26 Aug, 2021 | Health Insurance

What is the difference between health insurance and mediclaim?

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By Team Beshak
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You would’ve seen many articles & websites comparing mediclaim vs. health insurance and discussing how they are different. We’ve also received a lot of questions on our forum asking about the difference between health insurance and mediclaim, which is better and which should be purchased. 

So, we thought of clearing this out once and for all - A Mediclaim and a Health Insurance policy are not different. 

Before we tell you how and why these policies are the same, let us first learn about ‘Mediclaim.’ So, what is mediclaim? 

This will need us to go a little back in time. 

Year 1986. The concept of ‘Mediclaim’ was introduced by government/PSU insurers when they launched their first plans in India e.g. Oriental Mediclaim Policy, New India Assurance Mediclaim, etc. The word ‘mediclaim’ signified claiming for medical expenses through insurance. 

But just the way a lot of product names take after the popular brands that make them… a photocopy machine became a Xerox machine or bandages became Band-aids or sticky-notes became Post-its - Mediclaim too was a brand name of sorts that became synonymous with health insurance. 

But, there was a problem. 

These early-day mediclaim policies had several limitations like room rent limits, disease-wise cappings, co-pay clauses, etc. This didn’t invoke a positive impression of health insurance/mediclaim in consumer’s minds. Hence IRDAI & Insurers consciously did away with the name ‘Mediclaim’ and started calling all future launches & regulations by the name ‘Health Insurance'. 

Some of the above-mentioned limitations had been done away with in these new-age health insurance policies. Gradually, Insurers withdrew their old products (the so-called Mediclaim) or replaced them with new-age, more comprehensive Health Insurance products. 

What you find today with all Insurers is the new age Health Insurance.

What is covered under a mediclaim or a health insurance policy?

A lot of people think that a mediclaim policy is a basic hospitalisation policy and does not cover pre and post-hospitalisation expenses whereas a health insurance plan covers all health-related expenses. But, this is not true. Regardless of whether you have a mediclaim or a health insurance policy, they cover specific expenses. Let's learn about these expenses in detail.

Prefer watching a video instead? Check out our video- How does health insurance work? 

1️⃣ Pre-hospitalisation costs

Costs of OPD consultations, diagnostic tests, etc. conducted before you are admitted to the hospital or before undergoing any treatment such as blood test, x-rays, urine test, etc. come under pre-hospitalisation expenses. Most health insurance plans offer a pre-hospitalisation cover of 30 to 90 days.

2️⃣ Hospitalisation costs

All expenses that are incurred during your stay at the hospital such as - room rent, ICU charges, cost of the surgery or treatment, fees of the doctor, specialist, oxygen, blood, consultancy fees, cost of medicines, etc. are included in the policy. The minimum stay required at the hospital is 24 hours.

3️⃣ Post-hospitalisation costs

Costs that are involved after you get discharged from the hospital such as - follow-up visits to your doctor or the hospital, diagnostic tests, rehabilitation, physiotherapy sessions, etc. are included under post-hospitalization expenses that are covered by your policy. Most health insurance plans offer a post-hospitalisation cover of 60 to 180 days.

4️⃣ Costs of hospitalisation at home

This is called Domiciliary hospitalisation. In case of non-availability of beds at the hospital or if a patient undergoes treatment at home because he/she is unable to be moved to the hospital, all expenses incurred for such  treatment at home are covered under most health insurance policies. The domiciliary treatment has to be under the supervision of a Registered Doctor & full time monitored by the nursing/paramedics staff. 

5️⃣ Cost of Daycare procedures

Certain treatments/surgical procedures like cataract, hernia, chemotherapy, dialysis, etc do not require the patient to stay at the hospital overnight (more than 24 hours). Such expenses get covered under the daycare procedure clause of health insurance. 

6️⃣ Costs of the organ donor 

Some health insurance or mediclaim policies also cover the expenses incurred by the Organ donor during their period of hospitalisation and surgery in case of an organ transplant to the Insured. In the absence of such coverage, the expenses incurred by the Organ Donor during the period of hospital stay shall become Insured’s/Organ Recepient’s liability 

7️⃣ Optional Covers/Add-ons

Additional No Claim Bonus, Critical Illness add-on, waiver on exclusion of non-medical expenses including consumables, waiver of copay, etc are some of the useful add-ons available with health insurance/mediclaim alike. 

Summing up, the idea that mediclaim and health insurance are two different types of policies is just a myth. Both these types of policies are the same; and they are primarily hospitalisation policies meaning they cover the costs of hospitalisation & hospitalisation-related expenses as listed above. Most health insurance policies do not cover OPD expenses, cost of day to day medicines, etc unless such expenses are part of the pre & post-hospitalisation period.  

We’ve also written a detailed article about health insurance - when you should buy it, why it is necessary, inclusions and exclusions under it, etc. Read it before you decide on buying a policy. 

Got a question related to your health insurance or mediclaim policy? You can post it on our forum and get responses from experts!


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Key takeaways
  1. Mediclaim and health insurance are not two different policies and both cover only some medical and health-related costs.
  2. Apart from hospitalisation costs, pre and post-hospitalisation costs, a  health insurance or a mediclaim policy also covers expenses incurred during hospitalization at home as well as on daycare procedures.
  3. These policies also cover the surgery and hospitalisation expenses of the organ donor in case of an organ transplant.
Team Beshak
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Team Beshak, We breathe insurance :)

We are a group of young members of the Beshak community. We come together to brainstorm, write relevant and useful content for people (just like us) who want to figure insurance on their own. If you too want to share inputs/write for us - send us a "hey" to info@beshak.org

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