What Is the Difference Between a Mediclaim Policy and Health Insurance?

Mediclaim Policy and Health Insurance Difference

Ever bought a mediclaim policy and wondered what health insurance is?

We generally subscribe to Mediclaim policies in the belief that it must have adequate health insurance to address all health issues. This is not only inaccurate but might just prove a very costly oversight. 

Hence it is of utmost importance that we clearly understand the key features that differentiate Mediclaim policies from health plans so as to opt for the best mediclaim policy in India for your family.

Hospitalization expenses

Mediclaim pertains specifically to hospitalization expenses. In simple words, it only covers hospital-related expenses. For filing a Mediclaim, hospitalization is required.

Whereas health insurance is more complete and covers a lot more than hospitalization expenses. It covers pre and post-hospitalization expenses. For filing a health insurance claim, an eventuality is required which may not necessarily be hospitalization.


Mediclaim works on the indemnity principle wherein the hospitalization expenses incurred by the insured are reimbursed, thus covering up the loss.

Unlike the Mediclaim policy, health insurance has various components. Health insurance riders such as accidental disability rider and critical illness rider work on the benefit principle wherein a lump sum are paid to the insured, rather than making up for the loss incurred.

Moreover, in health insurance, there is the flexibility to reduce the premium after a specified period, to reduce the sum assured after a specified period, and to reduce the policy term after a specified period.


Mediclaim allows you to make a number of claims until the sum insured is exhausted.

However, in health insurance, for critical illness, personal accident cover, and accidental disability cover, the entire sum assured is paid out, so there is no option of making another claim during the policy tenure.

Types of Mediclaim Policies

There are mainly two types of Mediclaim policies in India:-

  1. Individual Mediclaim Policy – Under the individual Mediclaim policy, only a single person can be covered. The premium to be paid is based on the age of the person, who is being offered health cover. The insured person can claim the entire sum insured when needed.
  2. Family Floater Mediclaim Policy – Under the family floater mediclaim policy, one gets coverage for his or her family as well. The family comprises of self, spouse, dependent children, and in some policies even dependent parents. The premium for this type of policy is based on the family member who has the highest age. Furthermore, the entire sum assured can be used by the entire family jointly or by a single member alone.

There are three major types of Health Insurance in India:-

  1. Health insurance for individuals – It is one of the most awarded health insurance plans. The entire sum assured is available for only one individual and the premium is determined by the age of the insured.
  2. Health insurance for the family – With a family health plan, you can include all your family members against multiple diseases under a single cover. It offers a fixed sum assured for the entire family which can be availed by either one or all the members.
  3. Health insurance for senior citizens – It is a lifelong cover for self and spouse and is designed for anyone above the age of 60 years.
  • Personal Accident cover – Often provided as a rider, this insurance basically includes the hospitalization expenses and bears the medical outlay, in the event of an accident.
  • Maternity Health Cover – This is often used to bear the extra medical expenses including pre and post-natal care, child delivery, etc.
  • Surgery and Critical Illness Cover – This can be bought as a standalone policy or as a rider for the treatment of various critical illnesses like kidney failure, paralysis, cancer, etc.

So in a nutshell, a Mediclaim and health insurance vary from one another. These two terms are usually used interchangeably. As mentioned above, there are some stark differences between the two. Health insurance is comparatively more comprehensive and provides a cover that extends beyond hospitalization, unlike the Mediclaim policy which is limited to hospital expenses. So, make sure to double-check your requirements and then get either.

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