Health Insurance Vs Mediclaim | Difference you Must Know

Health Insurance vs. Mediclaim: What’s the Difference?

Mediclaim and Health Insurance are two different things. One of the most typical blunders is confusing a medical insurance coverage with a health insurance policy. It’s past time to take action and learn the difference between health insurance and mediclaim.

What is the difference between a health insurance policy and a medical insurance policy?

A health insurance policy is an indemnity-based insurance plan that provides full coverage for unexpected or scheduled hospitalization, as well as a variety of other benefits. In-patient hospitalization, ambulance fees, pre- and post-hospitalization expenses, daycare treatments, OPD expenses, COVID-19 hospitalization, and other expenses are included. The policy also includes a no-claim bonus, lifelong renewability, automatic recharge, yearly health check-up, organ donor coverage, second opinion, and other benefits. One of the smooth benefits of a health insurance coverage is the ability to make cashless claims at network hospitals.

health insurance vs mediclaim
health insurance vs mediclaim

In addition, if the policyholder chooses non-network hospitals, reimbursement claim settlement is an option. Exclusive add-ons like as reduced wait time, co-payment waiver, international second opinion, and care shield can also be added to your insurance to extend its coverage. Individual and family floater plans are available to meet the healthcare requirements of you and your family. With special online discounts, you may obtain these programs for a cheap price.

Related: Is Arogya Sanjeevani Policy Good

What is a Mediclaim Policy, and what does it entail?

A mediclaim policy is a type of health insurance that pays for hospitalization and treatment in the event of a medical emergency, such as a serious illness, surgery, or an accident. Its premium is slightly higher, but it covers a variety of life-threatening disorders, including cancer, for the rest of one’s life. In addition, it includes coverage for chemotherapy and radiation, as well as organ donation. These insurance are offered in monthly and quarterly installments, with 2- or 3-year coverage. For every year you go without filing a claim, you can earn a no-claim bonus. According to the policyholder’s preferences, cashless hospitalization and reimbursement claim settlement are both possible under the mediclaim. Those with a history of ailments such as cancer, heart attack, and so on might consider mediclaim. You may also get it as a supplement to your health insurance to shield yourself from the high expenses of critical illness care.

In conclusion, a mediclaim coverage only covers hospitalization costs. Health insurance, on the other hand, is a comprehensive insurance policy that includes a wide variety of benefits and coverage.

Mediclaim’s Advantages

  • When you are hospitalized, you can obtain instant medical expenditure coverage.
  • If you choose a Cashless Mediclaim coverage, your insurer will cover your expenditures immediately.
  • Your money will be repaid by the insurance if you choose Reimbursement.

Related: LIC Policy: Invest Rs 150 per day & Secure for your children’s education and marriage

Health insurance’s advantages.

health insurance
health insurance

• Provides you with a wide range of add-ons.

• A Family Floater Health Insurance plan can cover all members of your family under one policy.

• Hospitalization expenditures are covered both before and after the hospitalization.

• Allows you to add Critical Illness coverage to your policy.

• You may choose from a variety of advantages, such as outpatient, maternity, and restoration.

• You can get a senior citizen health plan for your parents.

• Claims can be made without the use of cash.

Health Insurance vs Mediclaim: Facts

The following are some key aspects to consider when comparing health insurance and Mediclaim policies:

Considerations.Health InsuranceMediclaim
The most basic definition.Health insurance is a form of insurance that covers all medical and surgical expenditures, even those not related to hospitalization.Mediclaim is a sort of insurance that solely covers hospitalization-related costs up to the insured amount.
Coverage InclusionsAmbulance, Pre- and Post-Hospitalization, Diagnostic Tests, Day Care Treatments, OPD Charges, Critical Illnesses, Maternity Expenses, Alternative Treatment, and other expenses are all covered.Hospitalization and treatment costs incurred as a result of an accident, surgery, or sickness are covered.
Cover that may be added on. (Add-on cover.)Add-on benefits include OPD coverage, COVID Care, Care Shield, worldwide coverage, international second opinions, and more.Optional Mediclaim advantages include deductibles, reduced PED wait times, and room rent modifications, among others.
Insured amount.Add-on benefits include OPD coverage, COVID Care, Care Shield, worldwide coverage, international second opinions, and more.The insured amount covered is determined on the type of plan you select.
Claims.Policyholders with health insurance can make claims on a cashless or reimbursement basis.Cashless or reimbursement claim settlement options are available to Mediclaim policyholders.
FlexibilityHealth insurance policies are quite versatile since they allow policyholders to personalize their plans by choosing a bigger sum insured, additional coverage, and so on.Mediclaim plans are not regarded flexible because to their restricted coverage, but they are quite advantageous when it comes to critical sickness, heart diseases, and other conditions.

Mediclaim vs. Health Insurance: Which one is more considered?

Several variables will influence your selection, including:. Your financial situation.

• Health problems that you and your family are experiencing.

• Whether long-term or short-term planning is more important to you.

• Whether or not your health-care plan requires flexibility.

• If you’ll need any additional coverage or perks.

• Willing to pay a high or low premium for a product.

• Consider your own or your family’s age, stage of life, and medical condition.

Assessing your and your family’s healthcare requirements is the most effective approach to find and evaluate the coverage you require. When compared to Mediclaim, health insurance offers a considerably broader and more complete coverage. Mediclaim, on the other hand, is usually recommended for persons who are relatively younger and want to save money on premiums. As a result, while selecting a plan, one should consider not only the premiums but also the potential advantages in the future.

In comparison to Mediclaim Policies, how does Health Insurance fare?

Mediclaim plans are frequently quite limited, yet they can be useful in times of need, such as hospitalization due to an accident or illness. Most experts, however, advocate obtaining a Health insurance plan since it provides 360-degree coverage. These plans are made to meet an individual’s whole healthcare needs. It covers you from the moment you have a health problem. So, when comparing the benefits of mediclaim versus health insurance plans, it’s evident that a health plan comes with a slew of extra features and perks, some of which are stated below.

Domiciliary Hospitalization: If your doctor recommends it, you can seek domiciliary hospitalization, which is covered by health insurance but not by mediclaim.

Annual Health Check-Ups: One of the nicest things about having health insurance is that you can get an annual health check-up straight away. However, it begins in the second year of mediclaim coverage.

Coverage: In mediclaim, the quantity of coverage or the sum insured is lower. Health insurance, on the other hand, allows you to select an amount covered of up to 6 crores.

COVID-19 Coverage: Hospitalization and treatment costs for the coronavirus are covered by health insurance. The COVID-19 therapy is not covered by Mediclaim.

Add-ons: You may expand the coverage of your health insurance policy by purchasing add-ons such as worldwide coverage, international second opinions, Care Shield, PED wait time reduction, no claim bonus super, and so on.

Daily Allowance: A daily allowance add-on to health insurance provides compensation for non-medical expenditures such as food, transportation, and other items that are not covered by mediclaim.

Co-payment Waiver: If the insured member is 61 years or older, this add-on allows you to avoid the 20% co-payment. In mediclaim, it isn’t applicable.

Insurance assumptions can differ. One family’s insurance plan may not be suitable for another. There are a variety of plans available for this purpose, all of which may be customized to fit the needs of different persons with various health issues. There’s a big difference between health insurance and mediclaim, which allows you to tailor a health plan to your specific needs.

Related: 11 Best Bank to Open Account in India : 2022 High Interest List

In India, a family can get a cashless mediclaim policy.

Customers can choose between reimbursement and cashless claim settlement through Mediclaim. Cashless therapy is available at any hospital in the insurer’s network. Simply defined, a cashless Mediclaim insurance is one in which the expenditures are paid directly to the healthcare facility, according to the terms and conditions of the policy. It’s advantageous since it lowers the individual’s direct financial burden during hospitalization. This is quite handy for the customer. For a stress-free experience, notify the insurer within the stipulated time frame after admission, which is 24 hours in the event of emergency hospitalization. Apart from that, one should study all major policy terms and conditions and have their health card with them at all times because it will be required at the hospital.

However, if a person desires to receive emergency care at a hospital of their choosing that is not on the insurance company’s list, they can still file a claim. They will have to pay for the hospital fees out of pocket in this situation and seek for reimbursement once they are discharged.

How Does Health Insurance and Mediclaim Work in India?

Though mediclaim policies are useful for covering hospitalization costs, health insurance policies, with their vast variety of benefits, have the upper hand over mediclaim policies. The elements listed below distinguish a Mediclaim policy and describe how it functions in India.

• Benefits Provided: Mediclaim insurance include benefits such as hospitalization expenditures coverage and cost coverage for accident-related treatment and certain diseases.

• Group Mediclaim: Similar to health insurance, a Mediclaim policy can be used to cover numerous family members such as parents, spouses, and children under one policy. A Group Mediclaim insurance is a form of Mediclaim policy that covers a group of people, such as an organization’s employees.

• Premiums and Sum Insured: Most Mediclaim plans have a set amount of coverage. Sum insured, gender, proposer’s age, treatment location, and policy length are all criteria that go into determining the premium.

• Claim: The insurance company usually pays for the hospitalization charges.

• Tax Benefits: Under Section 80D of the Internal Revenue Code, such plans provide a tax credit on premiums paid.

Due to the comprehensive type of coverage supplied by health insurance plans, they are the most generally selected insurance plans in India. Some unique elements that explain how they operate in India are listed below:

• Coverage Provided: Health insurance policies cover a wide range of medical issues, including severe sickness, pre-existing conditions, and so on.

• Coverage for the entire family: Family floater plans include parents, spouses, and children.

• Tax Advantages: Health insurance purchasers can deduct the premium they pay for a policy under section 80D of the Internal Revenue Code.

• Cashless Hospitalization: This feature allows an insured individual to receive cashless Mediclaim treatment at any of the insurer’s network hospitals, allowing for more convenience.

• Co-payment Option: Some senior citizen health insurance plans include a co-payment option that requires the policyholder to pay a portion of the medical expenses. Lower premiums might be expected for buyers.

• Savings and no-claim bonus: Health plans typically offer a number of additional advantages at policy renewal, including as premium discounts and a higher sum covered as a reward for a claim-free year.

Related: ICICI Zero Balance Account | ICICI Bank Savings A/c

Health Insurance or Mediclaim: Which Should You Choose?

Both Mediclaim and health insurance coverage cover unexpected hospitalization expenditures that may come as a result of accidents, illnesses, or other unforeseen circumstances. However, before deciding on which insurance to purchase, consider the following factors:

• Pick an insurance that fits your budget so you don’t have to worry about paying the premiums later.

• Select a policy based on your family’s medical history or the presence of a pre-existing condition.

• The policy’s duration, whether it should be for a year, a year and a half, or a year and a third.

• The coverage may be customized to meet the needs of the individual.

• Extending the policy’s coverage with add-on benefits.

• Hospitalization and treatment costs related to COVID-19 are covered.

• Determine if you are eligible to purchase an insurance that may be renewed for the rest of your life.

Often Asked Questions: Health Insurance Vs Mediclaim

Q) Is it preferable to have medical insurance or health insurance?

Ans: In general, guaranteed sums are smaller in Mediclaim than in health insurance. Premiums paid on a Mediclaim policy are tax-deductible from your taxable income under Section 80D of the Internal Revenue Code.

Q) Is mediclaim and health insurance the same thing?

Ans: What Is the Distinction Between Mediclaim and Health Insurance? Only hospitalization, accident-related treatment, and pre-existing conditions are covered by a mediclaim plan, subject to a certain maximum. A health insurance plan gives you the option to increase or decrease your coverage.

Q) Who is eligible for Mediclaim?

Ans: A national mediclaim insurance covers hospitalization expenditures incurred throughout the policy period for the treatment of an insured member’s illness or accident. This coverage is available to those between the ages of 18 and 65. Coverage is available for children aged 3 months to 18 years old who are accompanied by a parent.

Q) Is it possible for me to file a claim for health insurance every year?

Ans: Depending on the breadth of coverage and the limit of the sum insured, an infinite number of claims can be covered during the policy term. There’s a risk your limit of money covered may be exhausted in the first two or three claims; in such circumstances, the insurer will offer a restoration bonus once a year.

Health Insurance Vs Mediclaim A Summary

Given the significant differences and benefits between mediclaim and health insurance, choosing between the two might be difficult. Assessing your healthcare needs is the best method to figure out which insurance plan is suitable for you and your family. A person’s financial status, as well as the quantity of coverage necessary, any illness you or a family member may have, age, lifestyle, and so on are all things to consider.

If you understand what a mediclaim insurance is, you’ll see that it’s ideal for those who need adequate hospitalization coverage in the event of a medical emergency. If you have a family, including a spouse, dependent children, and parents, a family floater health insurance plan with benefits that go beyond hospitalization coverage is recommended.

Conclusion : Health Insurance Vs Mediclaim

Mediclaim insurance and health insurance are two separate types of health-related risk mitigation devices. Both are available to meet the purchasers’ insurance needs. You’ll be able to select the one that best suits you now that you understand the differences between a mediclaim and a health insurance plan. However, before purchasing a health insurance plan, consider your insurance needs and evaluate numerous insurance plans that meet them.


The content on this website is meant only for general information purpose and does not and shall not be construed as any solicitation, procurement, display, aggregation, marketing or advertisement of insurance products. is not an insurance intermediary and hence does not endorse or solicit any such products. The information on this website is derived from publicly available sources and cannot verify or confirm the genuineness, truth, veracity or authenticity of this information.

Display of any trademarks, tradenames, logos and other subject matters of intellectual property belong to their respective intellectual property owners. Display of such IP along with the related product information does not imply’s partnership with the owner of the Intellectual Property or issuer/manufacturer of such products.

About loanpersonal

Check Also

Buying digital gold on dhanteras-reasons to avoid

Digital Gold Buying 10 Reasons to Avoid on Karwa Chauth, Dhanteras & Diwali 2022.

Learn the top reasons to postpone purchasing digital gold at Karwa Chauth, Dhanteras, or Diwali …

Leave a Reply

Your email address will not be published. Required fields are marked *