The terms ‘Mediclaim’ and ‘Health Insurance’ are often interchangeably used. However, these two terms are not synonymous and have many notable dissimilarities.
Health insurance and mediclaim, though different from one another, are becoming increasingly popular to meet the spiralling costs of healthcare needs in India. However, most people make mistakes while buying a mediclaim or health insurance, considering the features of the two to be the same.

Therefore, it is necessary to address the differences between a mediclaim and a health insurance policy comprehensively.

Difference between a mediclaim and a health insurance plan

The following table explains the major differences between a mediclaim and health insurance across various parameters:
Health Insurance
Coverage limits
Only hospitalisation, accident-related treatment and pre-existing diseases up to a certain time span are covered under Mediclaim plans.
Health insurance plans are more comprehensive and also include both pre and post hospitalisation charges, ambulance charges, day-care charges etc. Some plans go to the extent of providing compensation in case of permanent disabilities and death that leads to a loss of income for the insured.
Basic Principle
Mediclaim works on the principle of indemnity. It essentially means that one can claim refunds only after hospitalisation.
Health insurance works on the principle of benefit. It essentially means that once you fall ill and your illness is covered under your health insurance plan, the insurance company will pay you a lump sum for treatment.
Critical Ailments
Mediclaim excludes all critical ailments.
Around 30 odd critical ailments are covered under a health insurance plan. The commonly included ailments are brain stroke, cancer, cardiovascular diseases and kidney failure.
Mediclaim offers no flexibility.
Health insurance is fully flexible. The insured person can modify his/her premium after a specific time span and alter the policy duration.
Policy features
Mediclaim plan differs from one company to another.
Most insurance companies offer the same health insurance policies of a specific sum insured.
A policyholder can file claims until the exhaustion of the total amount.
A policyholder can file claims as long as the sum insured does not get exhausted.
Add on options
Mediclaim generally does not have any add on options.
Health insurance plans offer several add on options such as accidental disability, critical ailment, maternity coverage and accident coverage etc.
Hospitalisation coverage
Mediclaim policies only include hospitalisation charges.
Health insurance plans not only include hospitalisation charges but also cover day-care treatments and diseases which require a considerable amount of pre- and post-hospitalisation treatment.

The insurance market is flooded with several mediclaim and health insurance policies that provide enormous support while dealing with ailments. Apart from the above-mentioned dissimilarities, both have many similarities as well, and each has its own pros and cons.

Therefore, it is recommended to take into consideration numerous factors such as age, income, the criticality of diseases, the network of hospitals etc., before taking the decision to purchase any of the two policies.

Learn more about Health Insurance Plans here.


The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.

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