Which is The Important Difference Between Mediclaim and Health Insurance?


Medically reviewed by

Bajaj Finserv Health

Aarogya Care

5 min read

Key Takeaways

  • People often don’t know the difference between mediclaim and health insurance
  • Health insurance is an indemnity-based insurance plan compared to mediclaim
  • Mediclaim and health insurance offer you tax benefits under section 80D of IT Act

These days, you can opt for different investment plans to avail benefits. It is better to invest in health insurance at an early age. This helps you get better access to healthcare and save more too [1]. Remember, you can never take good health for granted, and a medical emergency can arrive at any moment. There are two effective ways to tackle medical emergencies and avail benefits. You can sign up for mediclaim insurance or a health insurance plan. People often don’t get the difference between mediclaim and health insurance. While one offers specific benefits, the other has wider coverage.

Just like the difference between term insurance and health insurance, it is important to know the mediclaim and health insurance differences too. Read on to understand it below.

Additional Read: 6 Types of Health Insurance Policies in India: An Important Guide

What Is Mediclaim Insurance?

A mediclaim policy is a type of health insurance that offers limited coverage. It covers the following medical expenses:  

  • Hospitalization
  • Pre-specified ailments
  • Surgery
  • Accidents 

It doesn’t offer any add-on coverage. The sum assured on mediclaim policies doesn’t exceed Rs.5 lakh.

Additional Read: Sum Insured and Sum Assured: How Are They Different From Each Other?

There are two types of mediclaim plans, cashless and reimbursement. A cashless claim is a convenient option to choose. Here, you do not have to pay any amount when taking treatment. All the expenses are borne by the company for your treatment at a network hospital. Under the reimbursement claim, you pay for the expenses yourself and claim the amount later. You can do so by submitting the bills, discharge card, and other records to the insurance provider.

health insurance benefits

What Is Health Insurance?

A health insurance is an indemnity-based insurance plan. It offers comprehensive coverage including: 

  • In-patient hospitalization costs 
  • Pre-hospitalization and post-hospitalization expenses 
  • Daycare medical costs
  • OPD expenses
  • Ambulance charges 

It also provides benefits like a no claim bonus, lifetime renewability, health tests, and more.

Like mediclaim, you can either choose a cashless settlement or opt for reimbursement. Keep in mind that this health insurance policy is more extensive. It offers a higher sum assured than a mediclaim policy. So, it follows that its premiums are higher too. In this way, it offers more features and benefits as compared to mediclaim.

Health insurance plans cover more than 30 critical illnesses. These include kidney failure, heart attack, and cancer. Health insurance plans offer add-ons and rider benefits. These add-ons include: 

  • Personal accident 
  • Maternity cover 
  • Critical illness coverage
difference between mediclaim and health insurance

There Are Many Types of Health Insurance Plans Such As:

  • Individual health plans 
  • Family health plans 
  • Senior citizens’ health plans
  • Group health insurance

What Is the Difference Between Mediclaim and Health Insurance?

See the table below to understand the differences between the two.

Basis Mediclaim Health insurance 
Coverage It provides coverage for hospitalization, accident-related expenses, and pre-decided diseases only. It offers comprehensive coverage including in-patient hospitalization, pre-and post-hospitalization cost, ambulance charges, etc. 
Add-on coverage offered Mediclaim policies don’t offer any add-on coverage. Health insurance plans offer add-ons to cover critical illness, personal accident and maternity care.  
Sum assured The sum assured on the mediclaim insurance plan is up to a maximum of Rs. 5 lakh. Health insurance provides extensive coverage with a high sum assured. However, this amount doesn’t exceed Rs. 6 crore a year. 
Critical illness No critical illnesses are covered under mediclaim insurance. More than 30 critical illnesses including cancer, kidney failure, and stroke are covered. 
Hospitalization criteria You need to get hospitalized for at least 24 hours to avail mediclaim insurance and its benefits. Hospitalization is not necessary to get health insurance benefits. You can avail benefits like daycare cover. 
Flexibility Mediclaim policy doesn’t offer any flexibility concerning coverage. Health insurance plans offer flexibility such as reduction of insurance premiums, change in policy duration, and other benefits. 
Features The features and coverage offered on mediclaim insurance differs with each insurance company. The features and benefits offered on health insurance plans are generally similar, but each provider does have specific benefits. 
Filing of claims You can file for claim settlement until the total sum assured is exhausted. You can file claims as long as your sum insured isn’t exhausted. However, critical illness and accidental disability coverage claims can be filed only once during the policy tenor. Sum assured on such claims are paid in a lump sum. 

Now that you know the difference between mediclaim and health insurance, you can choose the right one for yourself. Both plans offer tax benefits under section 80D of the IT Act, 1961 [2]. Although both cover health-related issues, you may find that health insurance is the better option as it provides comprehensive coverage.

Check out the Aarogya Care Health Plans by Bajaj Finserv Health for you and your family. It offers loads of benefits such as health check-ups, online doctor consultations, network discounts, and more. It also offers both individual and family floater plans at affordable premiums.

Published on 1 Nov 2021Last updated on 15 Dec 2022
  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6713352/
  2. https://www.incometaxindia.gov.in/Pages/tools/deduction-under-section-80d.aspx

Please note that this article is solely meant for informational purposes and Bajaj Finserv Health Limited (“BFHL”) does not shoulder any responsibility of the views/advice/information expressed/given by the writer/reviewer/originator. This article should not be considered as a substitute for any medical advice, diagnosis or treatment. Always consult with your trusted physician/qualified healthcare professional to evaluate your medical condition. The above article has been reviewed by a qualified doctor and BFHL is not responsible for any damages for any information or services provided by any third party.


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