Mediclaim and Health Insurance

You must have heard friends and relatives usually referring to their health insurance policies as mediclaim. A mediclaim is a kind of health insurance that takes care of your hospitalisation expenses, but a health policy would provide additional benefits. Most policyholders are not aware of this difference and use the terms interchangeably. Read on to know about some significant differences between health insurance and mediclaim, of which you may not be aware.

Medical insurance or mediclaim offers coverage for hospitalisation and treatment costs for pre-specified ailments and accidents. You cannot buy any add-on cover with it. The different types of medical insurance are individual medical insurance policy, family floater health insurance policy, and group mediclaim. Your health insurance covers medical insurance and several other situations, which makes it an extensive plan.

Differences between policies

The differences between these two policies are explained in the table below:

Basis of comparisonMediclaimHealth Insurance
CoverageProvides coverage related to hospitalisation due to diseases and accidents up to a certain limit.Covers hospitalisation expenses and non-hospitalisation benefits also. The limit of coverage is extensive.
Add-on coversYou may not be able to buy add-on covers with this plan.To increase the extent of cover, you can buy add-on policies besides standard health insurance. Some popular add-on covers are critical illness cover, personal accident cover, accidental disability cover, maternity cover, etc.
Critical illnessesThis plan usually does not cover critical illnesses.If you have the critical illness add-on, it’ll cover several major critical illnesses like cancer, stroke, kidney failure, Alzheimer’s, Parkinson’s, paralysis, cardiovascular problems etc.
Sum insured (SI)The sum insured amount is quite limited, usually up to ₹5 lakhs.It offers adequate sum insured, and you can also top-up the existing limit.
Pre and post-hospitalisation expensesYou will not get covered for pre and post hospitalisation expenses.This policy covers pre and posts hospitalisation expenses like diagnosis, doctor’s consultation charges, etc. up to certain limits. You would find the duration mentioned in the policy document.
Ambulance chargesThere is no reimbursement for ambulance charges.The insurer will reimburse the ambulance charges up to a certain limit.  
Maternity benefitsMediclaim provides coverage for specific illnesses only. Usually, maternity benefits are not covered.Under health insurance, you can get covered for maternity benefits with a maternity add-on. It includes both normal and caesarean delivery.
Value-added servicesMediclaim policies don’t come with value-added services like free health check-up, second opinion, diet and nutrition consultation, online chat with medical practitioner, etc.You get to avail an interesting bunch of value-added services with health insurance policies. Some of those are free health check-up, information on offers related to healthcare services like consultation, diagnostics, medical equipment and pharmacy, e-opinion (second opinion), nutrition consultation, etc.

The above differences would help you to decide on a specific plan as per your needs. You may go for a health insurance family floater or individual policies for each member of your family. Sometimes, a combination of health insurance and separate mediclaim policies may also be a good decision.


Many policyholders are not aware of the difference between a mediclaim and a health insurance plan. In reality, these two plans have many dissimilarities in terms of policy features and extent of coverage. Health insurance is more extensive in terms of the cover that it provides. The differences between these two types of plans would help you make the best choice for yourself and your family.

By Punit