Mediclaim vs health insurance

Difference between Mediclaim and Health Insurance - Mediclaim covers hospitalization expenses, whereas health insurance offers comprehensive coverage including OPD, preventive care and critical illness benefits for comprehensive financial protection.
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Mediclaim vs health insurance
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3 min
09-May-2025

Thinking about getting health coverage? It's easy to mix up mediclaim and health insurance, but they actually have some key differences, especially when it comes to what they cover and how much they cost. If you're looking to buy a medical insurance plan, understanding these distinctions is super important so you can pick the one that really fits your health needs. Let's dive into what sets health insurance apart from mediclaim to help you make the right choice.

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.

Check the difference: Mediclaim vs health insurance

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

Features

Health insurance

Mediclaim
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.

What are the benefits of Mediclaim Insurance Policy

Know the benefits of mediclaim and health insurance in detail.

Benefits of mediclaim

  • Shielding finances: Mediclaim protects you from the high costs of hospitalization, surgeries, and medical care.
  • Hassle-free cashless care: Get treated at network hospitals without upfront payments; the insurer handles the bills directly.
  • Comprehensive coverage window: It covers expenses before (around 30 days) and after (around 60 days) hospitalization, effectively managing total medical costs.
  • Tax savings: Enjoy tax deductions on your premium payments under Section 80D of the Income Tax Act.

Benefits of health insurance

Here are the benefits of health insurance:

  • Wide-ranging coverage: Protects against a broad spectrum of medical costs, including hospitalization, outpatient care, diagnostics, maternity, and critical illnesses.

  • Focus on prevention: Often includes benefits like vaccinations and check-ups to promote early detection and better health.

  • Financial security for major illnesses: Provides crucial coverage for critical illnesses, offering financial stability during serious health challenges.

  • Continuous protection: Typically renewable, ensuring uninterrupted coverage for ongoing peace of mind.

Pro Tip

Avail hospitalisation and treatment benefits with health insurance plans starting at just Rs. 15*/day.

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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.

Mediclaim vs. health insurance in India: Which one should you choose?

Deciding between mediclaim and health insurance in India requires understanding their core differences. Many people wonder, is mediclaim and health insurance same? While both offer financial aid for medical expenses, mediclaim primarily covers hospitalization costs. Health insurance, on the other hand, provides broader protection, including pre and post-hospitalization, daycare, and sometimes even critical illnesses. 1 Your specific healthcare needs, budget, and risk tolerance will determine the ideal choice for you.

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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.

What is the fundamental difference between health insurance and medical insurance?

While often used interchangeably, the core distinction between health insurance and medical insurance lies in the breadth of coverage. Medical insurance, often represented by mediclaim policies, primarily focuses on covering hospitalization expenses. Health insurance, conversely, typically offers a more comprehensive scope, extending to costs beyond hospitalization, such as pre and post-hospitalization care, daycare procedures, outpatient treatments, preventive services, and potentially critical illness coverage, thus providing a more holistic financial shield for diverse medical needs.

For tax benefits under Section 80D, is health insurance superior to mediclaim?

No, for claiming tax deductions under Section 80D of the Income Tax Act, neither health insurance nor mediclaim holds an inherent advantage. Both types of policies qualify for the same maximum deduction limits on the premiums paid. The actual tax benefit realized depends on the premium amount paid, subject to the stipulated limits, rather than the specific type of policy.

Can you outline the general categories of diseases typically covered under health insurance and mediclaim policies?

Mediclaim policies generally cover expenses related to hospitalization due to illnesses, accidents, or injuries, including surgery, room charges, and doctor's fees during the hospital stay. Health insurance policies typically encompass these conditions and often extend coverage to a broader spectrum, potentially including critical illnesses, chronic diseases, infectious diseases, mental health conditions, and sometimes maternity care and alternative treatments, though the specific diseases covered are detailed in the individual policy documents.

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