Here’s the Difference Between Health Insurance and Mediclaim

If you are on your journey of buying a health cover, you must have heard the terms‘Mediclaim’ and ‘health insurance.’ Moreover,it isobserved that people often use these terms interchangeably or sometimes coherently as well.

The confusion between these two is long-standing and propounds various challenges to insurance bearers while understanding the benefits, terms, and conditions of both the health covers. Therefore, before making your final decision, it is important to properly understand the difference between a Mediclaim policy and a health insurance plan.

Health Insurance Plan vs. Mediclaim Policy

Health insurance is an insurance policy that provides extended and complete coverage for various medical as well as severe surgical conditions. Additionally,some plans also provide reimbursement for pre and post-hospitalization charges, consumable expenses, hospital room rent, and other related expenses.

The insurance provider either reimburses the amount to the insurance bearer later (reimbursement claim process) or clears the bill directly with the hospital (cashless claim process). In both cases, there is a need to submit essential documents for settling the claim.

On the other hand, a Mediclaim policy offers specified protection against expenses related to health. However, the coverage of a Mediclaim policy is limited to hospitalization, and other related expenses need to be borne by the policyholder. It is often considered one of the pocket-friendly ways to get financial support formedical events. But, its limitation of handling only hospitalization charges limits its preference.

Why are These Terms Used Interchangeably?

Often, terms such as Mediclaim and health insurance are used interchangeably. Most of the people get confused between these two and thereby end up buying flawed health covers. Moreover, sometimes they misunderstand thebenefits provided by their chosen health cover. This increases the chances of not being able to avail ofappropriate benefits during medical emergencies. But why does this happen?

Generally, people get confused between these two because of overlapping boundaries and benefits. Furthermore, as both of them reimburse hospitalization expenses during medical exigencies and are provided by the same insurance providers, the confusion between the two stays.

But, it is high time we clear this perplexion.

What are the Major Differences Between Mediclaimand Health Insurance?

Merely knowing about the exact meaning of health insurance and Mediclaim does not provide wisdom to differentiate between them precisely. As both of them share some invisible and overlapping boundaries, comprehending them as distinct entities might get difficult for some people. Here is a detailed comparison between them:

Health Insurance




Provides extended health insurance coverage for pre-hospitalization, hospitalization, and sometimes post-hospitalization charges as well(if incurred in a plan)


Provides coverage only in case of hospitalization
With the provision of add-on benefits, it provides an opportunity to insurance bearer to get insurance coverage extended


No availability of add-on coverage for getting extended coverage


Provides flexibility on coverage, upgrades, and more.


Less Flexible


A smartly designed plan covers most of the medical conditions. For example, a comprehensive health insurance plan from providers such as TATA AIG providesa plethora of benefits and exceptional support during chronic illness.


Lacks coverage for chronic and critical illness


Health insurance can be leveraged at flexible prices, thereby providing extended coverage. Generally, the limit is 6 crores (INR)


Generally, its limit is up to 5 Lakhs (INR)


Which One is Better: Mediclaim or Health Insurance?

The answer to this question is subjective. The smart choice of whether to opt for Mediclaim or health insurance stands on various important factors like your age, your health condition, how often you visit a doctor, do you prospectively need a surrey in the future, and last but not least, your financial capacity. However,a majority of people prefer buying health insurance from credible insurance providers like due to the comprehensive coverage they offer. Additionally, they have a reasonable claim settlement ratio and offer exceptional services, making them one of India’s top insurance providers.

One can introspect, compare and contrast different providers to get a better picture of the type of plan to choose.

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