Mediclaim vs health insurance

Know what makes health insurance different from mediclaim.
Mediclaim vs health insurance
3 min

Many people assume that mediclaim and health insurance are similar, but it is not. There are some differences in terms of coverages offered and premiums. If you are planning to buy a medical insurance policy, it becomes imperative to know the difference between these two types of policies.

Here is a detailed guide on what makes health insurance different from mediclaim. This will help you choose the best insurance policy that meets your medical needs.

What is a mediclaim insurance policy?

Mediclaim insurance provides financial coverage during medical emergencies. It is a pocket-friendly option, where you can receive monetary assistance only up to a particular amount to cover the expenses of in-hospital care. You can raise a claim to avail of the benefits of this policy (mediclaim insurance) during hospitalisation and when suffering from certain diseases.

What is a health insurance policy?

A health insurance policy provides coverage for a wide range of medical expenses. These include hospitalisation charges, consultation fees of doctors, accident, and surgery costs. You also get coverage for pre-and post-hospitalisation expenses and treatment of a variety of illnesses. This makes it more expensive when compared to mediclaim.

Also read: What is health insurance?

Check the difference: Mediclaim vs health insurance

Here is a quick read on the difference between health insurance and mediclaim:


Health insurance


Coverage offered Offers comprehensive coverage for hospitalisation charges, pre-and post-hospitalisation costs, ambulance expenses, and so on. Also, you can claim compensation if there is a loss of income after an accident-caused disability. This plan covers the hospitalisation bill incurred during in-hospital treatment for accidental injuries and certain other pre-existing diseases.
Flexibility to customise the policy You have the complete flexibility of increasing the policy coverage amount as per your need. You can avail of benefits like a cumulative bonus to increase the sum insured. Also, you can customise the policy as per your medical needs by adding coverages. There is no flexibility in changing the coverage amount. You will only receive financial coverage of up to the pre-set amount.
Add-on coverage options You can add add-on covers to the policy such as personal accident cover, critical illness cover, maternity cover, etc. You do not have the option of adding riders/add-on covers to this plan.
Critical illness cover Covers the treatment of certain critical illnesses such as cancer, kidney failure, and so on. You will not be able to claim coverage for treatment of critical illnesses.
Number of claims limit You can claim multiple times till the sum insured amount exhausts. Also, you can receive a lump sum payment in case of accidental disability. However, number of claims allowed depends on the insurer’s terms and conditions. You have the option of filing multiple claims till the insured amount is remaining.
Hospitalisation requirement It is not mandatory to get hospitalised to receive the health insurance benefit. It becomes mandatory to get hospitalised if you want to receive the mediclaim amount.
Premium charge It is high for a health insurance policy as you get extensive coverage. The premium amount is low for the mediclaim policy due to the relatively limited coverage offered.

Advantages of mediclaim and health insurance

Know the benefits of mediclaim and health insurance in detail.

Benefits of mediclaim

  • Coverage for medical and hospitalisation expenses.
  • Cashless mediclaim facility, wherein the insurer pays the sum insured directly to the network hospital.
  • Reimbursement claim settlement as well if you get your treatment at any of your preferred hospitals.

Benefits of health insurance

  • Comprehensive coverage for medical expenses.
  • Hospitalisation, pre-and post-hospitalisation expenses coverage.
  • Coverage for other medical expenses like diagnostic tests, doctor’s fees, ICU charges, room rent, and more.
  • You can avail add-on covers like critical illness cover, maternity cover, hospital cash cover, and more on comprehensive health insurance.
  • Cashless and reimbursement claim settlement.

Also read: Best health insurance plans

Top factors to check before you buy a mediclaim plan in India

available in India. Here are some factors you must consider before buying a mediclaim or health insurance:

• Plan type:

There are various types of mediclaim plans available in the market. Each of them is associated with different inclusions and conditions. Hence, make sure to check what health insurance covers before purchasing.

• Sum insured:

Most of the time, there is a pre-set sum insured that you cannot alter afterwards. So, before purchasing these plans, determine the coverage that you might need on facing unforeseen financial circumstances after a medical emergency.

• Network hospitals:

Check the reputation of the network hospitals and whether they offer good medical facilities. This ensures that you receive best-in-class treatment and consultation from certified doctors when needed. Also, know the list of hospitals nearest to you.

• Policy term:

Look for how long is the policy offered. You may choose the policy based on the policy term, as different policy terms have different premiums. So, choose the one that fits your budget. Choosing a long-term health insurance policy will keep you from frequently renewing the policy.

• Claim settlement:

Know the claim settlement process beforehand to understand what you need to do to avail the benefits. There are two kinds of claim settlement: cashless claim and reimbursement claim. Choose an insurer that offers a smooth claim settlement process. This will save you from the hassle of running around for documents and other processes during medical emergencies. Also, check the claim settlement ratio in health insurance of the insurer to stay informed about how easy it is to get the benefits of the policy.

• Discounts on renewal premium

The insurance companies offer a No Claim Bonus (NCB) to policyholders if not made any claims during the policy tenure. You can gain up to 50% NCB if you have five consecutive claim-free years. This NCB translates into a discount offered on renewal premiums, reducing the health insurance cost.

• Copayment clause

Most insurers offer a copayment option. This means if opted for the copayment, the policyholder will have to pay a portion of the claim amount during claim settlement. For example, if agreed to copay 20% of the Rs. 2 lakh sum insured, the policyholder has to pay Rs. 40,000 while claim settlement, and the remaining amount, the insurer will pay. Copayment also affects the premium. The higher the copayment, the lower the health insurance premium.

Which is better, health insurance or mediclaim?

Both mediclaim and health insurance policy help in mitigating health-related risks. A mediclaim comes at an affordable price than a health insurance policy, as the latter offers extensive coverage. So, select the one that fits your budget as well as provides the best protection for your family.

With insurers offering health insurance policies online, buying one has become easy and convenient. Visit the preferred insurer’s official website and search for the health insurance policy that you wish to buy. You can visit the Bajaj Finance Insurance Mall to compare and buy from a range of health insurance policies offered by leading insurers in India.

Some related articles to read

Types of Health Insurance

Claim Settlement Ratio

Waiting Period of Health Insurance

Co-pay in Health Insurance

Mediclaim policy

Health insurance tax benefit

Compare Health Insurance

Lifestyle Diseases

Medical Reimbursement


Frequently asked questions

Which is better, health insurance or a mediclaim policy?

Health insurance and mediclaim policies both give coverage against medical expenses. You get coverage for hospitalisation and treatment expenses. The range of coverages offered, and the sum insured makes mediclaim and health insurance different. Health insurance policies offer comprehensive coverage. You get coverage for pre-and post hospitalisation expenses, room rent, doctor’s fees, medicines, and more. You can avail of add-on covers to enhance your health insurance policy. You do not get these add-on benefits on the mediclaim policy. Therefore, choose a health policy based on your medical requirements and budget.

What are the benefits of mediclaim and health insurance?

Here are the benefits of a mediclaim policy:
1. Get immediate coverage for medical expenses when hospitalised.
2. You can apply for cashless, or reimbursement claim settlement.

Here are the benefits of a health insurance policy:
1. Get comprehensive coverage for hospitalisation, and pre-and post-hospitalisation expenses.
2. Covers modern and traditional treatment methods.
3. Avail add-on covers like critical illness cover, maternity cover, hospital cash cover and more.
4. Avail of cashless treatment or apply for reimbursement claim settlement.

Why choose a mediclaim policy?

A mediclaim policy offers coverage for medical expenses incurred during hospitalisation due to illness or injury. It provides financial protection in case of any unexpected medical emergencies that can lead to a significant outflow of cash. You can opt for cashless treatment at any of the network hospitals or pay for your medical bills and get medical reimbursement.

What is covered by health insurance?

Health insurance provides coverage for medical expenses incurred due to illnesses or accidents. This includes hospitalisation expenses such as room rent, ICU charges, doctor's fees, surgical costs, pre-and post-hospitalisation expenses, ambulance charges and other medical expenses. Some health insurance also covers maternity expenses, pre-existing illnesses, and critical illnesses, among others.

Is having a mediclaim necessary?

Having a mediclaim policy is not mandatory but is highly recommended as it provides financial protection in times of medical emergencies. With the rising costs of healthcare, a mediclaim policy helps prevent the depletion of one's savings in case of a medical emergency. In addition, it ensures that you get the best possible medical treatment without worrying about the high costs.

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