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Ref. No. KLI/22-23/E-BB/492
Understand health insurance and mediclaim policy differences. Choose the right coverage for your medical needs. Stay protected and secure.
Unforeseen health scare remains a permanent part of life. To rely on your hard-earned savings to get you through a medical crisis is risky and cost-heavy. Preparing for such situations is better and getting the necessary financial backing beforehand is better. At such times, a Health Insurance Policy or a Mediclaim Policy will come to your aid and cover the medical costs related to any illness, injury, or accident. While Health Insurance and Mediclaim Insurance, often mistaken to share similar features, offer different benefits.
Health insurance is a type of insurance cover that provides all-around coverage for medical emergencies. Health insurance coverage aims to provide comprehensive financial protection to the policyholder in the event of an illness, injury or accident.
Health insurance covers not only in-patient hospitalisation costs for medical treatment but also additional expenses like pre and post-hospitalisation costs, fees for home treatment, and payments for non-allopathic forms of therapy (Ayurveda, Yoga Unani, Siddha Homeopathy and Naturopathy). It also covers the costs of various surgical procedures, out-patient treatments and medication, among other requirements.
A Mediclaim Policy is a type of insurance cover that provides specific/limited coverage for certain medical emergencies. The scope of coverage in a Mediclaim Policy is pre-defined and is limited to particular injuries, accidents and ailments.
In addition, the range is restricted to in-patient hospitalisation costs at an allopathic facility/home care treatment. Moreover, the sum provided to the policyholder is also pre-defined and capped, beyond which they cannot make a claim.
Here is the health insurance, and mediclaim difference
Parameter |
Health Insurance |
Mediclaim Policy |
Scope of Coverage |
Provides extensive coverage. Covers:
|
Provides limited/ specific coverage. Covers:
|
Provides extensive coverage |
Up to ₹1,00,00,000 and above |
Up to ₹5,00,000 only |
Covers |
|
● Individual Mediclaim Policy ● Family Floater Mediclaim Policy ● Senior-citizen Mediclaim Policy ● Critical Illness Mediclaim Policy |
A medical insurance policy will only pay for inpatient care. Up to a certain extent, it might cover the treatment of various ailments. Contrarily, health insurance coverage has a wider scope. It comprises costs related to the diagnosis, medical visits, and other costs incurred days before and after the hospitalisation. These expenses are not covered by standard medical insurance coverage.
Ambulance fees are not reimbursable through a mediclaim. In contrast, most health insurance policies allow for the reimbursement of ambulance expenses up to a certain level. The insurance provider pays back these costs.
A mediclaim normally pays for hospitalisation expenses for predetermined illnesses. They exclude any expenditures related to pregnancy, including caesarean sections and other child-related medical care. As hospitalisation is a requirement for Mediclaim, daycare operations like cataract surgery that don’t require hospitalisation are inevitably excluded. These things could be included in a claim for health insurance.
The cost of the insurance policy is also less than that of a health insurance policy because the coverage of a mediclaim is limited. Typically, only ₹5 lakhs are covered under this. A health insurance policy, on the other hand, is much more extensive and includes much more. This results in a bigger sum assured while simultaneously raising the cost of the premium.
Multiple claims may be submitted under a Mediclaim policy throughout the course of a year provided the Sum Assured Limit is not reached. A health insurance policy usually allows the insured to submit one claim each year.
Both Health Insurance and Mediclaim Insurance policies provide coverage for health issues. The main difference lies in the scope of coverage each provides. If you need holistic financial support, opting for a health insurance policy is advisable. On the other hand, if you want limited financial support for a specific health condition, then a medical claim policy will work well. Based on your financial situation and health demands, you can make an informed decision.
Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.
Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors
Ref. No. KLI/22-23/E-BB/2435
The information herein is meant only for general reading purposes and the views being expressed only constitute opinions and therefore cannot be considered as guidelines, recommendations or as a professional guide for the readers. The content has been prepared on the basis of publicly available information, internally developed data and other sources believed to be reliable. Recipients of this information are advised to rely on their own analysis, interpretations & investigations. Readers are also advised to seek independent professional advice in order to arrive at an informed investment decision. Further customer is the advised to go through the sales brochure before conducting any sale. Above illustrations are only for understanding, it is not directly or indirectly related to the performance of any product or plans of Kotak Life.
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