People usually say ‘Mediclaim Policy’ and ‘Health Insurance policy’ as a synonym of one another. However, Mediclaim is just one type of health insurance. 

It is the most popular type of health insurance policy in India as it offers a medical cover at relatively cheap premium. However, the scope of coverage is limited in terms of hospitalization expense or cost of treatments depending on various policy terms. Any additional cost for treatments that are not covered in policy agreements has to be paid by the policyholder themselves.

The benefits of a Mediclaim policy are:

1. The expenses for treatment of pre-determined illnesses are paid by the Insurer up to a pre-determined sum assured.
2. The insurance claim can be made in the form of cashless treatments or reimbursements of expenses done for treatments. 
3. You can get Mediclaim cover for self, spouse, children and parents as well.
4. You claim tax relief under section 80(D) of Income Tax Act on the premiums paid for purchase of Mediclaim policy.

 What is a Health Insurance Policy?

A health insurance policy provides financial assurance for many different forms of medical expenses in the treatment or surgeries of illness or accidents to the policyholder. The scope of coverage for health insurance policy is wider than that of a Mediclaim policy and hence the premiums are costlier.

The benefits of a Health insurance policy are:

1. The scope of coverage is wider for a health insurance policy as you can get several medical expenses and treatments covered. 
2. You claim tax relief under section 80(D) of Income Tax Act on the premiums paid for purchase of Health Insurance policy.
3. You can get discount on premiums of health insurance policy renewals through No-claim Bonus (NCB) if no claim was made in the policy term.
4. You can increase the scope of medical coverage by purchasing additional riders at the time of purchase of new policy or at renewals. You can get riders such as critical illness, personal accident or hospital daily cash benefits.

What are the differences between Mediclaim Policy and Health Insurance Policy?

The below table highlights several points of comparison between a Mediclaim policy and health insurance policy:

How to evaluate best health insurance in India?

After understanding the difference between Mediclaim policy and Health insurance policy, you should now be try knowing what your insurance needs are? Do not simply buy a health plan that your friend or colleague has or suggested as your insurance needs may differ from them.

You can evaluate and compare various health insurance policies and select the best health insurance in India by following the steps mentioned below:

• Decide on the sum assured and the cost of coverage:

Sum assured is the maximum amount that the insurance provider will cover you for predetermined medical expenses. Premiums are the cost of coverage that policyholders pay to the insurance provider to get the health insurance. 

• The sum assured should be decided by taking into account the rising medical inflation. 
• Since the sum assured and premiums are directly related, you get lower sum assured for lower premiums and vice versa.
• People tend to save cost by opting for lower sum assured and remain under-insured or pay premiums that are more than their insurance needs. 
• As a general thumb rule, paying up to 10% of your monthly income towards insurance premiums and having a sum assured equal to 50% of your annual pay is ideal. However, depending on your insurance needs you can decide how much you should pay for a certain sum assured.

You can evaluate the best health insurance in India by comparing the premiums offered by the insurance provider for a certain sum assured and then select the health insurance policy which offers a certain sum assured at lowest premium.

• Check the scope of coverage:

It is very essential to check the scope of coverage of the health insurance policy you buy as it contains details related to specific inclusions and exclusions within the policy like pre- and post-hospitalization coverage, COVID-19 coverage, day-care treatment, etc.

You can evaluate the best health insurance in India by comparing their scope of coverage and select the health insurance policy which offers limited exclusions or specific exclusions that you want an insurance provider to cover in a policy you buy. 

Example, few health insurance policies have exclusions for maternity and pregnancy which a newly married couple may not want to be excluded from their policies.

• Check the sub-limits for specific diseases:

The health insurance policy might have sub-limits on certain treatments. A sub-limit means the insurance provider will provide partial coverage for treatment of a predetermined illness, even though your sum assured is higher than the total cost of treatment.  

For example, if a policy has a 50% sub-limit on cataract treatments, then irrespective of your claim amount being under the total sum assured limit, the settlement amount will be for 50% of the cost of treatment.

You can evaluate the best health insurance in India by comparing the predetermined medical treatments they cover under a sub-limit clause and select the health insurance policy which has no sub-limit for specific diseases you want a full medical coverage.

• Check the waiting period for specific diseases: 

Health Insurance policies don’t cover you against all illnesses from day one. For a few predetermined diseases, you need to wait a particular period (days/months/years) to be eligible to raise a claim for treatment. 

For example, a health insurance policy may have 2 years of waiting period for any treatment of cancers, so if the person insured is diagnosed with cancer a few months after buying a policy, the cost of treatment shall not get covered.

You can evaluate the best health insurance in India by comparing the predetermined medical treatments they cover under the waiting period clause and select the health insurance policy which has no waiting period for it. 

It’s important to note that all Health Insurance providers in India have different scope of coverage, certain sub-limit and waiting period clauses – additional riders can be purchased at the time of taking health insurance to cover the treatment cost for a few predetermined diseases that are in excluded list, have sub-limits or longer waiting periods.

• Check the list of Network hospitals:

Health Insurance companies in India have tie ups with a list of national and international hospitals for providing cashless medical treatments to the policyholder.

You can evaluate the best health insurance in India by comparing the network hospitals that have tie ups with the Health Insurer and select the policy having a long list of network hospitals, including prominent medical facilities. Also, make sure that you have hospitals in your vicinity in the network hospital list.

• Check the room rent limit: 

The room rent limit is the maximum amount an insurance provider would cover on the hospital room booked during the medical treatment. It is mentioned either as an amount or as a percentage of the sum insured on the policy documents. It’s important to note that these limits have a direct effect on the premium charged, coverage offered, and the claim settlement amount. 

You can evaluate the best health insurance in India by comparing the room rent limits of different insurance providers for the premiums they charge and select the health insurance policy which offers the highest limit at lowest possible premium.

• Buy any additional riders wisely:

Additional riders help in enhancing the scope of coverage of a health insurance policy. However, you should buy these add-ons only after reviewing the main policy documents as most often new buyers purchase add-ons which are already covered in their health insurance policy. 

You can evaluate the best health insurance in India by comparing the add-ons and its cost offered by different insurance providers and select the health insurance policy which offers more relevant add-ons as per your insurance needs.

• Comparing customer service and online reviews:

It’s difficult to evaluate the quality of customer service before you have purchased a health insurance policy. You may view the ratings and read reviews of the customer service experience on the internet for any Insurance company, however that does not guarantee a good customer service.

Hence, it’s recommended that you buy a health insurance policy from an insurance agent or advisor who can be your point of contact for most of your customer service requirements and also guide you in choosing the best health insurance in India.

Below is the list of best health insurance in India that are evaluated based on above parameters:

Conclusion:

After knowing the difference between a Mediclaim policy and Health Insurance policy and how to evaluate the best health insurance as per your insurance needs, you should be able to select a health insurance that matches your needs. However, if you would need more assistance you can count on our expert advisory.