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Difference Between Mediclaim And Health Insurance Policy

Team AckoNov 18, 2022

Buying health insurance is a crucial aspect of framing a productive financial plan. People often consider investing in mutual funds and the stock market to increase their savings. But what about shielding the savings? Here’s where health insurance covers your hard-earned money in case of medical emergencies. This way, you can rest assured that there is a safety net in place in case of expenses related to health issues.

Difference Between Mediclaim and Health Insurance Policy

There are a lot of options in the Indian insurance market when it comes to purchasing a suitable health insurance plan. There is no right or wrong plan as requirements differ based on individual needs. Therefore, the primary step in choosing a health insurance cover is to understand your health and insurance requirements so that you can choose the right cover.

People often come across two terms while researching about health policy – Mediclaim and Health Insurance cover. These terms might look similar on the surface, but you will start noticing the difference when you dig a little deeper and spend some time to understand the features offered by both policies. Read ahead to understand about Health Insurance and Mediclaim Policy in a better manner.



What is a Mediclaim Policy?

A Mediclaim policy is a type of health insurance policy that offers a cover for hospitalization and specified illnesses. It can be viewed as a low-premium health insurance plan. But you have to compromise on the coverage. 

What is a Health Insurance Policy?

Health insurance is a broad term involving different types of covers that offer comprehensive coverage. Features of a health insurance policy are not restricted to hospitalization. Depending upon the chosen cover and applicable terms and conditions, a health insurance policy can cover pre-hospitalization, post-hospitalization, critical illness, etc.

Difference Between Mediclaim Policy and Health Insurance Policy:

Here’s a table that highlights the major difference between Mediclaim and Health Insurance. However, it is advised to read the Policy Wordings carefully of the policy of your choice before purchasing it to make an informed decision.

Mediclaim Policy vs Health Insurance:

Difference inMediclaimHealth Plan
CoverThe health cover is usually restricted only to hospitalization.This is a comprehensive cover, which offers insurance in case of pre-hospitalization, hospitalization, post-hospitalization, medical tests, etc.
Extra Covers (like Ambulance charges)Not CoveredCovered
Sum InsuredThe Sum Insured is comparatively less (in lakhs).The Sum Insured can be more (in crores as well).
Co-paymentNot SupportedSupported
Multiple ClaimsPossible (based on Sum Insured)Not possible in case of Critical Illness as it offers lump-sum payment.
Variety/FlexibilityRigid PlansFlexible Plans where different features can be chosen or opted-out, based on your convenience.

How does Mediclaim work?

You can purchase a Mediclaim policy offline as well as offline. Once the payment is processed, you shall receive your policy document. It acts like a receipt of your transaction as well as a go-to document regarding claim settlement. It is also a contract between you and the insurance company and is governed by the corresponding policy document. Just like a health insurance policy, there are two ways to raise a claim against your Mediclaim policy.

Reimbursement Claims: Pay the hospital bill yourself and then raise a reimbursement request from your insurer.

Cashless Claims: Get admitted in a network hospital (affiliated with the insurer) and the bill (without deductibles) shall be taken care of by the insurance company. 

How does a Health Insurance Policy Work?

The basic process for a health insurance policy remains the same as mentioned above. These are some points that add value in the case of a health insurance policy:

Tax Benefit: You can avail tax benefits as per section 80D of the Income Tax Act. (Applicable in case of Mediclaim also)

Co-payment: Here, you can lower your payable premium by offering to contribute towards the claim amount. This lessens the burden a bit from the insurer, hence the low premium.

Medical Check-up: Some insurers also offer annual health check-ups as a part of their features and benefits.     

Which policy to buy, Mediclaim or Health Insurance?

The debate between Health insurance vs Mediclaim policy can be summarized as follows.

If are looking for comprehensive coverage and do not mind spending a considerable amount on a yearly basis towards safeguarding your finances, you should opt for a suitable health insurance policy.

In case you are running on a tight budget and are okay with a minimalistic health cover, you can choose a Mediclaim Health Insurance plan. Such plans are available at a comparatively lower price than the extensive health insurance policies but you will miss out on widespread coverage.

It is better to have some insurance cover than having none. Group policies such as those offered by your employer might provide some coverage, but they are not entirely reliable in the long run because of their limited features.

Frequently Asked Questions:

Which is better, Mediclaim or Health Insurance?


The answer depends upon your requirements. There is no absolute winner between Mediclaim vs Health Insurance.

Do all insurance providers offer a standard Mediclaim policy?


Inclusions and exclusions of a Mediclaim policy offered by different insurance companies can be different. Please go through the fine print of the policy to understand the scope of the cover.

Is it possible to purchase a long-term health insurance policy?


Yes, it is possible to purchase a medical insurance policy for more than a year. Some insurers offer a discount on insurance premium paid for a long-term policy.

How to check the Policy Wordings of a policy?


You can go through the Policy Wordings of your desired policy by downloading it from the insurer’s website, by visiting a branch office or co-ordinating with an agent.

Disclaimer: *Except for exclusions like maternity benefits, undisclosed diseases, etc. Please check policy wordings for more details.
**The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.


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