Difference between a Mediclaim Policy and Health Insurance

While you will often hear Mediclaim being used interchangeably with regular medical insurance, these terms couldn’t be more different. The primary difference is that Mediclaim is limited to hospitalization costs, while a health insurance policy is more wholesome and extends its coverage to medical care beyond hospitalization.


Here are some detailed differences between the Mediclaim and a health insurance policy.

Mediclaim Medical Insurance
Mediclaim is only applicable for hospitalization. Basically it will only provide coverage for hospital-related costs.


In order to file for Mediclaim, you have to be hospitalized.

Medical insurance is more wide-ranging and will cover a pre and post hospitalization expenses, ambulance charges, compensation for the lost income and a variety of other costs incurred during illness or injury.


One does not need to be hospitalized to make a claim on their health insurance policy. A critical illness diagnosis is sufficient to claim funds.

The cover provided is limited. The upper cap does not exceed a certain amount. The coverage provided is quite board and the sum insured can be quite high depending on various factors.
A Mediclaim policy functions on the indemnity principle so the hospitalization charges are compensated to the insured, to provide a reimbursement for his loss. There are multiple components in a health insurance. There can be different riders like critical illness and accidental disability which work on the benefit principle.

This means that the reimbursement is done in the form of a lump sum irrespective of the loss incurred by the insured. So the insured only receives the sum assured.

Mediclaim will allow the insured party to make multiple claims until the sum insured is used up. When claiming for critical illness, personal accident and accidental disability cover, the whole sum that is assured is paid out at one go. The insured can only use the health insurance policy once and can no longer make any claims in the policy tenure.

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