You’ve probably heard people debating the difference between mediclaim and health insurance policy, wondering which one is the right choice. And, the answer might surprise you: There really isn’t much of a difference at all.
Let’s rewind a bit –
Back in 1986, government insurers introduced policies under the name “mediclaim” to help people claim medical expenses through insurance. Over time, the term became widely used, almost like a brand name.
But those early mediclaim policies had some limitations. Things like caps on room rent and disease-specific restrictions which made people feel like they weren’t getting full coverage. To improve this, insurers introduced more comprehensive plans and started calling them “health insurance” instead. These new plans addressed many of the old limitations, offering broader coverage and better benefits.
So, what you see today isn’t a choice between mediclaim and health insurance, they’ve evolved into one and the same. The policies you buy now are modern versions that have been improved over time, giving you better protection and more peace of mind.
Coverage Under Mediclaim Or A Health Insurance Policy
Many people think that mediclaim policies only cover hospitalisation costs and don’t include expenses like pre- and post-hospitalisation, whereas health insurance covers everything related to your health. But that’s not quite accurate. Both mediclaim and health insurance policies have specific areas they cover.
1️⃣ Pre-Hospitalisation Costs
These include things like doctor consultations, diagnostic tests (blood tests, X-rays, etc.), and other medical expenses that happen before you’re admitted to the hospital or start treatment. Most health insurance plans will cover these costs for anywhere from 30 to 90 days before your hospital stay begins.
2️⃣ Hospitalisation Costs
These are all the expenses you might face during your hospital stay. This includes everything from room rent and ICU charges to surgery or treatment costs, doctor and specialist fees, oxygen, blood, consultation fees, medications, and more. The policy generally covers these costs, as long as your hospital stay is at least 24 hours.
3️⃣ Post-Hospitalisation Costs
These are the expenses that come up after you’ve been discharged from the hospital. Things like follow-up doctor visits, diagnostic tests, rehabilitation, physiotherapy sessions, and similar treatments are all part of post-hospitalisation expenses. Most health insurance plans cover these costs for anywhere between 60 and 180 days after your hospital stay.
4️⃣ Organ Donor Costs
Certain health insurance or mediclaim policies also cover the medical expenses for an organ donor during their hospitalisation and surgery if they are donating you. the insured person. If this coverage isn’t available, the costs during the donor’s hospital stay would typically fall on you or the organ recipient.
5️⃣ Daycare Procedures Costs
Some treatments or surgeries, like cataract removal, hernia repair, chemotherapy, dialysis, etc. don’t require an overnight stay at the hospital. These are considered daycare procedures, and health insurance policies cover these costs even if you’re not staying for more than 24 hours.
6️⃣ Domiciliary Hospitalisation Costs
Domiciliary hospitalisation involves treatments that can be administered at home instead of a hospital, either because there are no available beds or the patient can’t be moved to the hospital. As long as the treatment is supervised by a registered doctor and monitored by nursing or paramedic staff, most health insurance policies will cover these home treatment expenses.
7️⃣ Add-ons
There are plenty of valuable add-ons you can include with your health insurance or mediclaim policy. These might include an No Claim bonus, critical illness cover, consumable cover, or even the option to waive copay requirements. These extras can give you more comprehensive protection.
Wrapping Up!
Whether you call it mediclaim or health insurance, the policies available today are much more comprehensive and adaptable than ever before. Over time, what started as basic mediclaim coverage has evolved into modern health insurance plans that address a wider range of medical expenses, from pre- and post-hospitalisation costs to daycare procedures and even organ donor expenses. With the ability to add optional covers and customize your policy, you can now ensure greater protection and peace of mind for your health. Ultimately, both types of policies serve the same purpose, protecting you from the financial burdens of medical care. So what matters most is choosing the plan that best meets your needs.
