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Which One is Better: Mediclaim or Health Insurance?

Know in detail the difference between mediclaim and health insurance & understand what policy suits the needs of you and your family.

  • 3,298 Views | Updated on: Oct 12, 2023

In the last several decades, the Indian society has begun to warm to the notion of having insurance policies. While some see it as a necessary part of their financial planning, others see it as a responsibility towards their loved ones.

However, one question that most Indians have is what is the difference between mediclaim and health insurance, or which is better: mediclaim or health insurance?

In this post, we’ll provide a full comparison of the two to help you understand the differences and determine which is ideal for you.

Health Insurance vs Mediclaim

Difference Between Mediclaim And Health Insurance

Mediclaim Policy

A mediclaim coverage is solely responsible for paying for hospitalization and specific types of diseases up to a particular sum or limit. Paying for medical expenditures may be done in two ways: cashless or reimbursement. You shouldn’t have to pay with your own money if you have a cashless facility. Alternatively, you will be obligated to pay for the treatment, which the insurance company will cover up to the maximum level of the plan. Guaranteed amounts under mediclaim are, on average, smaller than those in health insurance.

Hospitalization plans, critical illness plans, cashless plans, personal accident plans, and hospital daily cash benefits are types of mediclaim insurance.

  • Add-Ons

Modifications and add-ons to mediclaim policy are not permitted.

  • Benefits

Mediclaim benefits can only be claimed in the event of hospitalization.

  • Payment

For the cashless option, payments either are repaid to the policyholder or paid to the hospital.

  • Sum Assured

Mediclaim’s hospitalization coverage is restricted, and it does not exceed beyond ₹5 Lakh.

Health Insurance

Health insurance, on the other hand, is a broader coverage that covers more than simply hospitalization. Health insurance covers more than just treatment and hospitalization. It also provides full coverage for ambulance costs, maternity costs, treatment options, animal bite vaccinations, and emergency domestic evacuation, among other things.

Furthermore, you do not need to be hospitalized in order to file a health insurance claim. Even if the therapy is provided in an outpatient setting, you will be compensated. A health insurance policy also has no limitations on the number of claims you may make.

  • Add-On Benefit

There are a variety of add-on coverage available, including Critical Illness Cover, Maternity Benefit, and IVF Cover, among others.

  • Benefits

Benefits from health insurance can be obtained without any need for hospitalization.

  • Payment

Payments are either repaid to the insured, paid to the hospital in the event of a cashless approach, or paid in one lump amount in circumstances like critical sickness, special illness plans, and so on.

  • Sum Assured

The health insurance policy might be as high as a few crores.



Health Insurance

Cover Benefits

Provides cover for hospitalisation, accident-related issues, pre-defined illnesses, etc.

Covers hospitalisation charges (both pre and post) and also looks into compensation for income loss.


Provides no add-on benefits.

Provides add-on benefits with riders like critical illness, accidents, etc.

Critical Illness Cover

Provides no critical illness cover.

Provides critical illness cover that looks into over thirty diseases such as organ failure, cancer, etc.

Sum Assured Amount

Does not exceed ₹ 5 lakhs.

Does not exceed ₹ 6 Crores on a yearly basis.


The insured must get hospitalised for availing mediclaim benefits.

Hospitalisation is not necessary to avail health insurance benefits.

To summarise, it is difficult to decide which one is better among Mediclaim and health insurance. When deciding between the two, understanding the difference between mediclaim and health insurance is critical. As a result, you must have a complete awareness of their numerous features to make the best decision based on your budget and needs.

- A Consumer Education Initiative series by Kotak Life

Amit Raje
Written By :
Amit Raje

Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.

Amit Raje
Reviewed By :
Prasad Pimple

Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors

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Ref. No. KLI/22-23/E-BB/2435