What makes Health Insurance different from Mediclaim Insurance?

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Archana Singh lives in Bangalore with her family. Since her husband has been diagnosed with borderline diabetes lately, she is now giving a thought to buying a health insurance policy. However, while she was doing her research online on the various options of health insurance policies, she also came across some mediclaim plans. Now she is a little confused if these two are the same or they come with different features.

Many of us think that these two are synonymous and hardly pay any attention to the difference between mediclaim and health insurance. Well, these two may sound similar but are different from each other. So let us discuss mediclaim vs health insurance and clear our confusion.

What is mediclaim Insurance?

A mediclaim insurance is one of the types of insurance plans that comes with particular financial protection against health-related expenses. It is a pocket-friendly option to take care of health-related emergencies. However, with a mediclaim policy, you will only get coverage for hospitalization. The rest of the medical expenses have to be borne by you.

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What is health insurance?

When you buy a health insurance policy, you will get coverage for medical as well as surgical expenses that have been incurred by you. To get the coverage, you can either pay the entire hospital bill from your pockets and later get the reimbursement from your insurer, or the second option is of informing the insurer about your hospitalization in just a few hours of being hospitalized. With this option, the bill will be settled by your insurer and the hospital where you received your treatment. The coverage offered by any health insurance policy is much more than the coverage offered by a mediclaim insurance policy.

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What are the differences between Mediclaim and Health Insurance Plans?

To understand the difference between insurance and medical insurance properly, here are some points mentioned for you:-

  1. Coverage offered
  2. Add-on covers
  3. Flexibility
  4. Sum insured
  5. Critical illness cover
  6. Hospitalization
  7. Claims


1. Coverage Offered

A health insurance plan comes with comprehensive medical coverage which includes hospitalization expenses, pre and post-hospitalization expenses, ambulance costs, etc. In addition to this, a health insurance policy also offers compensation if there has been a loss of income due to an accident.

A mediclaim policy provides coverage for hospitalization, treatment due to an accident, and pre-existing illnesses up to a pre-determined limit.

2. Add-on Covers

A health insurance policy comes with several add-on covers which include personal accident cover, critical illness cover, maternity cover, and many more.

A mediclaim insurance does not come with any cover at all. Once you understand how does insurance work, getting an add-on cover such as disability or critical illness cover can make a lot of sense which is only available with health insurance.

3. Flexibility

When you buy a health insurance policy, you get the flexibility to either increase or lessen the coverage. If you are not satisfied with your premium amount, you can change it after a certain period by changing the duration of the policy. You also must know that long-term health insurance policies come with discounts on premiums.

With a mediclaim insurance policy, you will not get any flexibility.

4. Sum Insured

The sum insured for health insurance policies starts from INR 50,000 and goes up to INR 6 crore per year.

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The sum insured for a mediclaim policy goes up to INR 5 lakh. For additional coverage, you have no option but to opt for health insurance.

Critical Illness Cover

With a health insurance policy, you can get coverage for over 30 critical ailments like cancer, kidney failure, stroke,  and many more. However, it depends on the policy which ailments are being covered.

There is no coverage for any critical illness in a mediclaim policy.

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To avail of the benefits of a health insurance policy, you do not necessarily have to get hospitalized. Even if you are taking day care treatment, you can avail of the benefits accordingly.

To avail of the benefits of a mediclaim policy, you must be hospitalized.


Once you have a health insurance policy, you can file claims till the time your sum insured is not exhausted. However, if the claim is related to accidental disability or critical illness, the sum insured is paid by the insurer in a lump sum amount. One such claim can only be filed only once during the entire term of the policy.

When you have a mediclaim policy, you can file several claims till the time your entire sum insured is exhausted.

Based on these factors you can find out the best policy according to your needs. For a comprehensive plan, higher coverage, and additional benefits, you can choose to go for health insurance instead of mediclaim.

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