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How is a health insurance plan different from a Mediclaim policy?

Mar 15, 2018 | 2 years ago | Read Time: 3 minutes | By iKnowledge Team

From coverage to group claims and tax benefits, a health insurance and a Mediclaim policy differ on various aspects.

Did you verify the medical insurance before purchase? Well, it can be a health insurance or a Mediclaim policy. Both differ on a few parameters and have some commonalities too. Knowing both can ease your purchase decision:


Mediclaim covers hospitalisation-related expense only for a specific treatment or illness. The insurer provides a list of treatments covered under the Mediclaim. This comes along with the policy document. It also means that hospitalisation is compulsory for making a claim. The Mediclaim premium is proportional to the sum assured.

A health insurance plan is a little broader. It covers pre- and post-hospitalisation expenses too. Expenses that you pay for before you undergo a treatment are pre-hospitalisation expenses. Expenses that you incur after discharge from the hospital are post-hospitalisation expenses. The insurer defines the expenses covered under both the terms. The insurer also specifies the duration of coverage before and after hospitalisation. Your policy may cover certain expenses 30 days after hospitalisation. You can mention the approved medical expense in the claim within 30 days of discharge.

Rider benefit

Under a health insurance plan, you can opt for additional covers. These include critical illness and accidental disability riders. These add-on benefits are available for an extra premium. The insurer pays you a pre-defined lump sum amount in case an unexpected event occurs. This is an extra sum that gets added to the hospitalisation cost. The option to add riders is not available with Mediclaim.

Suppose you opt for a critical illness cover along with the health insurance plan. The critical illness cover guarantees you a Rs 20 lakh lump sum pay-out for early-stage cancer. The insurer is liable to pay you the assured amount when you are diagnosed with early-stage cancer. Your health insurance can cover the hospitalisation expenses. But the Mediclaim policy covers only your hospitalisation expense.

Multiple claims

A Mediclaim policy and a health insurance cover differ due to the critical illness cover. Under a Mediclaim policy, you can claim many times. For example, you get hospitalised today for a heart stroke and file a claim for a certain amount. Six months later, you get hospitalised again for an ailment that your policy covers. You can file a claim till your total claim amount does not exceed the sum assured.

You can claim only once for a critical illness in a health insurance. Suppose you purchased a health insurance with cancer cover. The insurer pays you a lump sum when you are first diagnosed with cancer. Say you recover, but later in life you get cancer again. This time you cannot file a claim for a lump sum pay out.

Mediclaim and health insurance also have many commonalities. These include:

Tax benefit

You can claim an income tax deduction on the premium paid for Mediclaim and health insurance policies. This helps you to get insurance and enjoy an income tax benefit. But tax-saving should not be your only aim when buying a policy. Identifying your need is important too.

Group cover

You can cover yourself and your family under a Mediclaim or health insurance plan. The insurance coverage differs from insurer to insurer. Look out for the terms and conditions here too. A family cover can help you save a lot and protect your family against rising medical expenses.

To sum up

A Mediclaim can help you to cover medical treatment cost. On the other hand, a health insurance can offer you more tailored benefits through an add-on cover like critical illness.

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