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Difference between Mediclaim and Health Insurance

  • Highlights

  • Scope of coverage is the primary difference between Mediclaim and health insurance

  • The Bajaj Finserv Digital Health EMI Network Card takes care of all the expenses that are beyond the purview of these plans

  • Get the Digital Health EMI Network Card in just 5 minutes

  • Avail 800+ treatments from our 5500+ healthcare partners

Paying for healthcare costs can be a huge ask for many and so it makes sense to take some form of insurance as financial protection. Before signing up for a plan, you should know the difference between mediclaim and health insurance and not settle for either of the two without giving some thought to the decision. The key differences between mediclaim and insurance will help you decide which one is right for you in terms of your financial and health condition, the amount you are willing to pay as premium, and what you need coverage for.

Here is an introduction that will help you figure out which is better, mediclaim or health insurance, and also explain what you can do in case both plans fail to offer coverage.

What is Health Insurance?

Health insurance is a type of insurance through which you (the insured) can claim compensation for medical expenses you incur. Insurance companies normally offer coverage for expenses related to:

  • Hospitalisation

  • Surgery

  • Medication

  • Consultation

  • Accidents

  • Critical illnesses

  • Ambulance

  • Dental procedures

  • Pre- and post-hospitalisation

  • Room rent

  • Medical check-ups

Depending on the terms of your health insurance, coverage for certain expenses may be part of the basic plan or may be restricted to add-ons. The amount you incur is reimbursed to you or paid to the healthcare provider directly, while, in case of a critical illness, you are paid the sum assured as a lumpsum.

Health insurance policies offer comprehensive coverage, up to a large sum, which can run into crores of rupees, at pocket-friendly premiums. In case you do not make a claim in a given year, health insurance plans offer a No Claim Bonus, in which the coverage amount is increased or the premium is discounted as a reward. The premiums you pay for your health insurance are tax-deductible under Section 80D of the Income Tax Act.

Now that you know about health insurance, read on to learn about mediclaim. It will help you decide for yourself which is better, mediclaim or health insurance.

What is mediclaim?

Mediclaim is a type of health insurance, but a more restricted one. With mediclaim, you generally get compensation up to a specific sum assured for expenses related to:

  • Hospitalisation

  • Accidents

  • Specific diseases

  • Domiciliary care

You can get assistance up to a particular amount, which unlike a health insurance, is small, normally around Rs.5 lakh. Once again, you can receive the amount directly or in a cashless manner, in which case the insurer pays the amount to the networked healthcare provider directly. Here too, the premiums you pay qualify for a deduction under Section 80D of the IT Act.

From this brief description, you will already be able to make out the main difference between mediclaim and insurance. Read on for a more in-depth understanding.

Mediclaim vs Health Insurance

Scope of coverage can be said to be the primary mediclaim and health insurance difference. This pertains to diseases covered, the compensation offered, and the flexibility of the plan. For more clarity consider the table below.

Factor Category Offer
Coverage Mainly for hospitalisation, pre-decided diseases Comprehensive coverage for hospitalisation, pre- and post-hospitalisation, lost income, ambulance charges, etc.
Critical illness cover No Yes, as add-on
Add-ons Not possible Possible, in the form of critical illness cover, maternity insurance, personal accident cover, etc.
Flexibility Not customisable Premium, sum insured, and terms can be customised after a period
Sum Assured Lower, ~Rs.5 lakh Higher, can exceed Rs.60 lakh a year
Claims Reimbursed or cashless, until the sum assured is exhausted Reimbursed or cashless, till the sum insured is exhausted or one-time as a lumpsum
Hospitalisation required Yes No
Section 80D Tax benefit Yes Yes

This tabular roundup of mediclaim vs health insurance offers a great amount of insight; however, insurers may use the terms differently and so, check for all the features and benefits of the plan you are considering and not just the name it carries.

Use Health EMI Card for things not covered in Mediclaim and Health Insurance

The key difference between mediclaim and health insurance is scope of coverage and since health insurance itself has exclusions, you can expect mediclaim to have certain limitations as well. For expenses that fall out of the ambit of such plans, consider the Bajaj Finserv Digital Health EMI Network Card. It offers you pre-approved credit of up to Rs. 4 lakh, which you can use to avail treatment. You then have a flexible 24-month tenor which you can use to split your medical payment into manageable No Cost EMIs.

To get it now and get instant digital activation, existing Bajaj Finserv customers can:

  • Apply Online for Health Card

  • Verify yourself with your registered mobile number and an OTP

  • Check your offer and pay the one-time fee

  • Access your card through the Bajaj Finserv Wallet App

If you aren’t yet a Bajaj Finserv customer, avail No Cost EMI financing at the nearest partner store, clinic, hospital or medical centre, or check your pre-approved offer for a customised deal.

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