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How Is Health Insurance Different From Mediclaim?

Published On Jun 23, 2021 10:00 AM By InsuranceDekho

A Mediclaim and a health insurance policy are often misunderstood as synonyms. But, there is a major difference between the two terms which need to be understood. Certain features of both the plans are different, but ultimately both the mediclaim and the health insurance policy serve a similar purpose, which is to protect the health and secure the future to ensure your quality treatment. 

Both of these plans have different offerings for the policyholders which you should know to choose the best plan for yourself. Both might sound the same but have different benefits for the insured and since it is a matter of an individual’s health, this has to be addressed properly with utmost clarity. 

What Is Mediclaim?

Mediclaim is a type of insurance plan which offers specified financial protection during medical emergencies. This plan is limited to the costs of hospitalization and not the other expenses. The extra charges are to be borne by the policyholder. This is considered to be one of the pocket-friendly ways to get your health secured. 

What Is Health Insurance? 

A health insurance cover includes all the expenses like that of the hospitalization, medical and surgical expenses. In this type of insurance policy, either the insurance company settles the bill with the hospital directly, or the policyholder can pay out-of-pocket, which later is reimbursed in their policy by the company. 

How Is Health Insurance Different From Mediclaim?

Differences Between A Mediclaim And A Health Insurance Policy Features

There are certain features and offers based on which both mediclaim and a health insurance policy can be differentiated. Let us look at how they differ in these two types of health-related policies:

1. Add-On Coverage 

A  mediclaim policy does not offer any add-on coverage.

However, a health insurance policy offers add-ons like critical illness rider, personal accident coverage, maternity coverage, etc. to enhance the quality of policy. 

2. Coverage Offered 

In a mediclaim policy, the coverage is provided only for accident-related treatment, hospitalization, and pre-decided disease treatment. 

But in the case of a health insurance policy, you get comprehensive coverage which includes hospitalization costs, pre and post-hospitalization charges, and ambulance expenses. 

3. Hospitalization 

A patient must get hospitalized to avail of the benefits of the mediclaim policy. 

It is not necessary to be hospitalized for availing the benefits of a health insurance policy as daycare facility charges are available without being hospitalized.  

4. Claim

Insured can file claims until their total amount assured is exhausted in a mediclaim.

In a health insurance policy, claims related to accidental disability or critical illness are paid in a lump sum. Other than that, the policyholder can file their claim as long as the amount insured is not exhausted.

5. Flexibility 

Mediclaim policies are not flexible.

Health insurance policies are flexible and customized. 

6. Assured Amount 

For a mediclaim policy, the sum assured does not exceed Rs. 5 Lakhs. 

Health insurance policy coverage is extensive and cannot exceed Rs. 6 Crores per year.

Benefits Of Mediclaim And Health Insurance Policy 

Mediclaim policy has its own benefits. Let us look at some of them:

  • Immediate coverage from medical expenses when hospitalized 
  • In case of a cashless claim, the insurer directly pays to the linked hospital 
  • In case of reimbursement, the money paid by you is reimbursed by the insurer

Health insurance policies are more comprehensive and customized. They share more benefits than the mediclaim policies. Let us look at some of the benefits offered by a health insurance policy: 

  • Numerous add-ons 
  • The family floater plan covers all the family members in one policy 
  • Pre and post hospitalization expenses are covered 
  • Critical illness cover included 
  • Senior citizen plans and customized plans available 


Both mediclaim policy and health insurance policy, are for the better health and treatment of the policyholder but share different benefits and offers. Based on the above differences and benefits you can make a choice of your own. For choosing between the mediclaim policy and a health insurance policy you can consider factors like budget planning, coverage required, pre-existing diseases, number of family members, etc. 

Must Read: Top Up health Insurance and Mediclaim Policy Cover

Cashless Mediclaim Policy - How Does It Work?

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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