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What Is The Difference Between Mediclaim And Health Insurance?

Published On Nov 16, 2022 10:00 AM By InsuranceDekho

Everyone now places a high importance on having health insurance, especially in light of the present COVID outbreak. But mediclaim is frequently confused with health insurance, which is a typical error individuals make. Instead of understanding the distinction between health insurance and mediclaim, people simply purchase the first plan they come across. To know more about the difference between mediclaim & health insurance, read on.

What Is The Difference Between Mediclaim And Health Insurance?

What Exactly Is Health Insurance?

Medical and surgical costs incurred by the insured are covered by health insurance. Either the policyholder must pay these costs out of pocket and then receive reimbursement from the insurer, or the insurance provider pays the network hospital directly. The coverage is typically broader than hospitalisation costs, hence it is typically more expensive than mediclaim insurance.

Following are some primary benefits under health insurance -

  1. Comprehensive Coverage - A health insurance policy offers full protection, including critical illness insurance for a list of specified critical illnesses or medical conditions.
  2. Riders - The presence of riders allows you to increase the advantages of a health insurance plan. Various insurers may provide different versions of these riders.

What Exactly Is Mediclaim Insurance?

A form of insurance policy known as "mediclaim insurance" provides specific financial protection against medical bills. It is a cost-effective method of reducing any medical emergency. However, the mediclaim insurance coverage is just for hospitalisation; the insured is responsible for covering all other medical costs.

Following are some primary  benefits under mediclaim insurance -

  1. Simple Claim Settlement - A Mediclaim policy pays claims by providing cashless treatment and payment.
  2. Family Coverage - You may get medical insurance coverage to cover your spouse, children, and parents as well as yourself.

What Are Some Things That One Should Know Before Getting A Mediclaim / Health Insurance Plan?

Following are some of the things that one should know before getting a mediclaim / health insurance plan -

  1. Sum Insured – The plan typically has a predetermined sum insured that cannot be altered prior to renewal.
  2. Factors Affecting Premium - The premium for the plan is determined by the amount covered, the insured's age, gender, location, and the length they have chosen.
  3. Claim Settlement - The claim request is handled by reimbursement and cashless service.
  4. Plan Basis - The plan is available for individual and family floater purchases. The primary beneficiaries of a family floater plan are the self, spouse, children under 18, and parents under 18.
  5. Tax Benefits - In accordance with Section 80D of the IT Act of 1961, the plan provides tax advantages on premium payments.
  6. Renewal Offers - Health insurance often includes a No Claim Bonus bonus at the time of policy renewal following the conclusion of each claim-free year. The renewal premiums may be lowered with the aid of this advantage.
  7. Co-payment – A co-payment can be required for some plans. Due to the insured paying a certain percentage of the treatment costs while the insurance provider covers the remainder, the insurance premium might be reduced.

Should Someone Purchase Health Insurance or a Mediclaim Policy in India?

Insurance professionals advise choosing a health insurance plan even though both mediclaim and health insurance plans qualify for tax benefits under Section 80D of the Income Tax Act. This is so because health insurance policies provide extensive insurance protection. However, look for the health insurance provider in India with the greatest services before selecting the best health insurance plan.

There is no "best" insurance provider or "best" medical insurance plan, nevertheless. Since everyone has different insurance needs, a single plan cannot cover everyone's medical requirements. Similar to how one insurance provider could satisfy one client while falling short for another. The numerous health insurance plans offered by various firms must thus be compared in terms of their coverage, services, benefits, and premium.


In summary, two distinct tools for reducing health-related risks are mediclaim insurance and health insurance. Both are there to meet the purchasers' insurance needs. Knowing the distinction between a mediclaim plan and a health insurance plan can help you decide which one best fits your needs. However, consider your insurance expectations and evaluate several insurance plans that meet them before you purchase a health insurance policy.

Also Read: Is It Advantageous To Add Maternity Riders To My Existing Plan?


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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