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Key Difference between Health Insurance and Mediclaim Policy

A Mediclaim Policy is a type of insurance cover that provides specific/limited coverage for certain medical emergencies. Read to know the difference between health insurance and Mediclaim policy.

  • Nov 18, 2022

Unforeseen health scare remains a permanent part of life. To rely on your hard-earned savings to get you through a medical crisis is risky and cost-heavy. Preparing for such situations is better and getting the necessary financial backing beforehand is better. At such times, a Health Insurance Policy or a Mediclaim Policy will come to your aid and cover the medical costs related to any illness, injury, or accident. While Health Insurance and Mediclaim Insurance, often mistaken to share similar features, offer different benefits.

What is Health Insurance?

Health insurance is a type of insurance cover that provides all-around coverage for medical emergencies. Health insurance coverage aims to provide comprehensive financial protection to the policyholder in the event of an illness, injury or accident.

Health insurance covers not only in-patient hospitalisation costs for medical treatment but also additional expenses like pre and post-hospitalisation costs, fees for home treatment, and payments for non-allopathic forms of therapy (Ayurveda, Yoga Unani, Siddha Homeopathy and Naturopathy). It also covers the costs of various surgical procedures, out-patient treatments and medication, among other requirements.

What is a Mediclaim Policy?

A Mediclaim Policy is a type of insurance cover that provides specific/limited coverage for certain medical emergencies. The scope of coverage in a Mediclaim Policy is pre-defined and is limited to particular injuries, accidents and ailments.

In addition, the range is restricted to in-patient hospitalisation costs at an allopathic facility/home care treatment. Moreover, the sum provided to the policyholder is also pre-defined and capped, beyond which they cannot make a claim.

Difference between Health Insurance and Mediclaim Policy

Here is the health insurance, and mediclaim difference


Health Insurance

Mediclaim Policy

Scope of Coverage

Provides extensive coverage. Covers:

  • Various health ailments

  • Pre and post-hospitalisation costs

  • In-patient Hospitalization costs

  • Costs for daycare procedures, non-allopathic treatment (AYUSH), organ donor transplant, modern/ advanced treatments and a range of other surgical procedures

  • Ambulance and transportation costs

  • Costs for diagnostic tests, annual health check-ups, second consultations

Provides limited/ specific coverage. Covers:

  • Specific health ailments

  • In-patient Hospitalization costs

  • Domiciliary hospitalisation costs

Provides extensive coverage

Up to ₹1,00,00,000 and above

Up to ₹5,00,000 only


  • Individual Health Insurance

  • Family Floater Health Insurance

  • Critical Illness Health Insurance

  • Senior-citizen Health Insurance

  • Personal and Group Accident Health Insurance

● Individual Mediclaim Policy

● Family Floater Mediclaim Policy

● Senior-citizen Mediclaim Policy

● Critical Illness Mediclaim Policy

Health Insurance Differs From Mediclaim in 5 Ways

Expenses before and after hospitalisation

A medical insurance policy will only pay for inpatient care. Up to a certain extent, it might cover the treatment of various ailments. Contrarily, health insurance coverage has a wider scope. It comprises costs related to the diagnosis, medical visits, and other costs incurred days before and after the hospitalisation. These expenses are not covered by standard medical insurance coverage.

Ambulance fees

Ambulance fees are not reimbursable through a mediclaim. In contrast, most health insurance policies allow for the reimbursement of ambulance expenses up to a certain level. The insurance provider pays back these costs.

Daycare practices and maternity benefits

A mediclaim normally pays for hospitalisation expenses for predetermined illnesses. They exclude any expenditures related to pregnancy, including caesarean sections and other child-related medical care. As hospitalisation is a requirement for Mediclaim, daycare operations like cataract surgery that don’t require hospitalisation are inevitably excluded. These things could be included in a claim for health insurance.

Cost and advantages

The cost of the insurance policy is also less than that of a health insurance policy because the coverage of a mediclaim is limited. Typically, only ₹5 lakhs are covered under this. A health insurance policy, on the other hand, is much more extensive and includes much more. This results in a bigger sum assured while simultaneously raising the cost of the premium.

Amount of claims

Multiple claims may be submitted under a Mediclaim policy throughout the course of a year provided the Sum Assured Limit is not reached. A health insurance policy usually allows the insured to submit one claim each year.


Both Health Insurance and Mediclaim Insurance policies provide coverage for health issues. The main difference lies in the scope of coverage each provides. If you need holistic financial support, opting for a health insurance policy is advisable. On the other hand, if you want limited financial support for a specific health condition, then a medical claim policy will work well. Based on your financial situation and health demands, you can make an informed decision.

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- A Consumer Education Initiative series by Kotak Life

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