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Difference between Health Insurance and Mediclaim

The systematic way to plan things is to first thoroughly know about the subject, research, and then finalize. Now, try applying this logic to buying health insurance. It is always better to know what your plan is and what it has to offer rather than buy the first plan that pops on the screen.

If you don’t know what exactly your health insurance has to offer, it may be of little use to you. It is easy to make mistakes while buying health insurance. One of the most common mistakes people make is assuming that mediclaim and health insurance is one and the same. But both mediclaim and health insurance plans have their own features. Before discussing the difference between health insurance and Mediclaim, let’s look at what mediclaim and health insurance are.

What is mediclaim?

Mediclaim is a health policy that gives you specified financial protection at the time of a medical emergency. It is a cost-effective plan in case of a health emergency. It provides financial aid in the following cases-

  • Accidents
  • In case of sudden illness or surgery
  • Any surgeries during the policy tenure

Features of a mediclaim plan

  • You can get immediate coverage up to Rs 5 lakhs for medical expenses when you are hospitalized for an accident or a specific illness.
  • The sum insured is pre-decided at the time of purchase of the policy.
  • The premium for mediclaim is decided on various factors like the policyholder’s age, gender, and geographical location along with the sum insured.
  • The mediclaim cover can be purchased as an individual plan or as a family plan. The family plan including you covers your spouse, children, and parents.
  • If you opt for a Cashless Mediclaim policy, your insurance company directly pays the hospital for the expenses.
  • If you opt for the Reimbursement mediclaim policy, the money you paid for the expense will be reimbursed by the insurer.
  • You can also avail of tax benefits on mediclaim as per section 80D of the income tax act 1961.

What is health insurance?

Health insurance is a complete insurance cover that gives you coverage for medical and surgical expenses in case of emergencies. If you have health insurance, you can pay for the expenses out-of-pocket for which you are later reimbursed by your insurance company. The insurance company settles the bill directly with the hospital in case of cashless claims.

Features of health insurance

  • Health insurance plans give you comprehensive insurance coverage including a wide variety of illnesses.
  • Health insurance has provisions for numerous add-ons coverage over the original policy.
  • You can opt for a Family Floater Health Insurance plan to cover all family members under one comprehensive policy.
  • The wide coverage of the policy pays for all pre and post-hospitalization expenses which include expenses for an ambulance, testing, MRI, CT scans, etc.
  • You can opt for a Critical Illness cover and other covers as an add-on to the original policy.
  • Health insurance provides you benefits like Outpatient benefit, Maternity Benefit, Restoration benefit, etc.
  • You can opt for a customized senior citizen health plan for your parents.

Difference between health insurance and mediclaim

Both medical and health insurance might sound similar but have many different features. Let’s have a look at some of the differences between these two insurance policies.



Health insurance

Coverage offered

A Mediclaim offers coverage only for hospitalization and other expenses related to accidents and pre-specified diseases.

Health insurance offers a comprehensive cover that not only covers hospitalization expenses but also additional expenses such as annual health checkups, daily hospital cash, OPD expenses, and alternative treatments among others.


There isn’t any provision to inculcate add-on covers with Mediclaim.

Health insurance offers numerous add-ons covers such as Critical Illness Cover, Maternity Benefit and Infertility Cover, etc.

Sum assured

The sum assured or hospitalization cover provided in mediclaim is limited to Rs 5 lakh.

The sum assured in the case of health insurance doesn’t exceed 6 crore rupees.

Flexibility of plans

Terms of mediclaim policy are rigid and cannot be customized.

Health Insurance plans are flexible and can be customized to your preference.


In a mediclaim policy, you can keep filing claims until the sum insured is exhausted

In case of claims related to critical illness accidental disability coverage, the assured sum is paid in a lump sum. Hence such claims can only be made only once during the policy tenure.

Other insurance claims can be filed as long as the sum insured isn’t exhausted.

Availing the benefits

To avail of the mediclaim benefits, the insurer must get hospitalized. 

In the case of claiming health insurance benefits, hospitalization is not necessary. Benefits like daycare procedure cover can also be availed by the insured without getting hospitalized.

So, which one should you choose, mediclaim or health insurance?

Now that we know the benefits and differences between health insurance and mediclaim it should be easier for you to make the choice. If you’re still confused here are some factors that you should consider before buying any of the two health policies.

  • Consider the current health issues that you and your family are dealing with such as blood pressure, diabetes, arthritis, cancer, any other serious illnesses, etc.
  • Consider the age and lifestyle of your family members before opting for any plan.
  • Buy health insurance if you prefer investing for long-term protection and mediclaim if you prefer short-term investing.
  • If you need flexibility in your health plan options, go for health insurance otherwise you can also choose to take up a mediclaim.
  • If you need extensive add-on covers and benefits for your current health conditions, prefer buying health insurance over a mediclaim.
  • Health insurances have a higher premium than mediclaim. Make the decision according to your budget.

Mediclaim and health insurance are both ways of mitigating health-related risks. Before you decide to buy any of the insurance plans, analyze your insurance expectations and compare various insurance policies available in the market. The best insurance plan is the one that fulfils your needs. Use the information to your advantage and choose the plan that suits you better.

Author Bio

This article is written by Team, an independent website that writes about insurance, finance, health, and more. Our writers have a wealth of knowledge, experience, and degrees in the fields of insurance, finance, economics, and beyond.

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