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What is Mediclaim and How Is It Different From Health Insurance?

Published On Mar 23, 2021, Updated On Jan 04, 2022

Health Insurance and mediclaim are two different terms which are often used interchangeably. However, these two are different from each other. The major difference is that mediclaim provides cover to the limit of hospitalization expenses.

However, health insurance is a wider term than mediclaim. If offers a comprehensive cover which extends further than hospitalization expenses.

What is Health Insurance?

Health insurance provides coverage for the cost of medical and surgical expenses incurred by the policyholder. The policyholder either has to pay such expenses out of pocket or can avail reimbursement by the insurance company.

Features of Health Insurance Policy

  • Coverage

Health Insurance policy offers comprehensive Insurance coverage, including various diseases and illnesses.

  • Renewal Discounts

Generally, health insurance policy comes with no claim bonus benefit that means the policyholder can avail benefit at the time of renewal after a claim free year.

  • Co-payment

Some of the health insurance policies available in the market come with a co-payment option by which one can decrease the amount of premium to a certain extent. With this feature you would need to pay some percentage of the treatment expense out of your pocket.

  • Tax Benefits

Under section 80(D) of Income Tax Act, 1956, one can avail tax deductions on the amount paid for premium of health insurance.

What is Mediclaim?

Mediclaim Insurance is a type of insurance that provides coverage for hospitalization expenses. It is considered a pocket friendly way to deal with any health related emergency. The expenses other than hospitalization are to be borne by the insured himself out of his pocket.

Features of Mediclaim

A mediclaim insurance policy provides coverage against treatment expenses and hospitalization expenses due to an illness or disease.

  • Sum Assured

It comes with pre pre-decided sum assured.

  • Claim Settlement

A mediclaim policy can be settled by both the ways, either cashless or reimbursement.

  • Tax Exemption

Under section 80(D) of Income Tax Act, 1956, one can avail tax deductions on the amount paid for premium of mediclaim.

  • Plan Basis

A mediclaim policy can be purchased on an individual as well as family floater basis. Family floater provides coverage for you, your spouse, dependent children and dependent parents.

What is Mediclaim and How Is It Different From Health Insurance?

Difference Between Health Insurance and Mediclaim

Basis Mediclaim Health Insurance
Coverage A mediclaim plan offers coverage for only hospitalization and treatment expenses to a pre specified limit. A health insurance plan offers coverage for hospitalization expenses, pre hospitalization expenses, post hospitalization expenses and ambulance expenses. Also ,it provides compensation in case of loss of income due to an accident.
Add ons Mediclaim policies do not offer any add-on coverage. In order to enhance the insurance coverage health insurance policies provide add-on coverage such as critical illness coverage, personal accident coverage, Maternity cover etc.
Flexibility Mediclaim policies offer no flexibility in terms of coverage. While on the other hand health insurance policies offer much flexibility in terms of coverage .Policyholders can reduce health insurance premium amount after a certain period and can even change their policy duration.
Plan Features Features of mediclaim policy may vary from one policy provider to another. Different insurance companies offer different features on mediclaim policy. In the case of Health Insurance the benefits and features of an insurance plan remain the same over most of the insurance providers.
Sum Assured The maximum limit of the sum insured of mediclaim policies is ₹5,00, 000. Maximum limit of sum insured of Health Insurance is 5 crore rupees.
Claim In case of mediclaim policy one can file a claim until the total amount insured is used. In health insurance, in case of critical illness or accident cover the policyholder receives a lump sum amount from the insurer.
Hospitalization In order to avail insurance benefits in case of medical policy it is compulsory that the insured get hospitalized. While in case of health insurance policy it is not necessary for the insured to get hospitalized to avail insurance benefits.
Critical Illness Cover Mediclaim policy does not provide critical illness cover. Health insurance policy provides critical illness cover.

Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.

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