Difference between mediclaim and health insurance


21 Jul 2023

Read about Difference between mediclaim and health insurance. For more information, check out the health insurance plans from Kotak General Insurance.

Over the past few years, more and more people are understanding the importance of having the right health insurance policy. However, when it comes to buying a health insurance plan, there are certain confusions and doubts that one may face. One of the first few things that you need to understand is the difference between mediclaim and health insurance. Being the basis of health insurance, it is important to know their differences and not confuse them to be the same. While both these terms are often used synonymously, they do come with their set of differences. Let's take a look.

Health Insurance

Health insurance is a comprehensive concept. A health insurance plan offers you complete coverage for medical treatments. A health plan either directly settles your hospital bills in the form of cashless hospitalisation or compensates your expenses in the form of a reimbursement post-treatment. The coverage also includes pre and post-hospitalisation, daycare procedures, ambulance charges, check-ups, etc.


A mediclaim policy is a basic type of health insurance that offers you specified coverage against your health-related expenses. The coverage is mostly limited to hospitalisation and a few other expenses. Though mediclaim is comparatively reasonable, the coverage is also not as much as in a health insurance policy.

Just like health insurance, mediclaim policies can also be used to cover your family members also. Both plans offer tax benefits under Section 80D of the Income Tax Act. Despite these similarities, there are certain differences between the two. Some of them are listed below.


Health Insurance



Comprehensive coverage that includes in-patient expenses, overheads, pre, and post-hospitalisation, and loss of income as well.

Even when there is no hospitalisation, a claim can be raised for a daycare procedure.

Certain critical illnesses are covered in a health plan

Offers coverage for treatment in a hospital related to accidental injuries and specified illnesses up to a specified limit.

To avail of the mediclaim coverage, hospitalisation of a minimum of 24 hours is mandatory.

In most cases, a mediclaim policy does not cover critical illness.

Sum Insured:

A health insurance policy can have a sum insured of INR 50 lakhs or even more

The sum insured in a mediclaim policy is generally limited to a few lakhs


A long list of riders/ add-ons are available with a health insurance plan that allows enhanced coverage.

In a mediclaim, there are no rider benefits available.

Mediclaim or Health Insurance, what to choose?

Choosing between mediclaim and health insurance can seem to be a little difficult. However, to make a well-informed decision, you need to keep a few factors in mind. Although a health insurance plan offers more coverage, it comes with a higher premium in contrast to a mediclaim policy. If you are young and healthy and do not have any common health conditions in your family history, you may opt for a mediclaim. For someone over 30 who has had some medical issues should prefer a health insurance plan. When making a decision, chalk out your needs, and make a decision that best suits your and your family’s needs.

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Team Kotak GIC

The content of this blog has been created and carefully reviewed by the esteemed team at Kotak General Insurance, with the sole purpose of providing valuable guidance and sharing insights on the importance of general insurance. Our objective is to assist users in making informed decisions when purchasing or renewing insurance policies for their cars, bikes, and health. Our expertly curated information aims to empower our readers with the knowledge they need to protect their valuable assets and financial interests.