- Compare Mediclaim & Health Insurance
- Understand Mediclaim & Health Insurance plans
- Things to Consider Before Purchase
Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.
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Updated on Apr 08, 2025 4 min read
Clear Out the Difference Between Health and Mediclaim Insurance
The Indian healthcare sector is still developing as well as it has now become unaffordable to most Indian citizens. However, technological advancement comes with a cost, which starts burdening middle- and lower-class people. It’s pretty common these days that medical practices, doctor prescriptions, and surgery costs start from a few lakhs.
In case you’re not holding health or medical insurance, then surely medical bills impact your finances. It’s essential to secure your health using health insurance and mediclaim policies to protect your finances with expensive healthcare services. The most common mistake most of the time policy buyers make is to consider mediclaim as health insurance.
There’s just a mere difference between mediclaim and health insurance. So stay tuned with us to clear the misconceptions between mediclaim and health insurance policy differences.
Health Insurance or Mediclaim: Know the Difference
In India, there are a lot of misconceptions about health insurance and mediclaim. While buying medical insurance, people are usually confused and assume mediclaim is a synonym for health insurance. But in reality, there’s just a small difference between the policy. They both provide coverage for hospitalization and offer add-ons to customize the base policy. Check out the table below to understand the key difference between health insurance and mediclaim plans.
| Mediclaim Plans | Health Insurance |
|---|---|
| In mediclaim plans, buyers can opt for multiple claims throughout a year until the sum insured limit is not exhausted. | In a Health Insurance policy, you can opt for multiple claims throughout the year. Still, there may be certain limitations, such as annual or lifetime claim limits, waiting periods, and specific coverage terms outlined in the policy. |
| Mediclaim covers hospitalization expenses, including room charges, doctor fees, surgical procedures, and other hospital-related costs during a hospital stay. Remember that it may vary from company to company. | Health Insurance offers wider coverage for different types of medical and surgical expenses, including pre & post-hospitalization, OPD, IPD, ambulance charges, hospitalization costs, cost of medicines, or doctor consultation fees. |
| Mediclaim plans do not offer extra perks on basic plans, such as critical illness coverage and coverage for pre-existing diseases. But you can customize your basic plan with add-on riders. | Health insurance often provides an extra set of benefits in basic plans, such as free annual health checkups, waiting periods, preventive health care services, and coverage for pre-existing conditions. |
| Under section 80D of the Income Tax Act, it allows a tax deduction of up to Rs 25,000 annually on medical insurance premiums. | Under section 80D of the Income Tax Act, it allows a tax deduction of on health insurance premiums. For buyers below 60 years of age, the tax deduction is up to Rs. 25,000, while for senior citizens, it goes up to Rs. 50,000. |
What is a Mediclaim?
Similar to health insurance, a mediclaim policy provides cover for medical and surgical expenses that arise due to an illness or accident. It is a hospitalization insurance plan provided by both public and private insurers, and the features may vary from company to company.
The plan covers all the expenses of an insured person throughout the hospital stay, such as hospital room rent, surgeon, doctor fees, medical practitioner fees, diagnostic tests, and medicines.
Some mediclaim policies offer coverage for pre-hospitalization medical expenditures obtained up to a specific period prior to hospitalization and post-hospitalization medical expenses. However, basic Mediclaim plans only provide coverage for hospitalization-related expenses and do not cover OPD and IPD care charges.
What is Health Insurance?
Health insurance provides coverage for healthcare and surgical expenses that arise due to an illness or accident. It offers comprehensive coverage for both hospitalization and outpatient expenses.
The plan covers all the expenses of an insured person, such as doctor’s fees, surgery, nursing ambulance, OPD & IPD care, hospitalization costs, cost of medicines, or doctor consultation fees. However, some health insurers offer pre-and-post hospitalization expenses in basic health insurance policies.
Things to Consider While Buying Mediclaim/ Health Insurance Plan in India
There’s just a small difference between mediclaim and health insurance. So we’ve listed a few things to consider while buying a mediclaim or health insurance plan:
- Both plans come with a fixed sum insured amount, which you’ve to decide before buying a plan, and it cannot be changed before the policy renewal.
- Generally, the plan’s premium is estimated based on the fixed sum insured amount, age, geographical location, policy duration, and the type of plan you choose.
- Insured persons can opt for a claim request through reimbursement and cashless treatment.
- In reimbursement claims, an insured person has to pay for the medical expenses out of their pocket and later claim for the costs from the insurer.
- Under the cashless treatment, the hospital selected should be a network hospital, and then the insurer covers all the medical expenses directly to the hospital.
- Both plans can be bought on an individual and a family floater basis. However, a family floater plan covers individuals, spouses, and children.
Which one is better, mediclaim or health insurance?
As we know, expectations are individualistic. So, it is hard to choose between mediclaim or a health insurance plan because the decision is based on an insured person’s healthcare requirements and budget. Most of the time, mediclaim insurance is less expensive because it only provides coverage for hospitalization expenses. It is an ideal plan for those seeking coverage for unexpected hospital stays.
On the other hand, health insurance offers more comprehensive coverage against medical emergencies. It covers an insured person’s inpatient and outpatient expenditures, such as medical consultations, diagnostic tests, and medications. It is an ideal plan for those who are suffering from pre-existing medical illnesses or a higher risk of becoming ill.
Conclusion
There are just minor differences between mediclaim and health insurance policies. Mediclaim policies are more basic and cover inpatient hospitalization costs, but you can customize them per your needs. Most of the time, people assume that mediclaim is a synonym for health insurance and buy a policy due to a lack of knowledge. However, understanding a mediclaim and health plan will clear your misconceptions about both options and help you decide which best fits your medical needs.
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Health Insurance vs Mediclaim: FAQs
1. Which one should I buy, mediclaim or health insurance?
As we know, expectations are individualistic. So when it comes to choosing between mediclaim or health insurance, it may depend on the insured person& 039;s healthcare requirements and budget. Before buying a plan, analyze your expectations and compare plans to choose the correct option.
2. When is the right age to buy health insurance?
When it comes to buying health insurance, you may consider purchasing a plan at a younger age because the premium will be lower, and you& 039;ll get comprehensive coverage.
3. Is it good to buy a mediclaim?
Mediclaim insurance is less expensive because it only provides coverage for hospitalization expenses. It is an ideal plan for those seeking coverage for unexpected hospital stays.
4. What happens if I don& 039;t buy health insurance?
In case you& 039;re not holding health or medical insurance, then surely medical bills impact your finances.
5. What to do if you can& 039;t afford health insurance?
If you can& 039;t afford a health insurance plan, you can shop for more affordable options that you can easily afford as per your income. You may even consider opting for personal accident insurance to secure yourself from injuries resulting from accidents.
6. What are the benefits of health insurance?
Health insurance covers hospitalization expenses, routine check-ups, alternative treatment, and daycare procedures to manage financial losses in an emergency.
7. What is the cost of health insurance in India?
When it comes to the cost of health insurance in India, it may be around ₹500 and ₹850 (approximately) for an estimated cover of ₹5 lakhs for a single 30-year-old. However, the premium may vary from company to company due to various factors.
8. Do I get coverage for Diagnostic Expenses?
Yes, insurance providers offer coverage for most diagnostic tests, such as X-rays, blood tests, MRIs, and so on.
9. How much medical insurance do I need?
According to personal finance experts, a minimum health cover of Rs 5 lakh is appropriate for individuals. However, your health coverage should be at least 50% of your annual income.
10. Which diseases are covered under health insurance?
Whether you& 039;re holding a health insurance policy or a mediclaim plan, most of the diseases are covered, such as heart disease, diabetes, cataracts, and other critical illnesses. However, the list of conditions covered may vary from insurer to insurer.
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Written By: Simran Kaur Vij
Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.
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