Mediclaim vs Health Insurance: Which Should you Opt For?

The COVID-19 pandemic has opened our eyes to the importance of protecting your health. We now understand that medical emergencies don’t announce their arrival. Having a safety net that will protect you if your health gives out has never been more important. 

Now that awareness is increasing, the debate on Mediclaim vs health insurance has come to the fore. We generally use these terms interchangeably. But some key differences set Mediclaim apart from health insurance.

How then are Mediclaim and health insurance different from each other?

Read on to find out.

What is health insurance?

Health insurance is a comprehensive plan that protects you against a horde of diseases. It is like a huge umbrella that offers generic financial support for most medical issues. 

Imagine a bodyguard that you have employed. Now, this person is going to protect you against any physical danger. It doesn’t matter if the attacker comes armed with a knife or a gun — the bodyguard is still going to protect you.

Health insurance works in the same way. It provides extensive coverage for hospitalisation, screening tests, doctor consultations and more.

What is Mediclaim?

If health insurance is the big brother, Mediclaim is the dainty bite-sized sister.

Mediclaim offers protection against specific medical conditions. It is not a generic coverage that you can use for any kind of illness. In most cases, long-term physical ailments like heart disease or even cancer, are not included in base Mediclaim covers. You might have to purchase additional protection for those.

Mediclaim is quite useful. It is pocket-friendly, and you can use it to cover large expenses like hospital costs and medication. 

Mediclaim vs health insurance: Key differences summarised

Coverage

While health insurance provides comprehensive coverage, the scope of Mediclaim is limited, to say the least. 

In most cases, your Mediclaim will reimburse you up to a pre-specified fixed amount. This is quite useful — you can use this amount to deal with the bulk of your expenditure. But it is not a very huge lump sum. Chances are, you’ll still have to bear some of the additional expenses.

Health insurance is like a protection moat that you can stretch and extend until it covers every exposed surface. Depending on the policy that you have, your health insurance will cover everything from pre-hospitalisation expenses to post-hospitalisation expenses.

The Aditya Birla Capital Activ Assure Diamond + Super Health Topup Combi Health Insurance Plan covers all medical expenses up to Rs 1 crore.

Critical illness

Mediclaim prefers to skirt around any critical illnesses or pre-existing health conditions that you may have. For instance, ailments like heart issues, kidney failure and cancer are generally excluded from the coverage.

On the other hand, health insurance provides comprehensive coverage against critical illnesses and pre-existing health conditions. 

Flexibility

Mediclaim policies do not offer flexibility and work on a one-size-fits-all basis. If you’ve purchased such a policy, you will not be able to make any changes to the terms.

On the bright side, however, Mediclaim policies generally last for one year and have to be renewed after that. You can make changes to the policy when you renew it.

Health insurance offers a lot of flexibility. You can increase or decrease your premium payments, you can alter the sum assured and you can even alter the policy tenure.

Hospitalisation

One of the main reasons for getting a Mediclaim policy is to cover hospitalisation expenses. These policies will reimburse your expenses up to a specified amount. Depending on the specific plan, you can either opt for a cashless option or you can choose to get the payouts later.

Health insurance policies, however, cover more than just your hospitalisation expenses. Whether you get treated at home or you just visit the hospital for a day's procedure, you will still get reimbursed. In other words, you don't need to stay in the hospital to get the benefits.

Additional benefits

Mediclaim policies do not provide any additional benefits or facilities. It does only what it advertises and delivers a no-frills set of services.

Health insurance is more flamboyant in comparison. You get the option to choose from a range of additional features like maternity benefits and accident coverage. Some of these facilities are freely provided and some require additional premium payments.

Mediclaim vs health insurance — Which one should you get?

Now that we have covered the differences between Mediclaim and health insurance, we can now move on to which one to buy. The answer to this question will depend on you. There is no generic solution that fits all. But don’t worry, we’re going to help you figure this out. Ask yourself the following two questions.

1. How much are you willing to spend?
2. How much coverage and protection are you looking for?

Your budget will define your selection. If you have a very small budget, then Mediclaim might be the right option for you. But, if you can afford to spend a little bit more, then do opt for higher coverage.

In terms of coverage, of course, health insurance takes the cake. A comprehensive health insurance policy will cover almost all illnesses except optional cosmetic procedures. The Aditya Birla Capital Activ Assure Diamond + Super Health Topup Combi Health Insurance Plan, for instance, covers everything except hair loss treatments, hearing aids and cosmetic surgeries