insurance policies to provide financial protection against medical expenses. Health insurance policy plans cover every family member with a wider range of medical services beyond hospitalization, such as outpatient care, prescription drugs, preventive care, and sometimes even dental and vision care depending on the health insurance coverage you have chosen with your health concern.

 

Also Read: KNOW ABOUT GROUP MEDICLAIM POLICY AND GROUP PERSONAL ACCIDENT INSURANCE

 

What is the Mediclaim Vs Health Insurance?

Features

Mediclaim

Health Insurance

Scope

Mediclaim has a limited scope, it covers the expenses related to hospitalization and associated medical procedures.

 

 

Health insurance has a broad coverage that encompasses a wide range of medical services beyond hospitalization, it includes doctor visits, diagnostic tests, preventive care, and more.

 

 

Coverage

It covers hospitalization expenses, surgeries, and medical procedures during the insured's stay in the hospital.

 

It covers various medical expenses, including Pre-post hospitalization, outpatient care, prescription drugs, preventive care, maternity care, and sometimes dental and vision care.

 

Reimbursement

Mediclaim provides reimbursement for hospitalization expenses met with the insured, up to a predefined limit specified in the policy.

 

Offers reimbursement for a wide range of medical expenses, depending on the coverage provided by the policy.

 

Customization

Offers limited options for customization, typically with predefined coverage limits and benefits.

 

Health insurance provides more flexibility for the customization of coverage, allowing individuals to choose coverage options and add-ons based on their specific healthcare needs and budget.

 

Long-Term Care

Generally, mediclaim does not include coverage for long-term healthcare needs or chronic conditions beyond the hospitalization period.

 

Health insurance often includes coverage for chronic conditions, ongoing medical treatments, and long-term healthcare needs, providing comprehensive protection over an extended period.

 

Flexibility

It has flexible coverage options that are event-based, and triggered by specific medical events requiring hospitalization.

 

Health insurance offers flexible coverage for various medical needs, including preventive care, routine check-ups, and ongoing treatments, providing continuous protection ad support against healthcare expenses.

 

Understanding the differences between mediclaim vs health insurance policy can help you and the individuals make informed decisions when choosing the right insurance plan for themselves and their families.

 

How to Choose a Plan for Medical Coverage?

  •  Assess Your Healthcare Needs

Estimate your medical history, current health status, and any anticipated medical claim policy needs. While choosing medical coverage make sure you have to consider factors like age, pre-existing conditions, family medical history, and lifestyle habits.

  • Understand Plan Options

Research and compare different types of medical coverage plans available, such as individual plans, family floater plans, employer-sponsored plans, or government schemes. Ensure the coverage, benefits, limitations, and exclusions of each plan.

  •  Decide Coverage Scope

Determine the level of coverage you need, considering factors like Pre-post hospitalization, and coverage for existing and pre-existing conditions.

  • Review Network Providers

Check the network of hospitals, clinics, and healthcare providers included in your health plan. Ensure that your preferred healthcare facilities and specialists are within nearby areas and networks to maximize coverage and minimize out-of-pocket expenses.

  •  Compare Premiums and Costs

Always compare the premiums, deductibles, co-payments, and co-insurance of different plans. Balance the cost of the premium with the level of coverage provided to find the best health plans and quotes that offer the best value for money.

  • Check Policy Limits and Exclusions

Review the policy limits, waiting periods, and exclusions carefully to understand what is covered and what is not. Pay attention to coverage caps, restrictions on certain treatments or procedures, and any pre-existing condition clauses.

  •  Consider Additional Benefits

Look for additional benefits and features offered by the plan, such as wellness programs, telemedicine services, preventive care coverage, health check-ups, and emergency assistance services.

  •  Read Customer Reviews and Ratings

The most important thing is the reputation of a service provider, customer service quality, their claim settlement process, and overall satisfaction ratings. Always read their customer's reviews and feedback from existing policyholders to gauge their experiences with the insurer and the plan.

  • Seek Expert Advice

Consider consulting with an insurance advisor or healthcare professional to help you understand your coverage options and make an informed decision based on your unique needs and circumstances.

  • Review Policy Terms and Conditions

Before finalizing the plan, carefully review the policy documents, terms, and conditions.

 

Also read: GROUP INSURANCE FOR CORPORATE AND INDUSTRIES

 

Conclusion

Before you claim for medical expenses or buy health insurance for your family members connect with us to clarify any doubts or questions with the insurer to ensure you have a clear understanding of the coverage and obligations under the policy. Make sure you have compared the plans and claim facilities with the Best Insurance Quotes.

Ensure your all coverage needs with us, our health insurance quotes help you provide essential coverage based on your needs, while our mediclaim policy quotes focus on hospitalization expenses, compare your health insurance that offers comprehensive coverage for a broader range of medical services, and provides benefits for individuals with greater financial protection and flexibility in managing your healthcare needs.

 

FAQs

Q1. What factors should I consider when choosing a medical coverage plan?

Ans: Factors to consider include your healthcare needs, budget, coverage scope, a network of providers, policy limits, exclusions, and additional benefits.

Q2: How do I know if a plan covers my specific medical needs?

Ans: Review the plan's coverage details, including hospitalization, outpatient care, prescription drugs, pre-existing conditions, and any specific treatments or procedures you anticipate needing.

Q3. What is the difference between a premium, deductible, co-pay, and co-insurance?

Ans: The premium is the amount you pay for the insurance policy. The deductible is the amount you must pay out of pocket before the insurance coverage kicks in. Co-pay is a fixed amount you pay for certain services, and co-insurance is the percentage of costs you share with the insurer after meeting the deductible.

Q4. How can I switch plans or make changes to my coverage in the future?

Ans: Inquire about the process for switching plans, making changes to coverage levels, and updating personal information. Understand any implications, such as waiting periods or underwriting requirements, when making changes to your coverage.

go to top img

Insurance Companies