Walk into any insurance office and ask for health coverage. They’ll throw these terms at you – mediclaim, health insurance, hospitalisation cover.
Sounds the same? They’re not.
Let’s clear the confusion once and for all.
The Basic Difference
Here’s the truth. Mediclaim policy is actually a type of health insurance.
Think of health insurance as a big umbrella. Mediclaim sits under that umbrella, along with other types.
All mediclaims are health insurance. But not all health insurance is mediclaim.
Confusing? Let me break it down further.
What Mediclaim Actually Covers
Mediclaim is simple and focused. You get hospitalised. The doctor charges fees. The hospital charges room rent. Medicines are administered. Tests get done. Maybe surgery happens.
Mediclaim pays all these hospital bills. Either directly to the hospital or reimbursement to you. That’s it. Nothing before hospitalisation. Nothing after discharge, usually.
What Modern Health Insurance Includes
The best health insurance today does much more than just mediclaim.
- Before hospitalisation – The doctor consultation fees, diagnostic tests, and medicines prescribed.
- During hospitalisation – Everything mediclaim covers, plus special treatments, modern procedures, robotic surgeries.
- After discharge – Follow-up visits, prescribed medicines for 60-90 days, physiotherapy, and home nursing care.
- Plus other benefits – annual health check-ups, ambulance charges, daycare procedures, and alternative treatments like Ayurveda.
See the difference? Much broader coverage.
Why the Confusion Exists
Twenty years back, a mediclaim policy was the main product available. Everyone called health insurance “mediclaim.”
That word stuck. People still use it interchangeably.
But insurance evolved. Products became comprehensive. Yet the old name continues.
Like how we call all photocopying “Xerox” even though Xerox is just one brand.
Pre and Post Hospitalisation
Old mediclaim covered zero expenses outside hospital stay.
Doctor consultations before admission? Pay yourself. Medicines after discharge? Your cost. Follow-up tests? Not covered.
Best health insurance today covers 30-60 days before hospitalisation and 60-90 days after.
This adds significant value. Medical expenses don’t stop at the hospital gate.
Cashless vs Reimbursement
Both mediclaim and health insurance offer a cashless facility at network hospitals.
But here’s the difference in practice.
Basic mediclaim policies have smaller hospital networks. Maybe 2,000-3,000 hospitals.
Comprehensive health insurance has larger networks. Maybe 8,000-10,000 hospitals, including the best ones.
More network means more options during emergencies.
Daycare Procedures Coverage
Modern treatments don’t always need an overnight stay.
Cataract surgery – done in 4 hours, go home the same day. Dialysis – a four-hour process. Chemotherapy sessions – on an outpatient basis. Old mediclaim needed a minimum 24-hour hospitalisation to pay anything.
Good health insurance covers these daycare procedures. No hospitalisation needed. This matters because medical science is moving toward shorter hospital stays.
Annual Health Checkups
Basic mediclaim policy rarely includes preventive care. The best health insurance gives free annual checkups. Full body tests. Blood work. Scans if needed.
Detect problems early. Treat before they become serious. Save money long-term. Some policies even give checkups for the entire family if everyone is covered together.
Alternative Treatment Coverage
Mediclaim traditionally covered only allopathic treatment. Ayurveda, Homoeopathy, Unani? Not usually covered.
Many modern policies now cover AYUSH treatments. Some cover naturopathy and yoga therapy too. For people who prefer alternative medicine, this flexibility helps.
Premium Differences
Here’s where it gets interesting.
- Basic mediclaim costs less obviously. Maybe 8,000-10,000 yearly for 5 lakh coverage.
- Comprehensive health insurance with all features costs 12,000-15,000 for the same sum insured.
Worth paying 4,000 extra for much wider coverage? Most people say yes.
You get what you pay for, basically.
Co-payment Clauses
Many mediclaim policies have co-payment. You pay 10-20% of every claim.
Hospital bill is 2 lakhs. You pay 40,000 if co-pay is 20%.
Some health insurance plans remove co-payment. Company pays full amount.
Check this carefully during comparison. Co-payment reduces your actual coverage significantly.
Room Rent Restrictions
Mediclaim caps room rent at maybe 1% of sum insured daily. For 5 lakh policy, that’s 5,000 per day.
The hospital charges 8,000 per day. You pay the difference? No. The entire claim gets proportionately reduced.
Your 2 lakh bill becomes a 1.25 lakh payout. You lose 75,000. Best health insurance removes room rent limits. Take any room. Full coverage applies.
Maternity Coverage
Most mediclaim policies exclude maternity completely.
Specialised health insurance offers maternity coverage. Delivery expenses, newborn care, complications – all covered.
The waiting period usually applies. Maybe 2-4 years after buying the policy.
For young couples planning families, this feature is valuable.
Critical Illness Add-ons
Mediclaim policy covers treatment costs only. You get cancer. Hospital bills 10 lakhs. Mediclaim pays the hospital.
But you can’t work for a year. Income stops. EMIs continue. Who pays daily expenses? Best health insurance offers critical illness riders. Get a lump sum 10-20 lakhs on diagnosis.
The Real Answer
Forget the terminology confusion. Focus on what you’re actually getting.
Read the policy document. Check what’s covered and what’s not. See sub-limits and restrictions. Verify hospital network. Check the claim settlement record.
What matters is comprehensive coverage when you need it most. Buy adequate protection. Your health and your family’s health deserve that.
(DISCLAIMER: The information in this article does not necessarily reflect the views of The Global Hues. We make no representation or warranty of any kind, express or implied, regarding the accuracy, adequacy, validity, reliability, availability or completeness of any information in this article.)
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