The first thing to understand is that mediclaim has a more specific focus while health insurance policies have a broader coverage.
When deciding whether to choose a mediclaim or a health policy, it would be wise to first understand what your requirements are, what is the existing health condition of family members, and what are the hereditary diseases in the family. This should play a major role in deciding what options to choose in either a health insurance policy or a mediclaim policy.
A mediclaim policy has a premium that is calculated based on the sum assured amount. It usually covers expenses for hospitalization, the illnesses that have been specified previously (which would be under a specific limit in the sum assured amount), as well as accidents.
Health insurance policies, on the other hand, especially those that are currently offered by numerous life insurance companies, offer more far-reaching benefits and wider options. Depending on the company issuing the health insurance policy, there could be health coverage for up to 30 different critical illnesses, which would cover most of the major illnesses that are currently affecting the population worldwide or specifically in the country. Health insurance companies also offer several features that help policy holders, such as reducing the premium after a certain period of time, reducing the sum assured after a certain period of time, and reducing the policy term after a certain period of time has lapsed.
Both mediclaim and health insurance policies provide policy holders the added benefit of getting tax exemption. This is usually under the Income Tax Act 1961 Section 80D. For mediclaim, the tax exemption is applicable for a sum not exceeding 15,000 INR. If the mediclaim is taken for parents who are senior citizens, the tax exemption benefit is for a premium up to 20,000 INR and for a premium of 15,000 INR for parents who are not senior citizens.
Other differences between mediclaim and health Policy are that mediclaim requires a compulsory hospitalization for it to be paid or reimbursed as it only covers hospitalization expenses. The coverage is also limited to not more than 5 lakh INR for the sum insured. Mediclaim also only reimburses the hospitalization expenses to the patient, as it works on indemnity. The claimant can make any number of claims until the sum insured amount is completely finished.
Health insurance policies cover expenses before and after a hospital stay, including charges for ambulance and even compensation for income lost. A claim can be made even without hospitalization, with just a diagnosis, in the case of critical illnesses. The sum insured upper limit can be up to 60 lakh INR. Also, the total sum assured can be given in case of any eventuality as there are riders for critical illness accidents or disability.
These are the many reasons health cover has more advantages than a mediclaim.