Difference between Mediclaim and health insurance
Health Insurance

Difference between Mediclaim and health insurance


You may have bought the best medical insurance your money can buy. But unless you understand the fine print, all your work is going to go down the drain.Take the case of health insurance and Mediclaim insurance. Ignorance on the part of policyholders about the differences between health insurance and Mediclaim difference can act as a handicap. Even though these terms may sound similar, the health insurance v Mediclaim debate is worth visiting. Here are the basic differences between Mediclaim and health insurance you must know:


When it comes to coverage, Mediclaim only covers hospitalization expenses for certain specified events. It may cover the treatment of specified illnesses to a particular limit but that depends on the policy wording.

A health insurance plan provides comprehensive coverage for any medical treatment requiring hospitalization. This covers pre- and post-hospitalization charges, hospitalization charges, and ambulance charges. Some health insurance plans also offer compensation in the event of loss of income due to an accident.

Add-on covers:

One of the key differences between health insurance and Mediclaim policy is the ability to purchase add-on covers. There are several add-on covers you can get to increase the coverage under your existing health insurance plan. These include coverage for personal accidents, critical illness, maternity, among others. However, no such facility is available for Mediclaim policies.

Critical illness:

Mediclaim policies offer no coverage for critical illnesses, whereas most health insurance plans cover more than 30 critical illnesses, including cancer and kidney failure.

Sum assured:

The sum assured under a Mediclaim policy is capped at INR 5 lakh. But in the case of a health insurance plan, the coverage is decided on the basis of the age of the insured person, underlying illnesses, sex, city where they live, etc. As a result, the sum assured by a health insurance plan can be as high as a few crores.


Another important difference between health insurance and Mediclaim policy relates to how you can raise claims. In the case of a Mediclaim policy, the policyholder has a right to file claims until the total sum assured amount is exhausted. In other words, multiple claims can be raised. But in a health insurance plan, claims related to critical illness or accident disability are paid as a lump sum. Such claims can be raised only once during the tenure of the policy. Apart from these claims, the policyholder can raise claims until the sum insured isn't exhausted.


To get the benefits of a Mediclaim policy, the insured must get hospitalised. However, a health insurance plan can provide coverage for day-care procedures like cataract surgery when the insured isn't hospitalized.


Mediclaim policies offer no flexibility. But health insurance plans can be customised to suit your specific requirements. Apart from changing the policy duration, you can also reduce your health insurance premium amount.

Now that you know the differences, the question is Mediclaim vs health insurance -- which one is a better choice for you. Unfortunately, there is no straightforward answer to this question. You need to decide based on a variety of factors, including:

  • Your financial situation
  • Underlying health issues that you or your loved ones may be dealing with
  • Whether you are looking for flexibility in insurance premium payments
  • Whether you need add-on covers
  • Whether you suffer from any illness that may not require hospitalization but will need treatment nevertheless
  • Whether you are willing to pay a low or high premium

Also bear in mind that compared to a health insurance plan, a Mediclaim is much more affordable. So, if you are faced with a dilemma to choose from Mediclaim vs health insurance, go for a plan that offers you the best protection as per your needs. Make sure that it is an affordable option for you.

Disclaimer: The above information is indicative in nature. For more details on the risk factor, terms and conditions, please refer to the Sales Brochure and Policy Wordings carefully before concluding a sale.

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