Health Insurance vs
Medical Insurance
  • Health Insurance Benefits
  • Medical Insurance Coverage
  • How Are They different?
Health Insurance vs Medical Insurance in India
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Difference Between Health Insurance and Medical Insurance

Have you ever seen oil and water getting mixed? No, right? Because the density of both the elements is different from one another. Similarly, two different terms in the insurance sector often create confusion. We are here, talking about Health insurance and Medical insurance. Mostly, people get confused and consider both the plans as same. But! Let us tell you why these two are separate sides of the 'insurance' coin.

This guide will discuss how a health insurance policy and a mediclaim (medical insurance policy) differ from each other. Apart from this, we'll read about the features, benefits, and similarities of both kinds.

What is Health Insurance?

The health insurance plan provides you with all the basic coverage benefits related to your medical expenses with hospitalization, doctor's consultation, daycare, maternity, ambulance charges, medicines, and so on. It directly pays out or reimburses all the incurred expenses out of your sum insured and you need not pay anything on your own.

What is Medical Insurance?

Medical insurance or a mediclaim policy is quite different from health insurance because it provides you with a pre-decided coverage benefit for a specific critical illness or medical condition for which you are buying the policy. However, the insurer of your mediclaim policy settles the medical bills directly, you can enjoy the perks of this plan anytime in several terms.

The only condition here is that you can not go beyond the limit of your sum insured in a mediclaim policy.

Features of Health Insurance and Medical Insurance

Here we will see the properties of health and medical insurance policies:

Key Features Health Insurance Medical Insurance
Comprehensivity Depending on the plan, it covers expenses related to hospitalization, medications, doctor's consultation, pre and post-hospitalization, bed charges, etc. It covers the critical medical treatment and hospitalization related to the procedure that you have particularly opted for.
Claim Settlement You can claim as many times as you require during the policy year till your sum insured limit is over. You can claim as many times as you need but only until you exhaust your total sum insured.
No-Claim Bonus (NCB) Health insurance plans offer a no-claim bonus on the renewal of your policy. Mediclaim policy does not have a no-claim bonus benefit in general, but depending on the plan you can get an NCB.
Tax Exemption You can avail of tax deduction benefits under Section 80D of the Income Tax Act of India. Tax benefit under Section 80D of the Income Tax Act is applicable.
Cashless facility The insurance company settles the medical bills or gives a reimbursement Either you can receive the cashless hospitalization facility at networking hospitals or the medical bills are reimbursed post-treatment.

What is the Difference Between Health Insurance and Medical Insurance?

Read below to know the differences between health insurance and mediclaim insurance:

Aspects Health Insurance Policy Medical Insurance
Pre & post hospitalization It broadly covers the before and after medical expenses along with hospitalization for a disease. It covers a specified period of medical treatment particularly for a health condition and not the whole pre & post-expenses.
Sum insured It has a higher amount in the sum insured because it provides comprehensive coverage for multiple health conditions. The sum insured is comparatively lower than health insurance.
Additional Riders You are free to add as many riders as you require on an extended premium amount. You can not add any rider as these plans are not comprehensive.
Ambulance services Most health insurance policies cover or reimburse the ambulance charges up to a decided limit out of the sum insured. Mediclaim plans do not give coverage for ambulance services, nor do they provide reimbursement for it.
Daycare procedures It covers general costs of treatment like consultation, daycare procedures, medication, diagnosis, etc. Treatment cost is only covered for medical when the ATD (Admission, Treatment, and Discharge) is applicable.
Affordability Premiums are usually higher as they provide coverage for multiple health situations. Premiums are often lower than a standard health plan since it has no comprehensive coverage benefits attached to it.
Customization You can customize your health plan according to your ascending needs, even after buying the policy. There are not many options for customization in the mediclaim policy as it only covers a pre-decided medical condition.
Maternity benefits It covers health conditions related to maternity (normal and caesarian). Maternity expenses or any related medical condition are only subject to the specification of a plan.
Exclusions Alcoholism, breach of law, war or nuclear emissions related causes, dangerous sports, congenital disease, attempt to suicide, beautification treatment such as dental care, liposuction, surgeries related to it, etc are excluded. All the exclusions of health insurance plus daycare procedures are not covered.

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Which is Better - Health Insurance or Medical Insurance?

For individuals who want wholesome coverage for their medical requirements like- hospitalization, medication, doctor’s consultation, maternity cover, ambulance charges, etc- health insurance serves them the best.

For those who want coverage only for hospitalization but not overall coverage, they can opt for a mediclaim policy.

Wrapping It Up

Buying health insurance does not only secure the health of you and your loved ones but also saves you excess expenditures in times of distress. But the conversation of health insurance vs. medical insurance policy always gets fired up. So, let's finally end this war. Health insurance and medical insurance can work wonders, but it depends on your medical requirements and which suits you the best.

Are you still confused? Worry not. You can reach out to our expert advisors at PolicyX.com for detailed guidance.

Health Insurance vs Medical Insurance: FAQs

1. Does medical insurance cover critical illness?

Yes, it covers the critical illness but only if it needs in-patient hospitalization.

2. Is health insurance the other name for a mediclaim policy?

No, both these terms are quite different as they cater to different needs of the policyholder. Health insurance is more wholesome in terms of coverage whereas, mediclaim only covers hospitalization expenses.

3. Is daycare covered by a medical insurance?

No, daycare is not covered in a mediclaim policy.

4. Which is best- health insurance or medical insurance?

Health insurance is an ultimate plan that provides you with comprehensive coverage. It’s always a good decision if you buy a health insurance plan instead of mediclaim.

5. How does a mediclaim policy settle a claim?

While receiving treatment for a specific health condition, you need to pay your medical bills out of pocket. Later, your insurer will give you the reimbursement amount after you make a claim.

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Simran Nirala

Written By: Simran Nirala

Simran has an experience of 3 years in insurance content writing. She transitioned from hospitality to the insurance industry after her emerging interest in how vast insurance is. With her ability to write complex insurance concepts in a simple, relatable manner she keeps her audience hooked and solves their doubts smoothly.