Difference Between A Health Insurance Policy And A Mediclaim Policy

Before health insurance was introduced in India, people were only aware of the mediclaim policies. However, till date, most people use the two terms interchangeably and make mistakes while buying mediclaim or health insurance, considering the features of the two to be the same. Therefore, it is crucial to know the differences between the two in order to make an informed decision.

What is a mediclaim policy?

Mediclaim is a type of insurance that provides specific financial protection against expenses incurred for health-related issues. It is an affordable means to tackle medical emergencies. However, a mediclaim policy’s coverage is limited to hospitalisation charges, while the other expenses have to be borne by the insured person.

What is a health insurance policy?

Health insurance covers the medical expenses incurred by the policyholder. The insured either pays the medical expenses out of his/her pocket which is later reimbursed by the insurer, or the insurance company directly settles the bill with the hospital.

The features and benefits provided by a health insurance plan are subject to the terms and conditions mentioned in the policy document. Although the coverage is extensive, health insurance is generally more expensive than mediclaim.

Difference between mediclaim and health insurance

The following table explains the major differences between a mediclaim policy and a health insurance policy across various parameters:

ParameterMediclaim PolicyHealth Insurance Policy
Coverage limitsOnly hospitalisation, accident-related treatment and pre-existing diseases up to a certain time span are covered under mediclaim plans. Health insurance plans are more comprehensive and include both pre and post hospitalisation charges, ambulance charges, day-care charges etc. Some plans go to the extent of providing compensation in case of permanent disabilities and death that leads to a loss of income for the insured. 
Basic PrincipleMediclaim works on the principle of indemnity. It essentially means that one can claim refunds only after hospitalisation.Health insurance works on the principle of benefit. It essentially means that once you fall ill and your illness is covered under your health insurance plan, the insurance company will pay you a lump sum amount for treatment.
Critical AilmentsMediclaim excludes all critical ailments.Around 30 odd critical ailments are covered under a health insurance plan. The commonly included ailments are brain stroke, cancer, cardiovascular diseases, and kidney failure.
FlexibilityMediclaim offers no flexibility.Health insurance is fully flexible. The insured person can modify his/her premium after a specific time span and alter the policy duration. 
Policy featuresMediclaim plan differs from one company to another.Most insurance companies offer the same health insurance policies of a specific sum insured.
ClaimsA policyholder can file claims until the exhaustion of the total amount.A policyholder can file claims as long as the sum insured does not get exhausted. 
Add-on coversMediclaim generally does not have any add on options.Health insurance plans offer several add-ons such as accidental disability, critical ailment, maternity coverage and accident coverage etc.

The medical insurance market is flooded with both mediclaim and health insurance policies from several insurance companies. However, it is recommended to take into consideration numerous factors such as age, income, criticality of the diseases, network of hospitals etc. before purchasing any of the two policies.

Bajaj Finserv offers varied and easy insurance solutions for your health-related needs. Other than regular health insurance plans, it also offers a range of health insurance plans under its Pocket Insurance category.

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