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6 Questions about Mediclaim Policy that every Health Insurance Seekers should know

In India, Mediclaim and health insurance scheme are mostly used interchangeably. However, in actuality there is a fundamental difference between the two. While it is true that both schemes are designed to address health emergencies, the benefits of health insurance plan supersede mediclaim policy at any given day.

It is a common mistake for individuals to opt for mediclaim policy thinking that they have a health insurance policy. This particularly happens with first time health insurance buyers. To prevent potential health insurance buyers to make similar mistake, read on to find questions about mediclaim policy every health insurance seeker should know:

    1. What is a Mediclaim policy?

Mediclaim Policies are designed to cover the cost of hospitalization and treatment towards predetermined disease or illnesses. The premium of the policy depends upon the sum assured which has to be paid annually.

    2. Difference between Mediclaim and Health Insurance.

While both mediclaim policy and health insurance scheme cover hospitalization expenses, the latter is a more comprehensive and an extensive health plan. Health insurance policy offers hosts of additional benefits like reimbursement against emergency ambulance service, loss of income due to illness etc.

    3. Does mediclaim policy offer the facility of cashless settlement?

Yes, if the policy holder is seeking treatment at any of the partner hospitals, then the clause of cashless hospitalization is applicable. In case of non-partner hospital, relevant bills will have to be produced at the time of settlement. Similar drill applies to health insurance scheme as well.

    4. Does mediclaim policy cover critical illness?

No, mediclaim policy provide cover against critical illnesses. This is because, these policies have a lower sum insured and generally does not go beyond Rs. 5 lakhs. Since treatment for critical illness incurs huge expenses, the policy may not be enough to meet the cover. However, on the other hand, individuals who already have a health insurance can opt for a Critical Illness Rider, people get sum insured for Rs. 25 to 30 lakhs.

    5. Is the tenure of both schemes similar?

Mediclaim is a general insurance policy which has to be renewed annually. On the other hand, health insurance is offered by life insurer’s tenure of which is usually up to 3 years or more. So, while the premium amount of these policies may vary each year, the premium for health insurance remains unchanged.

    6. What if the claim is less than the sum insured?

In case of mediclaim policy, the policy holder can make end number of claims until the entire sum insured amount is exhausted. However, in case of health insurance, especially in cases related to critical illness, the insurer transfers the entire sum insured to the policy holder irrespective of the actual cost of treatment. Therefore, there is no scope for making repeated claims during the entire tenure of the policy.

A lot of people opt for Mediclaim Policy because the premium amount is less. While some experts may argue that it is a grave mistake, the truth is that it’s always better to have some form of health cover than no cover at all. Health insurance is a more comprehensive plan offering hosts of benefits. However, if your pocket does not allow you to afford health insurance, it is not a bad option to go for at least a mediclaim policy.

At the same time, if you have mistakenly purchased a mediclaim policy, thinking you have purchased health insurance, it is not a bad idea to buy a separate health insurance policy. The advantage of this would be is that you can utilize your mediclaim policy for any kind of minor hospitalization, which will give you no-claim bonus on your main health insurance plan.

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