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Difference between Health Insurance and Mediclaim

Difference between Health Insurance and Mediclaim
May 5, 2021 camsrep


Rahul’s mother suffered a cardiac arrest a few weeks ago. Rahul believed that since he had purchased a Mediclaim policy for his mother, the policy would cover all medical expenses. However, he was mistaken. The Mediclaim covered only the expenses incurred during hospitalization on a reimbursement basis. Due to this, he was utterly disappointed and stressed arranging the money up front. This is when he learned the Mediclaim policy he got for his mother was not the same as the health insurance policy during the event of this.

Are you also confused between Mediclaim and health insurance?

We have simplified the difference here, just for you.



  • In simple words, Mediclaim is an insurance policy that limits itself to covering the hospital expenses.
  • There are two types of Mediclaim policies in India
    1. Cashless Procedure
    2. Reimbursement
  • Mediclaim usually covers the following costs. However, the coverage may vary from one provider to another.
    1. Fee of doctors, nurses and other healthcare workers
    2. Charges for accommodation in hospital
    3. Medicines, Diagnostic procedures, X-rays and other scans, OT charges
  • If you decide to purchase a Mediclaim policy, these are the vital factors to consider.
    • Individual or Family Mediclaim policy
    • Maximum age for renewal
    • Pre-existing diseases
    • Coverage amount
    • Waiting period for pre-existing conditions
  • Hospitalization is necessary to file a claim for Mediclaim policies.
  • The costs of hospitalization are reimbursed by the insurance company upon submission of applicable medical bills up to the policy’s cap.
  • In a standard Mediclaim scheme, the maximum coverage available is Rs. 5 lakhs.
  • In the case of a Mediclaim scheme, you can make claims until the amount insured is expended.



  • Health insurance offers a comprehensive cover that extends beyond covering hospitalization expenses. It also includes pre- and post-hospitalization expenses.
  • The following types of health insurance policies are available in India.
    1. Individual health plan
    2. Family floater
    3. Critical illness & surgery
    4. Pre-existing disease cover
    5. Senior citizen health plan
  • Hospitalization is not necessary to make a health insurance claim in India. If the doctors confirm that the insured is diagnosed with a critical illness, he is eligible to make claims.
  • Health insurance plans have a wider coverage. The overall total insured amount can be more than Rs. 50 lakhs.
  • Health insurance policies are based on the principle of benefit. These policies offer a huge amount when an unforeseen incident happens, such an accident or a medical condition.
  • The following are the key benefits of purchasing a health insurance plan.
    1. Cashless treatment
    2. Tax benefits
    3. Medical checkups
    4. No claim bonus
    5. Pre and post hospitalization charges covered
  • However, in the event of any critical illness. The insurance company might use the  total coverage of your insurance policy  and the scheme will lose its validity. You cannot make a second claim.

To Summarise

Both Mediclaim and health insurance policies are advantageous, and each has its own set of merits and drawbacks. Although Mediclaim’s can be less expensive, Health insurance policy would provide you with more protection and coverage.

Once you have secured your family with the right medical insurance plan, the next important step is to e-Insure it. e-Insurance is a safe digital vault to secure your insurance policies digitally. By linking all your policies to your e-Insurance account, you can access them at your convenience.

Creating an e-Insurance account takes just a few minutes but comes with life long benefits.
Click here to register
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