Health insurance serves as a protective barrier, safeguarding you against medical expenses should illness strike. Timely premium payments ensure coverage for the policyholder, contingent upon meeting other specified terms and conditions. Fixed-benefit medical insurance policies disburse a predetermined sum upon claim initiation without requiring the submission of bills, whereas traditional policies reimburse actual medical expenses incurred. In India, medical insurance options are provided by both general insurance and life insurance companies.
Distinguishing Mediclaim Insurance from Fixed Benefit Health Insurance Policy
Mediclaim Insurance policies operate on an indemnity basis, reimbursing the policyholder for medical expenses up to the insured amount. The policyholder must provide hospital bills reflecting the costs incurred to make a successful claim. Claims can be processed through cashless transactions directly with healthcare providers or as reimbursements to the policyholder. However, coverage for critical illnesses like heart disease and cancer may be limited, necessitating additional medical insurance specifically tailored for such conditions.
In contrast, fixed-benefit health insurance policy offers coverage for predetermined diseases or conditions, such as heart ailments and cancer. These modern policies provide a lump sum payout upon initial diagnosis, regardless of medical expenses. Unlike Mediclaim policies, seeking treatment at a network hospital or filing reimbursement claims is unnecessary. Instead, fixed benefit plans deliver the coverage amount promptly upon diagnosis, allowing flexibility in choosing a preferred hospital for treatment.
| Mediclaim Policy | Health Insurance Policy |
| Mediclaim policy extends to expenses incurred before, after, and during hospitalisation | Fixed-benefit medical insurance pays a defined amount for a predetermined illness or condition, irrespective of treatment costs. |
| Mediclaim insurance claims are usually processed based on diagnostic reports, written consultations with doctors, discharge cards, treatment bills, medicine bills and other documents. | Claims under fixed-benefit medical insurance plans are usually processed based on diagnostic reports confirming the insured illness or condition. Submitting bills, documents and other expenses to the insurance company is a smooth process. |
| Mediclaim insurance policies reimburse you/your healthcare provider for expenses incurred up to the sum assured limit. | Fixed benefit medical insurance plans pay a fixed lump sum amount, regardless of your actual expenses. |
| Mediclaim insurance plans provide cashless facilities, i.e. direct reimbursement to healthcare providers, only at network hospitals. In non-network hospitals, you must pay, and the insurer will reimburse you later. | Fixed-benefit medical insurance plans pay the money to the policyholder directly, often even before treatment starts. |
| Mediclaim insurance plans usually do not pay any assured monthly payout if the policyholder is diagnosed with any significant illness/condition. | On the diagnosis of a predetermined major condition/illness, some fixed benefit insurance plans will pay the policyholder a portion of the base Sum Assured every month for a fixed period. |
| Some healthcare insurance plans require you to pay a part of your expenses while the insurer pays the rest. | Fixed-benefit healthcare insurance plans do not require you to pay any part of the defined amount. |
When to Purchase a Medical Insurance Plan
The following tips will assist you in identifying the right moment to invest in either a mediclaim insurance or health insurance policy.
- Commence Early:
Initiating your medical insurance coverage at an early stage results in lower premiums and reduces the waiting period for pre-existing conditions. Since exclusion periods for such conditions begin upon policy purchase, the sooner you acquire coverage, the sooner these waiting periods expire, enhancing your benefits.
- Avoid Sole Reliance on Employer Coverage:
While employer-provided healthcare insurance may seem sufficient, it’s important to note that such coverage typically ceases upon changing jobs or transitioning to self-employment. Purchasing independent medical insurance at this juncture becomes considerably pricier due to advancing age, leading to higher premiums.
- Tax Savings Opportunity:
Medical insurance premiums qualify for deductions from taxable income under Section 80D of the Income Tax Act, 1961, up to certain limits. By initiating coverage early, you maximise the benefits of these deductions, potentially saving significant amounts on taxes each year.
Bottom Line
Understanding the disparities between a Mediclaim policy and a Health Insurance policy is crucial for making informed decisions about one’s healthcare coverage. While both offer financial protection against medical expenses, they differ significantly regarding coverage scope, flexibility, and additional benefits.
A Mediclaim policy typically provides limited coverage for hospitalisation expenses. In contrast, a Medical Insurance plan offers a broader range of benefits, including pre and post-hospitalisation expenses, outpatient care, and wellness benefits. For comprehensive coverage tailored to individual needs, consider exploring Niva Bupa’s range of Medical Insurance plans.
With Niva Bupa, you can access personalised coverage options designed to safeguard your health. It also ensures your financial well-being, providing you and your loved ones with peace of mind. Choose Niva Bupa today and prioritise your health with confidence.