Is Mediclaim The Same As Health Insurance?

Yes, it’s confusing but allow us to decode the two terms and what you need to know before buying health insurance 

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People often make a number of mistakes when purchasing health insurance. One of the most common blunders is mistaking Mediclaim for Health Insurance. Mediclaim and Health insurance plans are very distinct, yet are frequently confused terms. In fact, purchasing an insurance policy is not the same as purchasing a Mediclaim. 

Hence, knowing the distinction between these two policies can help you determine the best decision. But what exactly is the difference? 

What is a Mediclaim Policy?
Mediclaim is a low-cost insurance policy that provides specific financial protection against medical emergencies. However, the Mediclaim insurance coverage is specific and limited to hospitalisation expenses incurred in the event of an accident, sudden illness, or surgery during the policy's tenure. Mediclaim can be either cashless or reimbursed.

What is a Health Insurance?
Health insurance pays for the insured's medical and surgical expenses. Most of the time, the coverage is more extensive than hospitalisation expenses and thus more expensive than a Mediclaim policy. The policyholder can either pay such expenses out of pocket and be reimbursed later by the insurer, or the insurer settles the bill directly with the network hospital.  

They sound the same, don't they? There are, however, some differences between the two. With the help of the following table, let us understand how Health insurance differs from Mediclaim:



Health insurance


A mediclaim plan only covers you if you are hospitalised and for claims related to accident-related treatment and pre-existing diseases, up to a certain limit

Health insurance provides comprehensive coverage that extends beyond the costs of hospitalisation. Among these expenses are pre and post-hospitalisation charges, ambulance expenses for transportation, annual health check-ups, daily hospital cash, OPD expenses, and alternative treatments AYUSH

Add-on Covers

It does not offer any add-on cover.

It may provide a variety of add-on covers such as critical illness cover, personal accident cover, maternity cover, and so on.


Mediclaim policy is not flexible

A Health Insurance plan is flexible and can even be customised to enhance or reduce the coverage

Critical Illness Cover

It does not provide coverage for critical illnesses

Depending on the policy, it covers more than 30 critical diseases such as cancer, stroke, kidney failure, and so on

Sum Insured

The sum insured does not exceed Rs 5 lakh

The sum insured for health insurance plans ranges from Rs 50,000 to Rs 6 crore per year and is determined by age, city, the number of members in a single plan, and other factors


A policyholder can file multiple claims under a Mediclaim plan until the total amount insured is exhausted

A claim can be filed as long as the insured hasn't exhausted his/her sum insured. But when claims related to critical illness/ accidental disability cover arises, the assured sum is paid in a lump sum only made once during the entire policy tenure


It is necessary for the insured to be hospitalised in order to avail of Mediclaim benefits.

It is not necessary for the insured to be hospitalised in order to receive Health Insurance benefits. For Instance, even a day-care procedure can be availed.

What is the best choice, Mediclaim or Health Insurance?

While there are several factors, listed below are some of the key factors that will influence your decision:
●    Your financial situation
●    You and your family's health problems
●    Whether you prefer long-term or short-term planning
●    Whether you require flexibility in your health care plan or not
●    Whether you require additional coverage and benefits
●    Whether you are prepared to pay a high or low premium
●    Your age and/or your family members' age, life stage, and medical condition.

All things considered, if you keep all the factors above in mind, making a decision between the two should not be difficult.