How is Health Insurance Different from Mediclaim Policy?


How Mediclaim Differs from Health Insurance?

One of the most common mistakes a person believes is mediclaim and health insurance policies are alike. It’s high time to address the issue, but before that let’s understand what health insurance and mediclaim are.

Mediclaim is a type of insurance that offers coverage of domiciliary care and Hospitalization expenses in case of an accident, however health insurance policy has a comprehensive coverage and covers the cost of medical and surgical expenses beyond basic hospitalization that includes Ambulance, Pre and Post-Hospitalization Expenses, Day Care Treatments, OPD Expenses, Critical Illnesses, and much more.

Mediclaim Vs Health Insurance

Here are a few main points of comparison between health insurance and Mediclaim policy:



Health Insurance

Basic Definition

A type of insurance that offers coverage for hospitalization related expenses for a specified time limit

Comprehensive insurance coverage for medical costs and surgical expenses beyond basic hospitalization


Cover for domiciliary care and hospitalization expenses in case of an accident

All-inclusive coverage for Ambulance, Pre and Post-Hospitalization, Diagnostic Tests, Day Care Treatments, OPD Expenses, Critical Illnesses, Maternity Expenses, etc.

Cover for critical illnesses

Hospitalization cover not applicable for critical illnesses

Cover for 32 major critical illnesses including cancer, major heart surgeries and liver transplant


Main characteristics of a Mediclaim policy might vary from one insurance provider to the other

Benefits and advantages by general health insurance plan remain the same over most health insurance providers

Sum Assured

The sum assured restricted to five lakhs only

The sum assured can go unto six crores, per year


A Mediclaim policyholder has the right to file claims until the total amount is completely exhausted

In some health insurance plans like critical illness cover, the sum insured must be paid in lump sum and claims can be made only once during the entire policy duration. For most plans, claims can be made until the total amount is completely exhausted. 

Cover for Hospitalisation

To avail the benefits of Mediclaim, it is necessary for the insured person to be actually hospitalized

To avail the benefits of health insurance plans, the insured person need not be actually hospitalized. He/she can avail benefits like daycare, regular check-ups, prenatal expenses, etc.

How Does Health Insurance Score Over Mediclaim Policies

Mediclaim policies are often very restrictive but can come in handy during emergencies like hospitalization due to accidents. However, since health insurance offers 360-degree coverage, most experts recommend having a Health insurance plan. Such plans are designed keeping all healthcare requirements of an individual in mind. It accommodates coverage from the very start of any health issue. A health plan has many added benefits and features, some of which are listed below.

  • Pre-Hospitalization involving OPD care such as doctor consultations, diagnostic tests, and pharmacy
  • Global Coverage for planned hospitalization with the option of cashless hospitalization for specified illnesses from a medical facility abroad.
  • Cover for alternative treatments such as Ayurveda and Homoeopathy (AYUSH)
  • Annual Health Check-ups which every insured member can avail once.
  • No claims bonus for policyholders who do not claim in a policy year. Insurers offer a 10% increase in Sum-Insured for 5 years i.e. a maximum increase of 50% in 5 claim-free years.
  • Automatic Recharge of Sum Insured once it gets exhausted in a policy year so that one never runs out of coverage. This is at no extra cost and technically the insured gets double sum insured for the same premium.
  • Daily hospital cash allowance involves additional coverage like food and hospital visits.
  • Cover for surgery costs for organ transplants as an add-on, either in full or in partial amounts.
  • Lifelong renewability. Once enrolled an insured can stay covered for a lifetime as long as they timely renew their policy every year.
  • In-built maternity cover feature, with a waiting period of nine months, for both prenatal and postnatal expenses. Some policies also extend coverage for newborns from birth up to ninety days.
  • Cost cover for ambulance and day-care treatments in which hospitalization is less than 24 hours
  • Add-on covers with the choice to enhance/upgrade policy coverage by paying a very small amount.
  • Coverage for loss of income due to an accident.

Insurance suppositions can be different from one another. An insurance plan that works for one family might not work for another. For this very purpose, all health insurance companies provide a wide range of plans that can be tailored to suit different people with different medical backgrounds.

Religare Health Insurance resolves to offer a solution for customers from all walks of life. Their comprehensive Health Insurance - Care offers the aforementioned benefits and in addition comes with features like Automatic Recharge of Sum Insured, Annual Health Check-up for all Insured Members, No-claim bonus and Air Ambulance Cover. All of this with a service commitment of just 2 hours for cashless claim approval.

Cashless Mediclaim Policy for Family in India

Health Insurance offers its customers two claim settlement options - reimbursement and cashless. Every health insurer allows its customers to avail cashless treatment across any hospital empaneled in their network. Simply put, a cashless Mediclaim policy is one where the health insurance provider company deals with the expenses directly with the healthcare institution. This is done, to minimize the direct financial load on that particular individual at the time of hospitalization. For the customer, this is highly convenient. For a hassle-free experience, one should intimate the insurer post-admission within the specified time period which is 48 hours in most cases. Apart from this, one should read all key policy terms and conditions and keep their health card handy as it must be presented in the hospital.

However, if an individual at the time of emergency wishes to go-ahead with their treatment in a hospital of their choice and which is not in the insurance company's list - they can still claim. In this case, they will have to bear the hospital expenses from their own pocket and file for reimbursement after getting discharged.

Things that Separate Mediclaim from a Health Insurance

Mediclaim usually provides coverage against hospital bills, treatment expenses that occur during accidents and a list of specific diseases. Typically, there are often three types of exclusions in a Mediclaim insurance plan:

  • Permanent (diseases that are not covered at all)
  • Temporary (diseases that are covered after a specific time period is covered)
  • Limited (diseases covered within the policy with a cap on the payout)

There is a number of other exclusions - temporary or permanent that are not covered by most Mediclaim policies - wars, nuclear weapon strikes, circumcision, non-allopathic treatment, pregnancy and childbirth-related complications, cosmetic surgeries, HIV or AIDS-related diseases, substance abuse, intentional self-injury, vaccination, vitamins, nutritional supplements, cost of spectacles, hearing aids and artificial teeth. Usually, Mediclaim policies cover dental-only if it mandates a minimum of 24 hours of hospitalization.

These days there are options also to have a mediclaim policy to suit senior citizens. The age for a senior citizen to apply is between sixty-one to sixty-nine years. The premium for the Mediclaim for senior citizens is usually high. Some insurance companies also offer add-on coverages for alternative medical treatment methods.

How Does Mediclaim and Health Insurance in India Work?

Mediclaim policies are extremely beneficial when it comes to meeting hospitalization expenses. The following features are unique to a Mediclaim policy and define the way it works in India.

  • Cover Offered: Mediclaim policies offer specific coverage such as hospitalization expenses cover and cost cover for accident-related treatment and certain diseases.
  • Group Mediclaim: Just like Health Insurance, a Mediclaim policy also offers a family health insurance plan which means one could cover multiple family members like parents, spouse, and children in a single policy. A Group Mediclaim is a type of Mediclaim policy wherein the coverage is extended to a group of people, for example, employees of an organization.
  • Premium and Sum Insured: Mediclaim policies have usually a predefined sum insured. The policy premium is calculated on the basis of factors like sum insured, gender, proposer’s age, treatment location, and policy duration.
  • Claim: The claim settlement is generally in the form of reimbursement of the hospitalization expenses by the insurance company.
  • Tax Advantages: Such plans offer a tax rebate on the premium paid under section 80D of the Income Tax Act.

Health insurance plans are the most widely preferred insurance plans in India owing to the comprehensive nature of coverage offered by them. Listed below are some exclusive features that explain how they work in India:

  • Cover Offered: Health policies offer complete coverage for various medical exigencies such as critical illness, pre-existing diseases, etc.
  • Family Cover: Family floater plans offer health insurance coverage for the entire family parents, spouse and children.
  • Tax Benefits: Health insurance buyers can get tax deductions under section 80D of the Income Tax Act on the premium they pay for a policy.
  • Cashless Hospitalisation: This feature enables an insured person to avail cashless Mediclaim treatment in any of the network hospitals of the insurer, thus providing a high level of convenience.
  • Co-payment Option: Some senior citizen health plans have a co-payment option which requires the policyholder to bear some percentage of the medical costs. Buyers can look forward to lower premiums.
  • Discounts and no-claim bonus: Health plans bring a variety of additional benefits generally offered during policy renewal in the form premium discounts and higher sum insured as a bonus for having a claim-free year.