Health Insurance vs Mediclaim

It is a misconception that Health Insurance and Mediclaim can be used interchangeably. Although they do have some similar characteristics, they are quite different in terms of their function. Health Insurance covers a wide range of expenses, including pre and post-hospitalisation, cost of treatment, transportation costs and maternity-related costs. Some policies even cover outpatient expenses and surgeries. Mediclaim provides limited coverage that is restricted to hospitalisation and the treatment of certain diseases. Health insurance plans offer a higher coverage compared to Mediclaim. It is customisable and can be further enhanced with add-on covers, while Mediclaim doesn’t offer any such facilities. 

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Overview on Health Insurance & Mediclaim

Health insurance is a comprehensive insurance policy that covers a plethora of medical expenses, including pre-hospitalisation costs, treatment costs, post-hospitalisation costs, transportation costs, and maternity-related costs. Many health insurance policies even cover outpatient procedures and surgeries as well.

Mediclaim insurance, on the other hand, only covers hospitalisation expenses and the treatment of certain diseases. Not only does this policy offer limited coverage, but the sum insured is also quite low compared to a typical health insurance plan. 

Differences Between Mediclaim and Health Insurance 

Let’s understand the differences between mediclaim and health insurance with the help of this table given below: 


Health Insurance 



Health insurance covers a wider range of expenses, including pre and post-hospitalisation expenses, ambulance costs, OPD costs, and even covers loss of income due to accidents or diseases.

Mediclaim insurance only covers expenses incurred during hospitalisation.


You can extend the scope and amount of coverage in a health insurance plan by opting for add-on covers at the time of purchase.

Mediclaim insurance doesn’t offer any add-ons or riders that you can opt for.

Maximum Sum Insured 

The amount of coverage offered by a health insurance plan is quite high and can even go up to ₹1 crore or more.

The amount of coverage in a mediclaim insurance plan is usually low at around ₹5 lakh or lower.


Health insurance plans offer a greater amount of flexibility in terms of the amount of coverage, tenor, policy terms, and even premium payments.  

Mediclaim insurance doesn’t offer any level of customisation.

Critical Illness Cover 

Most health insurance plans provide coverage against a wide range of critical illnesses, including cancer, heart disease, organ failure, etc.  

Mediclaim plans do not provide any separate coverage against critical illnesses. 

Domiciliary Cover 

Many health insurance plans provide coverage for domiciliary treatments and expenses. 

Mediclaim policies generally do not have any provision for domiciliary cover. 

Premium Costs 

Health insurance provides a wide range of coverage for various types of treatment-related expenses, so their premium cost is generally higher. 

The premium cost of mediclaim plans is generally lower than health insurance. 

Things to Know Before Buying a Mediclaim or Health Insurance Plan in India 

Here are some important things that you need to consider before buying a mediclaim or health insurance for yourself or your loved ones: 

  • Sum Insured 

Sum insured refers to the maximum amount of medical coverage you are eligible to receive through your mediclaim/health insurance plan. You should try to pick a plan that offers the higher sum insured at reasonable rates. 

  • Type of Plan 

It’s also important to consider which type of mediclaim/health plan you should buy. There are a variety of plans available such as individual health plans, family health plans, and senior citizen health plans that you can choose from. 

  • Extent of Coverage

While you’re deciding the amount of coverage, it is also a good idea to take the extent of coverage that you want into account as well. While some may want more comprehensive coverage that includes pre-hospitalisation costs and ambulance costs, others may want to just take care of the hospitalisation part of the expenses. Deciding the extent of coverage beforehand can allow you to better customise the insurance plan according to your needs.

  • Policy Duration 

This is another major factor that you should be aware of before deciding to purchase an insurance policy. Usually, most health insurance plans are offered for only a year. However, there are plans that are offered for a tenor of 2 or more years as well. The longer the tenor you opt for, the better, as you would effectively be shielded from any unexpected premium increases.

  • Network Hospitals 

Finally, before making your purchase decision, remember to check the network hospitals supported by the insurance plan. The more the number of hospitals in the network, the better, as it would allow you to opt for cashless claims, which can significantly reduce your financial burden.

Should You Buy a Mediclaim Policy or a Health Insurance in India?

The ultimate decision of whether you should purchase a mediclaim policy or a health insurance plan lies with you. If extensive and comprehensive coverage for almost all kinds of medical expenses is what you seek, a health insurance plan will serve you well. On the other hand, if you’re only looking to cover hospitalisation expenses and treatment costs for certain specified diseases, a mediclaim policy should be enough for you. Before you make a purchase decision, make sure to take your needs and requirements into account.


Although a mediclaim policy is a good safeguard against hospitalisation expenses, it is limited in scope and will only help you cover a part of your medical expenses. On the other hand, a full-scale health insurance plan will help you cover the majority of your health-related expenses.  If you are not sure about what you need, you can head to Bajaj Markets and check out the health insurance plans available on the website. 

Health Insurance Plans Available at Bajaj Markets

FAQs on Mediclaim vs Health Insurance

  • ✔️What is the difference between health insurance and mediclaim insurance?

    The primary difference between the two policies is that mediclaim only covers you during hospitalisation. However, health insurance provides comprehensive coverage irrespective of your hospitalisation.

  • ✔️Does mediclaim insurance offer cashless claim settlements?

    Yes. Mediclaim insurance has a cashless claim settlement facility. The expenses incurred during your hospitalisation are directly taken care of by the insurer.

  • ✔️Does health insurance offer cashless claim settlements?

     Yes. Health insurance, too, offers cashless claim settlements. The insurer will compensate the hospital directly for the incurred expenses.

  • ✔️Can I buy health insurance at Bajaj Markets?

    Yes. You can buy health insurance plans with us at Bajaj Markets online by going to the ‘Health Insurance Premium Calculator’ page and entering your details.

  • ✔️ Is it safe to buy mediclaim or health insurance online?

    It’s completely safe to buy mediclaim or health insurance policies online as long as you are buying them from a reliable company or aggregator.

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