Difference between Mediclaim and Health Insurance


Difference between Mediclaim and Health Insurance

How is Health Insurance Different from Mediclaim Policy?

One of the most common mistakes a person believes that a mediclaim policy and a health insurance policy are alike. It’s high time to address the issue and understand the difference between Health Insurance and Mediclaim.

What is a Health Insurance Policy?

A health insurance policy is an indemnity-based insurance plan that offers comprehensive coverage for emergency or planned hospitalization along with several distinct benefits. It includes in-patient hospitalization, ambulance costs, pre and post-hospitalization expenses, daycare treatments, OPD expenses, COVID-19 hospitalization, and more. Additionally, no claim bonus, lifelong renewability, automatic recharge, annual health check-up, organ donor cover, second opinion, etc., are also part of the policy coverage. A cashless claim facility at network hospitals is one of the seamless benefits of a health insurance policy. Moreover, reimbursement claim settlement is also available if the policyholder opts for non-network hospitals. You can also increase the policy coverage with exclusive add-ons like reduction in wait period, co-payment waiver, international second opinion, and care shield. There are different types of individual, and family floater plans that you can choose as per your and your family's healthcare needs. You can get these plans at a low premium with special online discounts.

What is Mediclaim Policy?

A mediclaim policy is a health insurance policy that offers coverage for expenses incurred by a person during a medical emergency, including hospitalization and treatment due to critical illness, surgery, or accident. However, its premium is slightly higher, but it provides lifelong coverage for various life-threatening diseases, including cancer. Moreover, it also covers the expenses for chemotherapy and radiotherapy along with organ donor cover. These plans are available monthly and quarterly installment basis with multi-year policies of 2 or 3 years.  You can earn the reward of no claim bonus for your good health for every claim-free year. Cashless hospitalization and reimbursement claim settlement both are available under the mediclaim as per the policyholder's preference. Individuals who have a history of diseases like cancer, heart attack, etc., should opt for mediclaim.  Moreover, you can also get it as an additional health cover to stay protected from the exorbitant treatment costs of critical illnesses.

To summarise, a mediclaim policy limits itself to just the hospitalization expenses. In contrast, health insurance is an all-inclusive insurance policy that offers a wide range of coverage and value-added benefits.

Comparison Between Health Insurance and Mediclaim (Mediclaim Vs. Health Insurance)

Here are a few main points of comparison between health insurance and Mediclaim policy:

Factors Mediclaim Health Insurance
Basic Definition Mediclaim is a type of insurance that covers only hospitalization-related expenses up to the sum insured. Health insurance is a type of insurance that provides comprehensive coverage for medical costs and surgical expenses beyond more than hospitalization.
Coverage Offers cover for hospitalization and treatment expenses incurred due to an accident, surgery, or illness Offers comprehensive coverage for various expenses like Ambulance, Pre and Post-Hospitalization, Diagnostic Tests, Day Care Treatments, OPD Expenses, Critical Illnesses, Maternity Expenses, Alternative Treatment, etc.
Add-on cover Mediclaim offers optional benefits such as deductible, reduction in PED wait period, room rent modification, etc. Health plans provide add-on covers like OPD cover, COVID Care, Care Shield, global coverage, international second opinion, etc.
Sum Insured The sum insured depends upon the type of plan you want to choose.  The sum insured can go upto six crores, per year and varies as per the plan.
Claims A Mediclaim policyholder can go for cashless or reimbursement claim settlement.  Under health insurance, policyholders can file  claim on cashless or reimbursement basis.
Flexibility With limited coverage, mediclaim policies are not considered as flexible policies, but they are highly beneficial when it comes to critical illness, heart ailments, etc. Health insurance policies are highly flexible as it gives policyholders the option to customize their plans like selecting the higher sum insured, add-on covers, etc.  

How Does Health Insurance Score Over Mediclaim Policies

Mediclaim policies are often very restrictive but can come in handy during emergencies like hospitalization due to accidents or ailment. However, since health insurance offers 360-degree coverage, most experts recommend having a Health insurance plan. Such plans are designed to keep all the healthcare requirements of an individual in mind. It accommodates coverage from the very start of any health issue. So, on assessing the benefits of mediclaim vs health insurance plans, it is clear that a health plan has many added benefits and features, some of which are listed below.

Domiciliary Hospitalization: If required or suggested by the doctor, you can go for domiciliary hospitalization which is covered in health insurance but not in mediclaim.

Annual Health Check-Ups: The best part of health insurance is that you can go for an annual health check-up once right from the first year. But in mediclaim, it starts from the second year of the policy. 

Coverage: The amount of coverage or sum insured is less in mediclaim. Whereas, in health insurance, you can choose up to 6 crore sum insured. 

COVID-19 Cover: Health insurance covers coronavirus hospitalization and treatment cost. Mediclaim does not cover COVID-19 treatment expenses.

Add-Ons: You can increase the health insurance policy coverage while opting for add-ons like global coverage, international second opinion, Care Shield, reduction in PED wait period, no claim bonus super, etc.

Daily Allowance: Health insurance also offers a daily allowance add-on in which you will get coverage for non-medical expenses such as food, transportation, etc., which you will not get in mediclaim.

Co-payment Waiver: If the age of the insured member is 61 years or above, you can get rid of the 20% co-payment by opting for this add-on. It is not applicable in mediclaim.  

Insurance suppositions can be different from one another. An insurance plan that works for one family might not work for another. For this very purpose, there is a wide range of plans that can be tailored to suit different people with different health problems. It is a significant difference between health insurance and mediclaim where one can customise a health plan as per individual needs. 

Care Health Insurance resolves to offer a solution for customers from all walks of life. Our comprehensive Health Insurance provides the exclusive benefits and features that help policyholders to avail of the best posisble treatment during a medical emergency.

Cashless Mediclaim Policy for Family in India

Mediclaim offers its customers two claim settlement options - reimbursement and cashless. Policyholders can avail of the cashless treatment across any hospital empaneled in the insurer's network. Simply put, a cashless Mediclaim policy is one where the expenses are directly settled with the healthcare institution, subject to policy terms and conditions. It is beneficial, as it reduces the direct financial load on that particular individual at the time of hospitalization. For the customer, this is highly convenient. For a hassle-free experience, one should intimate the insurer post-admission within the specified time, which is 24 hours in case of emergency hospitalization. Apart from this, one should read all key policy terms and conditions and keep their health card handy as it must be presented in the hospital.

However, if an individual at the time of emergency wishes to go-ahead with their treatment in a hospital of their choice and which is not in the insurance company's list - they can still claim. In this case, they will have to bear the hospital expenses from their pocket and file for reimbursement after getting discharged.

How Does Mediclaim and Health Insurance in India Work?

Though mediclaim policies are beneficial when it comes to meeting hospitalization expenses but it is health insurance policies that have the edge over mediclaim plans, given the wide range of features available. The following features are unique to a Mediclaim policy and define the way it works in India.

  • Cover Offered: Mediclaim policies offer specific coverage such as hospitalization expenses cover and cost cover for accident-related treatment and certain diseases.
  • Group Mediclaim: Just like Health Insurance, a Mediclaim policy also offers a family health insurance plan, which means one could cover multiple family members like parents, spouses, and children in a single policy. A Group Mediclaim is a type of Mediclaim policy wherein the coverage is extended to a group of people, for example, employees of an organization.
  • Premium and Sum Insured: Mediclaim policies usually have a predefined sum insured. The policy premium is calculated on the basis of factors like sum insured, gender, proposer’s age, treatment location, and policy duration.
  • Claim: The claim settlement is generally in the form of reimbursement of the hospitalization expenses by the insurance company.
  • Tax Advantages: Such plans offer a tax rebate on the premium paid under section 80D of the Income Tax Act.

Health insurance plans are the most widely preferred insurance plans in India owing to the comprehensive nature of coverage offered by them. Listed below are some exclusive features that explain how they work in India:

  • Cover Offered: Health policies offer complete coverage for various medical exigencies such as critical illness, pre-existing diseases, etc.
  • Family Cover: Family floater plans offer health insurance coverage for the entire family parents, spouse, and children.
  • Tax Benefits: Health insurance buyers can get tax deductions under section 80D of the Income Tax Act on the premium they pay for a policy.
  • Cashless Hospitalisation: This feature enables an insured person to avail cashless Mediclaim treatment in any of the network hospitals of the insurer, thus providing a high level of convenience.
  • Co-payment Option: Some senior citizen health insurance plans have a co-payment option, requiring the policyholder to bear some medical costs. Buyers can look forward to lower premiums.
  • Discounts and no-claim bonus: Health plans bring a variety of additional benefits generally offered during policy renewal in the form of premium discounts and higher sum insured as a bonus for having a claim-free year.

Which Policy Should You Buy Health Insurance or Mediclaim?

Mediclaim and health insurance policies both cover unexpected hospitalization costs that may arise due to sudden injuries, accidents, or illnesses. But, consider these factors before you decide which policy you should buy:

  • Choose the policy as per your financials so that premium won't burden you later
  • Pick the policy as per your family past medical history or pre-existing disease
  • Duration of the policy, whether it should be for 1/2/3 years
  • Customization available in the coverage as per the healthcare needs
  • Add-on benefits to increase the policy coverage
  • Coverage for COVID-19 hospitalization and treatment expenses 
  • Check the eligibility of buying the policy with lifelong renewability 


Given the marked difference and benefits of mediclaim vs health insurance, it might be confusing when deciding between buying a mediclaim and opting for a health insurance policy. The best way to know which health coverage is best for you and your family is to assess healthcare needs. Some factors to keep in mind include one’s financial situation, and the coverage amount required, any ailment you or a family member may be suffering from, age, lifestyle, etc. 

If you are clear about what is mediclaim policy, you would see that it works best if you are looking for good hospitalization cover to help you in times of a medical emergency. However, if you have a family, including a spouse, dependent children, and parents, it is advisable to go for a family floater health insurance with benefits that offer much more than hospitalization cover.

>> Also Read Benefits of Unlimited Automatic Recharge in Mediclaim

Disclaimer: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.

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