Health Is Wealth: Stay Insured

Health Insurance and Mediclaim

Individuals with limited savings and income must necessarily consider buying a health insurance policy so that any unplanned expense related to health-related emergency can be taken care of without worries.The article highlights the two kinds of covers that are available – health insurance and mediclaim

At all times all of us are exposed to the risk of both mortality and morbidity. And the reality is that as of now healthcare costs are at their peak, and getting higher by the day. In case of a medical emergency, the cost of treatment cannot be predicted, and thus can be well beyond what one can afford. In a particular year, the cost of medical treatment might be low, but in some other year it could be prohibitively high. Thus, medical insurance is required to protect oneself against such emergencies as well as uncertainties. For example, if an individual meets with an accident while driving back home on his two-wheeler and suffers brain injuries, it might call for immediate surgery, the financial implications of which would be huge. It is at such times that a health insurance policy can come to the rescue.

Health Insurance
The above example highlights the need for health insurance given that it provides risk coverage against expenditure caused by any unforeseen medical emergencies defined as ‘coverage that provides for the payments of benefits as a result of sickness or injury.’ This policy refers to a wide variety of policies. A health insurance policy is generally an annual insurance policy, renewable every year. The policy covers hospitalisation due to sickness and accidental injury, subject to certain exclusions, which are explicitly mentioned in the policy text. This plan also offers comprehensive insurance coverage, including critical illness cover and pre and post-hospitalisation expenses.

You can claim health insurance in two ways – cashless or reimbursement. In case you opt for cashless claim the insurance company directly pays the admissible claim amount to the hospital. The insured person pays only those expenses which are not covered under the health insurance policy. Whereas if an individual opts for reimbursement, then if you happen to be admitted in a hospital which is not in the network of your insurance company, you will have to make all the payments on your own to the hospital and then submit the original invoices and other documents along with the claim form to the insurance company for reimbursement.

Mediclaim Insurance
Like health insurance, mediclaim is also an instrument that provides coverage and benefit over unexpected medical emergencies. It provides reimbursement or cashless payment depending on the policy type. Mediclaim, as the name suggests, is a claim that needs to be made but there are policies available in the market which also provide a cashless option. A mediclaim policy might cover pre and post-hospitalisation expenses depending on the policy and the policy provider you have opted for. However, generally it only covers hospitalisation expenses. It has many options available for premium such as monthly, quarterly or yearly.

For some policy options you can also claim bonus for claimfree years too. There are also group policy options available for the entire family. A mediclaim policy covers hospitalisation expenses such as a room rent, boarding expenses provided by the hospital or nursing home, nursing expenses, surgeon’s fees, anaesthetist’s fees, medical practitioner’s visiting charges, consultants, specialist’s fees, anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, diagnostic materials and X-ray, dialysis, chemotherapy, radiotherapy, cost of pacemaker, artificial limbs, cost of organs and similar expenses.

Differences between Health Insurance and Mediclaim

Making the Right Choice
There are some pointers to consider when deciding between health insurance and mediclaim:
1. Financials: It is important that the premiums do not burden the insurer and hence health insurance or mediclaim should be chosen as per one’s financial capabilities.
2. Medical History: The medical history of a particular person or family matter a lot as both offer different coverage for different illnesses and hence choosing a policy without considering the medical history might leave you with no benefits when needed.
3. Duration: It is very important to decide on the premium payment schedule as well as the duration of coverage for the policy selected which can be decided depending on one’s age when purchasing the policy.
4. Renewability: Choosing a policy with flexible renewability is important as it would benefit one in terms of planning or adding benefits as and when required.
5. Add-Ons: In the current scenario it is vital to ensure whether you get a customisable policy or not depending on your approach to the situation as both policies work differently.