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Mediclaim vs Health Insurance - Find the Best One for Self

Published On Apr 15, 2019, Updated On Jan 04, 2022

The significance of health insurance cannot be emphasised much. In today’s time, it is important for every person to think about their financial security during a medical emergency. The best way to do so or to survive the already stressful situation without any futher pressure is to invest in health.

Are you too in search of a health insurance plan? Have you recently came across a great mediclaim policy online?


Are you assuming both to be one and the same? If that’s the case, you are at mistake. HEALTH INSURANCE AND MEDICLAIM POLICY ARE TWO DIFFERENT TERMS!

While many people use mediclaim and health insurance interchangeably, the fact is that the two words are completely distinct. This is one of the most common mistakes made by Indians when looking for a health insurance plan that suits their medical requirements.

Now that it’s clear that mediclaim and health insurance are NOT SYNONYMS, let’s uncover the mediclaim policy and health insurance difference in detail.

Mediclaim Policy
​Mediclaim insurance is an insurance kind that provides specific financial protection against health-based expenses. In other words, a mediclaim health insurance offers insurance coverage against hospitalisation & treatment expenses, owing to specific diseases or an accident. The rest of the expenses are to be borne by the insured.

An absolutely affordable way to dial down health-related expenses, a mediclaim policy possesses features such as:

  • A pre-decided sum assured.
  • Purchase of plan on an individual or family floater basis.
  • Exemption of tax according to Section 80D of IT Act 1961.
  • Claim settlement either in the form of reimbursement or cashless treatment.
  • Insurance coverage against hospitalisation & treatment expenses, owing to an accident and specific diseases.
  • Formulation of premium based on sum insured, proposer’s age, gender, geographical location, and preferred plan’s opted duration.

Health Insurance Policy
Health insurance plans provide the insurer with coverage for medical and surgical expenses. Note that in health insurance, either the insurance company settles payment for such expenses directly with the hospital or the insured pays the bills and is later reimbursed the amount. That said, let’s uncover the features that a health insurance plan in India comprises. 

The list includes:

  • Tax benefit under the Section 80D of Income Tax Act.
  • No claim bonus, which is a discount in premium that the insured gets upon the time of renewal after the end of a claim-free year.
  • Comprehensive insurance coverage, which comprises critical illness Insurance (a rider that can be opted for. Doesn’t come as a part of the basic health plan) for multiple illnesses.
  • The option of co-payment. However, there are only a few policies that support it. As far as the benefit of co-payment is concerned, know that it helps in minimising the insurance premium.


When it comes to the mediclaim and health insurance difference, there are many other than the offered coverage. To have a better understanding of the basic and the most important dissimilarities, let’s take a look at the below mentioned points:

  • Add-on coverage

Mediclaim:- No add-on coverage.

Health Insurance:- Critical illness coverage, personal accident coverage, maternity coverage, accidental disability coverage, and others are offered to increase insurance coverage.

  • Flexibility

Mediclaim:- No flexibility.

Health Insurance:- Allows the insurance buyers to not only minimise their premium amount after a certain period, but also change the duration of policy. Also, insurance buyers can opt for availing long-term policies to reap maximum insurance benefits.

  • Sum Assured

Mediclaim:- The amount is usually low.

Health Insurance:- Offers large-scale coverage as the sum assured can go up to Crores.

  • Critical Illness Cover

Mediclaim:- No coverage.

Health Insurance:- Offers coverage for numerous critical illnesses like kidney failure, stroke, cancer, and others.

  • Plan Features

Mediclaim:- Depend on the insurance provider as different providers offer different coverage.

Health Insurance:- Features and benefits of a plan of a specific sum insured are generally same over most insurance providers.

  • Claims

Mediclaim:- The policy holder can keep making claims until the entire amount is exhausted.

Health Insurance:- A policy with critical illness or accidental disability cover, the sum assured is paid in one go. However, note that claims like such can be only made once during the entire policy duration or during the policy tenure. Other than the same, the insured individual can file claims as long as the sum insured doesn’t get exhausted.

  • Hospitalisation

Mediclaim:- It is important to get hospitalised in order to avail mediclaim benefits.

Health Insurance:- Not necessary to get hospitalised. Without getting hospitalised, you can avail benefits such as daycare procedure.

The Conclusion

Now, that the mediclaim and health insurance difference is clear to you, are you ready to make the best possible insurance decision?

If all set to make a worthy health investment, go ahead and analyse your insurance expectations in the first place. Comparing different insurance plans, whether mediclaim or health insurance according to your precise requirements would also be of significant importance.

The understanding of mediclaim vs health insurance concept is a must. The two may be different tools to cushion the health-based risks, but they fit the diverse needs of different insurance buyers in an unmatched way.

So, get started with the selection process without further ado!

Make sure your health investment is the ideal one!

Also Read

Cashless Mediclaim Policy - How Does It Work?

Challenges to Cashless Mediclaim Plan

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