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Health Insurance vs Medical Insurance: Know Major Difference & Benefits
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Health Insurance vs Medical Insurance – How To Choose Between The Two

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Health Insurance vs Medical Insurance

Did you think these are two names for the same insurance product? Even though the purpose of both these products may be similar, they are both different and have different features. One should carefully choose between these two depending on one’s healthcare requirements.

Health insurance companies offer two types of health insurance products: 

  1. Indemnity Products
  2. Benefit Products

Indemnity insurance pays the actual amount up to a certain limit. Medical insurance is a kind of indemnity insurance. Benefit products are those that pay a lump sum amount, such as in the case of critical illness insurance, accidents and hospital cash. 

In this article, we’ll take a look at the difference between mediclaim and health insurance. Let’s look at what both these types of insurance plans cover, individually. 


Health Insurance

Health insurance plans offer comprehensive coverage: hospitalization, pre and post hospitalization, ambulance and room rent, and more. Health insurance coverage even extends to critical illnesses, maternity coverage and more.

6 Different Types of Health Insurance Plans

  • Individual
  • Family Floater
  • Group Health Insurance
  • Senior Citizens Health Insurance
  • Critical Illness Health Insurance
  • Specific Disease Health Insurance


9 Common Features of Health Insurance Policy

  • In-patient hospitalization coverage
  • Pre and post hospitalization coverage
  • Cashless Facility
  • Daycare Treatments
  • Coverage for Critical Illnesses
  • Maternity and Newborn Baby Coverage
  • Tax Benefits
  • Pre-Existing Disease Coverage
  • Annual Health Check-Up Facility

Medical Insurance

Medical insurance is limited in the expenses it covers compared to health insurance. Under medical insurance, only hospitalization expenses are covered provided the policyholder is hospitalized for at least 24 hours. It provides treatment towards pre-specified illnesses, and accidents for a pre-specified or limited amount.

Common Features of Medical Insurance Policy

  • Coverage against hospitalization expenses
  • Accident and emergency-related hospitalization
  • Specific Illness


6 Major Difference Between Health Insurance and Medical Insurance

Let us take a look at health insurance vs mediclaim from a tabular perspective which helps us to make the right choice to cover our healthcare expenses.

Basis Medical Insurance Health Insurance
Insurance coverage Medical insurance provides hospitalization coverage (provided hospitalized for at least 24 hours), specific diseases and a specified amount. It does not cover any expense other than actual hospitalization expenses. Health insurance provides comprehensive coverage – hospitalization, critical illness, preventive health check-up, ambulance and more
Availing benefits To avail the benefits of medical insurance, hospitalization is a must Health insurance benefits can be availed without hospitalization
No. of claims Allows multiple claims till sum insured gets exhausted Usually single claim, e.g. in the case of critical illness for a lump sum amount
Payments Payments are either reimbursed to the policyholder or paid to the hospital in case of the cashless method Payment is either reimbursed to the policyholder, or paid to the hospital in case of cashless method, or paid in lump sum in cases such as critical illness, specific illness policies, etc.
Sum Insured Sum insured is usually limited to Rs 5 lakhs Sum insured can be higher up to a few crores
Add-on benefits Medical insurance does not allow coverage extensions and add-ons. Health insurance offers add-ons for various healthcare needs such as maternity, accidents, critical illness, etc.
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Health Insurance vs Medical Insurance – how to choose between the two?

By looking at health insurance vs medical insurance with the perspective of benefits, it becomes very simple for the customer to compare both.

4 Top Benefits of Health Insurance vs Medical Insurance

  1. Tax Benefit: One of the few similarities between medical and health insurance is the tax benefits. Both types of plans provide benefits under Section 80D. Those who want to buy insurance for the purpose of availing of tax benefits could choose any – health or medical insurance. However, it is best to buy any insurance plan as a financial security against medical expenses, not just as a tax-saving tool.
  2. Coverage: Health insurance has an advantage over medical insurance when we talk about coverage in health insurance vs mediclaim. Those who want to ensure more comprehensive protection towards healthcare should opt for health insurance. Those whose healthcare needs are limited to the coverage offered under medical insurance policies, should choose medical insurance plans.
  3. Healthcare Needs: The kind of plan that one must choose, depends on one’s personal health care needs. This, in turn, depends on factors such as family medical history, lifestyle, pre-existing diseases, and more.
  4. Budget: While a comprehensive health insurance plan would be more beneficial, it is better to have some kind of healthcare protection in health insurance vs mediclaim. While Hence, those with a smaller budget could opt for a medical policy, which is more cost-effective compared to health insurance.


An increasing number of people are falling ill due to lifestyle, pollution, air-borne diseases, contagious viruses. Health safety of self and family is a key concern for everybody. Moreover, the rising costs of medical care lead to the need for ensuring enough financial security towards healthcare expenses. Choosing good health insurance or medical insurance can take care of these health concerns. This is why it is important to know the difference between mediclaim and health insurance. Getting to know the similarities and differences in health insurance vs medical insurance helps you choose the best insurance plan for your healthcare expenses depending on your budget and insurance needs.

FAQs: Health Insurance vs Medical Insurance

What is the difference between health insurance and mediclaim?

While both are often used interchangeably, there are differences between the two:
Mediclaim insurance provides limited coverage: for hospitalization of over 24 hours, specific diseases and specified amount. Health insurance provides comprehensive coverage – hospitalization, critical illness, preventive health check up, add-ons, ambulance and more.

Do health insurance and mediclaim offer the same coverage?

No, the coverage offered by both these plans differs. While mediclaim insurance offers coverage for domiciliary care and hospitalization expenses incurred during hospitalization of at least 24 hours, health insurance provides comprehensive coverage such as pre and post hospitalization, critical illness, day care treatments, OPD expenses, alternative medicine and maternity, among others.

Do mediclaim and health insurance plans offer the same kind of flexibility?

No, mediclaim and health insurance do not have the same kind of flexibility features. Mediclaim is limited in coverage and flexibility, whereas health insurance plans provide more flexibility such as customizing the plan, portability and more.

Is cashless claim facility available in both mediclaim and health insurance?

Yes, both mediclaim and health insurance plans provide cashless claim facility depending on the plan chosen.

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