Health Insurance vs Mediclaim: Which is Best in 2021?

Health Insurance vs Mediclaim which health insurance is best? Read the whole article to know the important differences for your best plan.

Many people make this mistake of assuming health insurance and mediclaim as the same thing. However, each of them works differently and has various benefits. In this article, you will get to know the difference between health insurance and mediclaim. You will also find out how an individual plan will work out in your favor.

So, what are health insurance and mediclaim?

Health Insurance vs Mediclaim:

Health Insurance

Health insurance provides an individual with coverage for medical and surgical expenses. With this insurance policy, the insurance company settles the bill with the hospital directly. However, with some insurance companies, you have to pay the expenses from your pocket that will be later reimbursed by the company.

Now, let’s find out the features of a health insurance plan –


A typical health insurance plan safeguards you against any kind of medical expenses. It also offers an add-on of critical illness of more than 30 diseases.

Renewal Discounts

At the end of a claim-free year, a health insurance plan provides you “No Claim Bonus” benefit.


Some health insurance plan comes with co-payment. The primary purpose of co-payment is to lessen the insurance premium. This is because health insurance companies bear a certain percentage of medical expenses. The remaining amount has to be paid by you.

Tax Benefits

Any health insurance plan will offer you tax benefits under Section 80D of the Income Tax Act in India.


Mediclaim insurance offers you financial coverage for any health-related issues. It is comparatively cheaper insurance that bears your expenses for medical emergencies. Nevertheless, mediclaim insurance will only provide you with limited coverage for hospitalization. The other costs should be paid by the policyholder.

So, how does a mediclaim insurance work?


Mediclaim insurance covers your hospitalization expenses, treatment expenses because of an accident and some particular diseases.

Sum Assured

A typical mediclaim insurance comes with a sum assured that is pre-determined.

Premium Factors

The premium of a mediclaim insurance plan depends on the following factors –

  • Sum insured
  • Policyholder’s age
  • Gender
  • Geographical location
  • Duration of the plan

Claim Settlement

Insurance companies process the claims for mediclaim insurance through reimbursement or cashless treatment.

Tax Benefit

Mediclaim offers tax benefits under Section 80D of the Income Tax Act in India.

Are you still confused between health insurance and mediclaim? Look at the table below to see what makes them apart.

Core Differences between Health Insurance and Mediclaim:

Factors Health Insurance Mediclaim
Coverage A health insurance plan provides complete coverage against hospitalization expenses, pre and post-hospitalization expenses, and ambulance expenses. Moreover, it provides compensation if an individual loses his job due to an accident. A mediclaim offers coverage for hospitalization expenses, treatment expenses due to accident, and pre-existing diseases to some extent.
Add-ons It offers some add-on coverage, such as coverage for critical illness, personal accident, accidental disability, maternity, and much more. It offers no add-on coverage.
Flexibility A health insurance plan gives you the freedom to reduce the premium amount after a certain period. You can also change the policy duration as per your need. Medicalim insurance plans do not offer any flexibility in terms of coverage.
Features The benefits and features of a health insurance plan are the same for almost all insurance companies. Different insurance companies offer various mediclaim benefits, and the features vary as well.
Critical Illness Cover It offers critical illness cover as an add-on for more than 30 diseases, including cancer, stroke, cardiac diseases, etc. It does not have any option for critical illness coverage.
Sum Assured A health insurance plan provides extensive coverage with a sum assured of not more than Rs.6 Crores per annum. Mediclaim insurance plans come with a pre-assured sum of Rs.5 Lakhs.
Claims In case of critical illness or accidental disability, you can file a claim only once during the policy duration. For other cases, you can file claims as long as your sum insured is not finished. With a mediclaim insurance plan, you can file claims till your assured amount is drained.
Hospitalization An individual does not need hospitalization to get the benefits of health insurance. You can get benefits like day-care procedures without hospitalization. Individual needs to be hospitalized to get the benefits of mediclaim insurance.


These are all the sectors that make the difference between health insurance and mediclaim. By now, you should be able to understand what health insurance and mediclaim are and how each of them can benefit you. Hence, you can make a wise decision to choose between the two.

Frequently Asked Questions

  • What are the top 3 Mediclaim insurance policies in India?

Here are the top 3 Mediclaim insurance policies in India:

  1. Aditya Birla Mediclaim Policy – sum insured of Rs.10-30 lakhs
  2. Bajaj Allianz Mediclaim Policy – sum insured of Rs.1.5-50 lakhs
  3. Bharti AXA Mediclaim Policy – sum insured of Rs.3, 4, 5 lakhs
  • Which is better between mediclaim and health insurance?

Mediclaim and health insurance have their individual benefits and features. A health insurance plan offers you coverage for all hospitalization expenses, pre and post-hospitalization expenses, including ambulance fees. Whereas a mediclaim plan provides limited coverage to only hospitalization expenses.

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