Mediclaim vs Health Insurance : What Is The Difference Between Mediclaim Policy And Health Insurance Policy?


5 min read

Mediclaim policy and Health Insurance policy are the two terms that are often confused with each other. In layman’s words, they are both related to medical insurance that provides financial coverage to the policyholders at the time of a medical emergency. Despite this resemblance, some major factors highlight the differences between them. Let us compare mediclaim vs health insurance.

What is a Mediclaim Policy? 

A Mediclaim Policy is a kind of health insurance that covers the insured members, financially in case a medical emergency arises. The policyholders can either choose for reimbursement or direct bill settlement of the expenses incurred on the hospitalization due to accident, critical illnesses, or surgeries. 

Benefits of a Mediclaim Policy

  1. In the case of hospitalization, the expenses incurred can be claimed immediately. 
  2. Direct bill Settlement facility is available on cashless policies by the mediclaim insurance company. 
  3. A reimbursement facility is available according to the type of plan you choose. 
  4. Affordable premiums are applicable in comparison to health insurance policies.

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What is a Health Insurance Policy?

Health insurance meaning is an insurance policy that provides wider coverage to its policyholders when he/she is stuck in a medical emergency. The comprehensive coverage offered under a health insurance policy can include much more than just hospitalization expenses, like coverage for critical illnesses, alternative treatments, daycare procedures, and others. 

Benefits of a Health Insurance Policy

  1. The policy offers comprehensive coverage with several add-ons. 
  2. Covers the pre-and-post hospitalization charges of the insured, apart from the hospitalization costs.
  3. Numerous policies are available to suit the requirements of all, be it senior citizens or your entire family. 
  4. The policy allows you to choose for extra coverage regarding maternity benefits, outpatient benefits, and critical illness coverage.

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Mediclaim vs Health insurance : Mediclaim And Health Insurance Policy Difference

Let’s see this table to understand the difference between Mediclaim and Health insurance policy:

Difference In Mediclaim  Health Insurance
Coverage  Provides coverage on hospitalization charges of the insured. Can also cover critical illnesses up to a certain limit. Provides comprehensive coverage to the insured and bears the expenses of in-patient hospitalization, outpatient charges, medical tests, etc.
Pre & Post hospitalization charges Does not cover. It covers the expenses, depending on the type of plan chosen.
Ambulance charges  Does not cover It Covers ambulance expenses up to a certain limit.
Daycare procedure Does not cover 

(Mediclaim only covers for the hospitalization charges, thus will not bear the charges of daycare procedures)

Covers for the patient’s daycare treatments like cataract surgeries, maternity-related treatments, diagnosis, etc.
Co-payment facility  Not permitted  Permitted 
Cost and Benefits  With lesser benefits offered, Mediclaims are available at low costs. Mediclaims generally provide coverage up to INR 5 lakhs.  Health Insurances offer wider coverage under comprehensive plans and demand higher premiums with increased S.I options.
Number of Claims allowed  Under a Mediclaim policy, you can make numerous claims in one policy year until the limit of sum assured, exhausts. Generally, a Health Insurance policy allows you to make only one claim per year.
Flexibility  Rigid plans with almost no variety or customization  Numerous health insurance plans are offered to suit the requirements of all with additional features and extra benefits.

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What should I invest in Mediclaim Insurance or Health Insurance?

You have now seen that both Mediclaim Insurance and Health Insurance have their own pros and cons. Therefore, you should analyze your budget, requirements and the number of members to be insured, before investing in either of them. 

If you are someone who cannot spend much on premiums but also does not want to overlook your family’s health, then opting for a Mediclaim can be a good choice. However, if you want wider coverage for your loved ones and afford the premium costs, then you should go for a suitable Health insurance policy. So, apart from your financial condition, there are certainly other factors that you can keep in mind before making a choice:

  1. If your and your family’s medical history  has been healthy, you may consider a Mediclaim 
  2. Also, keep in mind their age and stage. Elderly people, women planning a family, individuals working in a risky environment would need better coverage
  3. Whether you wish to make a short term or long term investment
  4. Flexibility and freedom to customize is available only in a health insurance policy
  5. Mediclaim policies have a lower premium


There are certain basic differences between mediclaim and health insurance, nevertheless, both of them will stand out for you financially when you are in a medical emergency. Whether you invest in a Mediclaim or a Health Insurance policy, it is important that you at least have some source to cover your expenses in an unfortunate situation. After all, an emergency can never be predicted, and in such a situation you would have to dig into your savings unless you have a strong backup plan.

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FAQs: Mediclaim vs Health Insurance

Which is better health insurance or mediclaim?

Should You 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 plans provide extensive insurance protection.

Is mediclaim insurance and health insurance same?

A medical insurance policy will only pay for inpatient care. Up to a certain extent, it might cover the treatment of particular illnesses. Contrarily, a health insurance policy has a wider scope.

Is mediclaim policy good?

Protection from medical debt is offered by Mediclaim insurance. At network hospitals, you can use the cashless payment option. Both individuals and families are eligible for Mediclaim. On the yearly premium, it offers tax advantages.

Is mediclaim necessary?

Additionally, the cost of healthcare has generally been increasing at a rate of 15% per year. Therefore, having mediclaim insurance to cover any unforeseen or anticipated medical needs is essential, as purchasing a health cover is always a lot less expensive than blowing through all of one's savings on treatment.

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Sep 15, 2021
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PayBima Team
PayBima is an Indian insurance aggregator on a mission to make insurance simple for people. PayBima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. PayBima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.

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