Have you ever bought a
mediclaim policy and end up wondering, is it any different from health
insurance? These two terms are too often used interchangeably. However, there
are some sharp differences between them. While mediclaim limits itself
specifically to hospitalization expenses, a health insurance is much more
comprehensive and provides a cover that extends beyond hospitalization. Let's
look at the detailed differences between Mediclaim and Health Insurance.
Mediclaim pertains specifically to hospitalization. Simply
put, it covers only hospital related expenses.For filing a mediclaim,
hospitalization is required. The cover given is limited. The upper cap on the
sum insured does not exceed 5 lakh in a typical mediclaim policy. Health insurance is more comprehensive and covers not
only hospitalization expenses but also pre and post hospitalization expenses,
ambulance charges, compensation for the lost income and more.
For filing a health insurance claim, an eventuality is
required which might not necessarily be hospitalization. For instance for a
critical illness cover, all the insured needs to get the sum assured is a
diagnosis. The cover given is quite extensive. The upper cap on the sum insured
can go up to Rs 60 lakh.
Mediclaim works on indemnity principle wherein the
hospitalization expenses incurred by the insured are reimbursed to him, thus
making up for his loss. E.g. Arun owns a mediclaim policy. Last month, he was
severely infected so he was hospitalized for 5 days. The total medical expenses
he had to incur turned out to be Rs 120,000. He filed a claim and his insurance
company paid out Rs 120,000 to him. On the other hand There are many components
in a health insurance. Health insurance riders such as critical illness
rider and accidental disability rider works on benefit principle wherein a lump
sum is paid to the insured in case of an eventuality, rather than making up for
the loss. E.g. Arun owns a health insurance plan with critical illness cover (5
lakh sum assured). Last month, he was diagnosed with cancer. He filed a claim
and his insurance company paid out the total sum assured to him.
Mediclaim allows the insured
to make 'n' number of claims until the sum insured is exhausted on the other
hand In the critical illness cover, personal accident cover and accidental
disability cover, the entire sum assured is paid out at once. Hence, there's no
question of making another claim during that policy tenure