Difference Between Mediclaim vs Health Insurance in India

By Okbima 08 Mar 2024 163
mediclaim vs health insurance


Mediclaim vs Health Insurance: Mediclaim typically covers specific medical expenses, such as hospitalization and surgeries, while health insurance provides more comprehensive coverage, including preventive care and chronic disease management. Understanding the differences between the two can help individuals to choose the most suitable coverage for their needs.


What is Mediclaim Insurance?

Mediclaim insurance, also known as health insurance, is a type of insurance policy that covers medical expenses incurred by the insured individual. It provides financial protection against unforeseen medical emergencies, hospitalization, surgeries, and other medical treatments. Mediclaim insurance typically covers expenses such as doctor's consultation fees, diagnostic tests, medication costs, and hospital room charges. 

It can also include coverage for pre-existing conditions, maternity expenses, and critical illnesses. By paying a premium, policyholders can avail of these benefits and receive reimbursement for their medical expenses. Mediclaim insurance ensures that individuals do not have to worry about the financial burden of healthcare costs in times of need.


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What is Health Insurance?

Health insurance provides protection that covers the costs of medical and surgical services for the insured person. It typically includes coverage for a range of services such as doctor visits, hospital stays, prescription medications, and preventive care. Health insurance can be purchased individually or provided through an employer-sponsored plan. 

By paying a monthly premium, policyholders can access necessary medical services without incurring large out-of-pocket expenses. Health insurance helps individuals and families manage the high costs associated with healthcare, ensuring they receive the medical attention they need to maintain their well-being and quality of life.


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Mediclaim vs Health Insurance: Detailed Comparison

Here is the comparison between the mediclaim vs health insurance based on coverage, add-on covers, flexibility, etc.




Health insurance

Offered Coverage

A medical insurance plan offers coverage for hospitalization, accident-related treatment, and pre-existing conditions, up to a specified limit.

A health insurance plan provides coverage for hospital bills, ambulance costs, and loss of income due to accidents.

Add-on Covers

There are no additional cover options available.

It provides various additional covers, such as critical illness cover, personal accident cover, maternity cover, and more.


There is no flexibility in terms of coverage.

Health insurance plans allow policyholders to adjust coverage levels and duration to meet changing needs. 


Long-term policies offer discounts on premiums for extended coverage.

Critical Illness Cover

Critical illnesses are not covered by this policy.

The policy offers protection against over 30 serious illnesses, such as cancer, stroke, kidney failure, and more.

Sum Insured

Typically, the maximum sum insured for a mediclaim insurance plan is Rs 5 lakh.

Health insurance plans can have a sum insured ranging from Rs 50,000 to as high as Rs 6 crore per year.


A policyholder covered by a mediclaim plan can submit multiple claims until reaching the total insured amount limit.

An insured individual can submit claims in health insurance as long as their sum insured has not been depleted. 


However, in cases of critical illness or accidental disability, the full coverage amount is paid as a lump sum. Claiming for these situations is limited to once during the term of the policy.


To receive mediclaim benefits, the insured must be admitted to a hospital.

The insured can access health insurance benefits, such as coverage for daycare procedures, without needing to be admitted to the hospital.


Disclaimer: The insurer offers all savings as per the IRDAI-approved insurance plan. Standard terms and conditions apply.


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Things to Know to Buy a Mediclaim or Health Insurance Plan in India

Here are a few key considerations to keep in mind when purchasing a mediclaim health insurance policy in India.

  • Sum Insured: Typically, the plan will come with a predetermined sum insured that cannot be altered until renewal.

  • Premium Factors: The premium for the plan is determined based on factors such as the sum insured, age, gender, location, and chosen duration.

  • Claim Settlement: Claims can be settled through reimbursement or cashless treatment.

  • Plan Options: Plans can be bought individually or as a family floater, covering the insured, spouse, dependent children, and parents.

  • Tax Benefits: Premiums paid for the plan are eligible for tax deductions under Section 80D of the IT Act, 1961.

  • Renewal Discounts: Many health insurance plans offer a No Claim Bonus, reducing renewal premiums after each claim-free year.

  • Co-payment: Some plans may include a co-payment option, where the insured pays a fixed percentage of the treatment cost to lower the premium.


Should You Buy a Mediclaim Policy or Health Insurance in India?

When it comes to buying a mediclaim health insurance policy, it is important to consider both your current health needs and financial situation. A mediclaim policy typically offers coverage for hospitalization expenses and surgical procedures, while health insurance provides a broader range of benefits including out-patient treatments, preventive care, and maternity coverage. 

Deciding which option is best for you will depend on factors such as your age, medical history, and budget. It is advisable to compare various insurance policies to find the most suitable option that meets your specific needs and provides adequate coverage for any unforeseen medical expenses. 


Why Buy Mediclaim/Health Insurance Policy From Okbima? 

There are so many reasons to buy mediclaim/health insurance policies from okbima such as allowing you to compare plans at convenience with a wide range of options.

  • Comparison: Okbima allows you to compare various health insurance plans offered by different insurance companies. 

  • Convenience: Okbima makes the process easy to buying health insurance by allowing you to do so from the comfort of your own home. 

  • Wide Range of Options: Okbima provides a wide range of options to buy mediclaim insurance plans to choose from. 


Read More:

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In conclusion, both Mediclaim and health insurance play crucial roles in providing financial protection against medical expenses. While Mediclaim is more limited in coverage and benefits, health insurance offers more comprehensive coverage and flexibility. Ultimately, the choice between the two depends on individual needs, budgets, and preferences for healthcare coverage. You can consult with “Our Experts” to buy the best insurance plan.


When comparing mediclaim and health insurance, it becomes clear that health insurance is a superior option. The advantages it offers go beyond just coverage for hospitalization.

While health insurance and mediclaim policies do differ, a mediclaim plan still holds value for the cost, depending on your requirements. If you need more comprehensive coverage, health insurance may be the better option.

Affordable health insurance options are available based on your income, with the option to also purchase personal accident and critical illness policies for added financial protection.

Mediclaim and health insurance are not the same, as mediclaim typically only covers hospitalization expenses while health insurance provides a broader range of coverage for healthcare costs.

It ultimately depends on individual needs and preferences, as mediclaim typically provides coverage for specific medical treatments while health insurance offers a broader range of benefits and coverage options.

Yes, you can purchase mediclaim health insurance for senior citizens to ensure they have coverage for medical expenses.

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