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Mediclaim Vs Health insurance: What is the Difference

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​​When choosing a medical expenses policy, many need clarification on health insurance vs mediclaim. 

Though these are often used interchangeably, the terms health insurance and mediclaim reflect distinct concepts with some key differences. While medical insurance or mediclaim covers the costs of hospitalisation, health insurance offers more comprehensive coverage.

Whether you opt for the straightforward hospital coverage of mediclaim or the expansive benefits of health insurance, understanding health insurance and mediclaim differences is necessary. It will ensure that you and your family are well-protected in times of medical emergencies.

Let us explore the specifics of each option. We will compare the coverage, benefits, premiums and more to help you determine which best meets your healthcare needs.

What is Mediclaim Insurance?

Mediclaim is a type of health insurance policy that primarily covers hospitalisation expenses. It provides financial protection against medical emergencies, ensuring that policyholders can manage their hospital bills without financial strain. 

Typically, mediclaim policies reimburse the insured for their hospitalisation costs up to a specified limit, which may include room charges, doctor’s fees and other medical expenses. 

Mediclaim can be availed for both planned treatments and unforeseen medical emergencies. However, it generally has a capped sum insured, and the coverage is limited to hospitalisation expenses, excluding broader health benefits like preventive care and wellness services.

What is Health Insurance?

Health insurance is a comprehensive policy designed to cover a wide range of medical expenses beyond just hospitalisation. It includes outpatient consultations, diagnostic tests, pre and post-hospitalisation expenses and sometimes even preventive health check-ups. 

Health insurance policies often come with additional benefits like coverage for critical illnesses, maternity care and alternative treatments. 

Unlike mediclaim, health insurance offers higher sum insured options and extensive coverage, providing financial security against various health-related risks. 

This type of insurance is more flexible and inclusive, catering to the overall health and well-being of the insured beyond just emergency medical situations.

Diff between Health Insurance and Mediclaim


Health Insurance

Coverage Offered

A mediclaim plan covers only hospitalisation, treatments related to accidents, and pre-existing conditions up to a set limit.

A health insurance plan provides extensive coverage for hospitalisation expenses, pre-hospitalisation and post-hospitalisation costs, ambulance charges and more. It also offers compensation for loss of income due to accidents.

Add-On Covers

Mediclaim insurance does not include any add-on cover options.

It can include various add-on cover options, such as critical illness cover, personal accident cover and more.

Critical Illness Cover

A mediclaim policy does not cover critical illnesses.

Health insurance plans cover a wide range of critical illnesses, such as cancer, kidney failure, stroke, etc., depending on the policy specifics.


A mediclaim policy provides no flexibility in coverage.

A health insurance plan allows policyholders to adjust their coverage, increasing or decreasing as needed. They can also lower the premium amounts by altering the policy duration. For example, opting for long-term policies may offer discounts on premiums.

Sum Assured

Generally, the sum insured for a mediclaim policy does not exceed ₹5,00,000.

The sum insured for health insurance plans can range from ₹50,000 to ₹5,00,00,000 per year.


A mediclaim insurance plan does not cover ambulance charges.

Most health insurance policies include reimbursement for ambulance expenses up to a specified limit as per the insurance claim.


Under a mediclaim, a policyholder can make multiple claims until the insured amount is fully utilised.

In health insurance, the insured can file claims until the sum insured is depleted. However, for claims involving critical illnesses or accidental disability cover, the assured sum is dispersed in a lump sum. These types of claims can be made only once during the policy period. 

Things to Consider Before Buying a Mediclaim or Health Insurance Policy

Inclusions and Exclusions of the Plan : Before you buy health insurance, you must fully understand the coverage and inclusions. This clarity will prevent unexpected expenses and claim rejections.

Opt for Health Insurance Early :

It is wise to purchase health insurance early in life. Younger individuals make fewer claims, which reduces the overall costs. Don’t wait until you are older to start searching for a policy.

Choose the Right Health Insurance Company :

It is essential to select a reliable insurance company, like Reliance General Insurance. Claim processing speed varies by insurer. Use online resources to compare different policies and providers.

Understand the Waiting Period :

Check the waiting period before you make claims, especially for pre-existing conditions or maternity benefits. 

Policy Premium and Sum Insured :

The amount of coverage directly influences the premium costs. Broader coverage requires higher premiums.

Coverage for Daycare Procedures :

Check if the health plan covers daycare procedures, such as short treatments like cataract surgeries or tonsillectomies, which are completed within a day.

Specific Treatments and Diseases :

Coverage for some diseases and treatments are only available after the first two policy years. Verify these details with your insurance provider before buying a plan.

Room Rent Limits :

Room rent limits are vital. Choosing a room rent that exceeds the permitted limit can increase your out-of-pocket costs.

Availability of Add-On Covers:

Add-ons can enhance your coverage but require an additional premium. Choose your add-ons according to your needs.

Pre/Post Hospitalisation Coverage :

It includes tests and treatments before or after hospitalisation. Confirm these details before buying a health plan.

Mediclaim Policy vs Health Insurance: What is best for You?

Choosing between a Mediclaim policy and health insurance depends on your needs. The features of mediclaim vs health insurance vary slightly. Mediclaim provides specific coverage for hospitalisation expenses, which is ideal for basic healthcare.

Health insurance offers broader coverage, including pre and post-hospitalisation, daycare procedures and more. It is preferable if you want comprehensive protection that covers a wide range of medical issues and treatments. 

Consider your health needs, budget and the extent of coverage you need before considering features of mediclaim vs health insurance for you or your family.

Why Should You Choose Reliance General Insurance?

Reliance General health insurance policies provide substantial coverage options up to ₹5,00,00,000 and Cashless Everywhere.

We are proud to offer a 100% claim settlement ratio and ensure reliability and trust in our services. Our health insurance solutions are designed to meet the diverse needs at competitive premiums. 

You can also browse through our critical illness insurance, which provides coverage for life-threatening conditions and personal accident insurance for added protection.


​​Understanding the differences between mediclaim vs health insurance is essential while choosing a policy for your medical needs. Mediclaim offers a narrower focus, primarily covering hospitalisation expenses, which are sufficient for basic healthcare requirements. 

However, for those seeking a more comprehensive safety net, health insurance provides extensive coverage, including hospitalisation, pre- and post-hospitalisation expenses and much more. It covers a variety of medical conditions and needs. 

When considering a health plan, assess your health requirements, financial capabilities and desired coverage scope. 

Frequently Asked Questions (FAQs)​

Can mediclaim cover my entire family?

Yes, Mediclaim policies can cover your entire family under family floater plans, but they are limited to hospitalisation expenses.

Can I switch from mediclaim to a comprehensive health insurance plan?

Yes, you can switch from a Mediclaim to a more comprehensive health insurance plan. Many insurers allow you to upgrade with additional features and broader coverage as your healthcare needs change.

Are maternity benefits included in mediclaim and health insurance?

Basic Mediclaim policies generally do not cover maternity benefits unless specifically mentioned. In contrast, many comprehensive health insurance plans include maternity benefits and newborn care. However, it is best to confirm with the insurer before buying a policy.​