Difference between Mediclaim & Health insurance

5 mins read
by Angel One
Explore the difference between mediclaim and health insurance in this comprehensive guide. Discover the unique features, benefits, and considerations of each, empowering you to make an informed choice for your healthcare financial planning.

In today’s fast-paced world, it’s crucial to have proper financial protection against medical expenses. Two common ways to achieve this are through mediclaim and health insurance. Although many people consider them the same, they differ in the coverage they offer for medical expenses.

In this article, we’ll delve into the meaning of mediclaim and health insurance. We’ll also explore their benefits and compare mediclaim vs health insurance to help you decide based on your needs.

What is Mediclaim?

Mediclaim is a specialised insurance policy designed to protect you financially when it comes to hospitalisation expenses. It’s a cost-effective choice, focusing specifically on covering costs related to being in the hospital. However, it’s essential to know that mediclaim policies only cover hospitalisation expenses, and any additional medical costs will be the responsibility of the insured individual.

Benefits of Mediclaim

Now that you have a clear understanding of what mediclaim is, here are the key benefits associated with it:

  • Health Cover

Mediclaim policies operate on the principle of providing financial assistance during times of hospitalisation and for specific medical treatments. The coverage amount is predetermined, ensuring policyholders have a financial safety net to handle medical costs without excessive financial strain.

  • Easy Claim Settlement

One of the standout features of mediclaim policies is the simplicity and efficiency of the claim settlement process. Policyholders can choose between cashless treatment and reimbursement, streamlining the claims process and making it more accessible and user-friendly.

  • Family Cover Available

Mediclaim policies extend their protective umbrella not only to the policyholder but also to their family members. This inclusive approach allows individuals to cover their spouse, children, and parents under the same policy, providing a comprehensive and cohesive solution for family health protection.

  • Tax Savings

Beyond the direct health benefits, mediclaim policies also contribute to financial planning by offering tax savings. Recognised under Section 80D of the Income Tax Act, investing in a mediclaim policy allows policyholders to reduce their tax liability, presenting a dual advantage of health coverage and financial planning.

What is Health Insurance? 

Health insurance acts like a financial safety net for people and families, helping them handle medical bills. By paying a regular amount, individuals get coverage for various healthcare services, such as hospital stays, daycare procedures, post-hospitalisation costs, ambulance fees, medicines, and preventive care. Policyholders either pay upfront and subsequently receive reimbursement or opt for the cashless mode, wherein the insurance company directly settles the bill with the hospital.

Also Read More About How to Choose Health Insurance?

Benefits of Health Insurance

Before exploring the difference between mediclaim & health insurance, here are the benefits offered by health insurance that you must check:

  • Comprehensive Coverage

A health insurance policy covers various medical expenses, including critical illnesses. This means you get extensive protection for various health conditions.

  • Tax Benefits

Just like mediclaim policies, health insurance plans also offer tax advantages. The money you pay for your health insurance premiums makes you eligible for tax deductions, providing a financial perk while ensuring you have health coverage.

  • Discount on Renewal

When renewing your health insurance policy, you may receive a No Claim Bonus if you haven’t made any claims in the previous policy period. This acts as a reward for maintaining good health practices.

  • Option to Include Riders

You have the flexibility to enhance your health insurance plan by adding riders or extra features. The availability of these additional benefits may vary among insurance providers, allowing you to tailor your policy to meet specific needs.

Also Read More About the Types of Health Insurance

Mediclaim vs Health Insurance

Let’s explore the difference between mediclaim & health insurance through the following table:

Aspect Mediclaim Health Insurance
Offered Coverage Covers hospitalisation, accident-related treatment, and pre-existing diseases up to a specified limit. Offers comprehensive coverage, including hospitalisation charges, pre and post-hospitalization expenses, ambulance costs, and compensation for income loss due to an accident.
Add-on Covers No additional covers are provided. May include various add-ons like critical illness, personal accident, maternity cover, etc.
Flexibility Limited flexibility in coverage adjustments. Offers flexibility to modify coverage, allowing premium amounts and policy duration adjustments. Long-term policies may provide premium discounts.
Critical Illness Does not cover critical illnesses. Covers over 30 critical diseases, such as cancer, stroke, and kidney failure, depending on the policy.
Sum Insured Usually capped at around Rs 5 lakh. The sum insured ranges from Rs 50,000 to Rs 6 crore annually, providing a broader coverage spectrum.
Claims Process Multiple claims are allowed until the total insured amount is exhausted. Continuous claims can be made as long as the sum insured isn’t depleted. Critical illness/accidental disability claims are settled as a lump sum, with a one-time limit during the policy tenure.
Hospitalisation Required for mediclaim benefits. It is not mandatory for health insurance benefits; daycare procedures can be covered without hospitalisation.

Which One is Better Mediclaim or Health Insurance? 

When deciding between mediclaim or health insurance in India, it’s advisable to lean towards comprehensive health insurance for better coverage and added tax benefits. Take the time to explore and compare various health insurance plans from different providers, considering factors such as coverage, services, benefits, and premiums. Finding the right health insurance plan is aligning it with your specific needs and preferences, as everyone’s insurance requirements vary.


To sum up, mediclaim and health insurance are crucial components of financial protection against medical expenses, each offering distinct features tailored to different healthcare needs. Medlclaim excels in providing cost-effective coverage for hospitalisation expenses. At the same time, health insurance takes a broader approach, covering various medical costs and additional benefits like critical illness coverage and policy flexibility. The choice between mediclaim or health insurance depends on individual preferences and requirements.


What does mediclaim insurance specifically cover?

Mediclaim insurance provides financial protection for hospitalisation expenses, accident-related treatments, and pre-existing diseases. This coverage, however, is limited and comes with a predefined monetary limit.

How is health insurance different from mediclaim in terms of coverage?

Health insurance takes a more comprehensive approach, extending coverage beyond hospitalisation charges to include pre-and post-hospitalization expenses, ambulance costs, and even compensation for accident income loss. This broader coverage ensures a more extensive safety net for various healthcare needs.

What are the key benefits of mediclaim insurance?

The benefits of mediclaim insurance include predetermined health coverage for hospitalisation and designated medical treatments. It offers a straightforward claim settlement process through options like cashless treatment or reimbursement. Furthermore, it provides the flexibility of family coverage and the added advantage of tax savings under Section 80D of the Income Tax Act.

Why choose health insurance for critical illnesses?

Opting for health insurance becomes crucial when considering critical illnesses, as it provides coverage for more than 30 such diseases, including significant ones like cancer and stroke. In contrast, mediclaim insurance does not include coverage for critical illnesses, making health insurance the preferred choice for comprehensive protection.

Is there flexibility in adjusting health insurance coverage?

Yes, health insurance offers policyholders the flexibility to tailor their coverage. This can be done through adjustments in premium amounts and policy duration. Long-term policies may even provide the added benefit of premium discounts, ensuring a customisable and adaptable solution to meet specific healthcare needs.