Milan Square

What is the difference between Health Insurance and Mediclaim Policy?

  • Square Insurance
  • 28 Apr 2022
What is the difference between Health Insurance and Mediclaim Policy?

When it is the time to safeguard your health and the well-being of your loved ones, you take various measures like maintaining a healthy routine, having a balanced diet, and getting regular check-ups that keep you healthy and safe from any unfortunate health issues in the later stage of life.

But, when it comes to securing the health of you and your loved ones for the times when you are with them, and even for times when you are not there to support your loved ones the health insurance covers have your back easily with the proper insurance claims, that may help for saving the extra costs that you may bear at the time of some health emergency in your life.

More than half of the population keep their health safe with the proper insurance policies to help them in the contingencies of life.

But, many times with the insurance, the customer takes health insurance and Mediclaim policy as synonyms of each other where they both are completely different from each other and have separate meanings and purposes.

Let us now read about both of the claims in detail and know the importance of both of them.

Mediclaim insurance

Mediclaim insurance can be considered to be a type of insurance policy, where particular specified financial expenses in regards to the medical treatment in the time of any medical conditions. Mediclaim insurance can be considered to be one of the pocket-friendly ways to deal with any health-related emergencies. In Mediclaim policy, the insurance claim for the condition can be covered when the customer submits the bills of the expenses borne to the insurance company, or the same can be dealt in a cashless manner if the partner hospitals of the insurance companies are referred by the insurance bearer. Most of the insurance customers, prefer to buy a Mediclaim policy because of the following reasons

  • The cashless facility can be easily availed at the network hospitals of the insurer.
  • The Mediclaim facility can be taken for both individual person and the family or corporate groups.
  • The Mediclaim policies helps in the annual tax savings.

There are many different types of Mediclaim policies available in the market which can be availed by the customers depending on the needs and life of the insurance bearer, the policies available can be categorized as

>1. INDIVIDUAL POLICY-it is the one where you can insure yourself alone as an individual from any health issues which might occur in the future.

2. FAMILY FLOATER POLICY-it is the one where you can take the Mediclaim policy for your family as a whole and any expenses of the health issues in the family will be taken care of by the insurance provider.

3. Senior citizen policy- in the senior citizen policy, people over 60 years of age are covered from any illness, that occurs with the age.

4. Critical illness Mediclaim- In this kind of Mediclaim, all critical illnesses like cancer, kidney failure, and heart diseases are covered fully, as they cover the expenses when you are liable to pay the lump sum policy for a long period of time for the serious illness.

5. Mos- Bite Protector Policy- the policy under the same lump sum amount is paid by the insurer to the insured party for the vector born diseases which may come in the name of malaria, dengue fever, chikungunya and zika virus.

6. Personal accident policy- in this Mediclaim policy, you get covered for the accidental deaths, permanent disability, partial disability or any other disability you meet through the accident.

Now let us see what all is included when you take the Mediclaim policy from the best of the insurers:

The benefits which are included in the Mediclaim policy differ and can vary from insurer to insurer, and as per the plans the customer is planning to take, but some of the general inclusions which most of the insurers include are as follows:

1. Hospital charges- the Mediclaim covers the hospitalization changes which duly include oxygen cylinder, blood, organ donor expenses, room charges, organ donation, tests, etc, all free of cost and can be cashless, as per the needs and policy of the insurers.

2. Day Care Treatment – In this situation where the customer is admitted for less than 24 hrs is covered and all the hospitalization procedure is taken care of by the insurer.

3. Pre and post-hospitalization- in the said policy, the policy covers the expenses that have to be incurred before and after the hospitalization of the customer, which may include the necessary treatment that is needed before the hospitalization of the customer, and also the treatment and things needed after the discharge of the customer from the hospital.

4. Hospital stay- the Mediclaim policies covers the bed expenses till the time you are admitted, which may save you from the extra expenses which you can incur in the private rooms, wards or ICU.

5. Consultation/ doctor’s charges- the Mediclaim policies also covers the consultation charges which may be a burden while going through treatment.

With the benefits, there are some exclusions that are not covered in the policy. Some of the exclusions that are included like

  • Pre-existing diseases are not covered after the completion of the waiting period.
  • Plastic surgery
  • External diseases like hearing and contact lenses.

External diseases like hearing and contact lenses.

It is very normal for a person to get confused about the new buyers while they choose the Mediclaim policy when they look for the policies on the website. Here are some ways with which you can decide the type of policy you need to buy while you are new in the insurance world.

Decide what kind of plan you want?

There are many different categories of plans, from which you can choose while taking the Mediclaim policy. The very first thing you have to choose Is whether you want an indemnity plan or the fixed benefit plan. Here the indemnity plans cover you for the medical expenses, whereas the fixed benefits plans cover you with a pre-decided expense when you suffer from some medical condition. Most of the experts in the insurance industry suggest that one should go for the indemnity plans and add the benefit plans to the same for better coverage to ensure all-around protection.

Choose the right sum you want to be insured with

The sum with which you want to be insured has to be decided depending on the health record, age, lifestyle, and other factors that may affect the overall health of the individual or family. Also, the medical claims will be different according to the place you are staying, in urban areas the medical expenses are a bit high, and in rural areas, the medical expenses can be comparatively low as compared to the urban areas.

What are the points that should be kept in mind while buying a Mediclaim policy?

There are several points that should be highly considered while buying Mediclaim insurance from any of the insurers to avoid complications and problems at the time of claim settlement. Some of the points that should be kept in mind are listed below

1. Choose the plans that cover the wide range of hospitals that are covered under the policy. For the same one should shortlist the insurers that give you all the needed plans. One should start checking the network hospitals of the insurer, which are easier to be accessed while you go for cashless treatment during emergency conditions. The choice of the hospitals allows you to focus more on the treatment and getting better rather than focusing on the bills of the hospital.

2. Claim settlement ratio of the claim should be comparatively equal to the claims the company has been settling in one year. You should compare the ratios and go for the plans that have a higher settlement ratio.

3. Less waiting periods are one of the most important things that have to be considered while going for a Mediclaim policy. Once the waiting period is over you can get the claim of the policy you have duly opted for, so less waiting period will result in better claims results and easier hospitalization in the future.

4. Premium of the policy is also one of the important facts that has to be kept in mind, while you look for the Mediclaim policy. The premiums policy should be pocket friendly for the insured. This comparison helps you to keep your pocket light and also covers all the claims and expenses in the long run.

How to buy the Mediclaim policy?

or some of the customers, health insurance is one thing that they should take the health policy, by sitting with the insurance giver in person. For some buyers, health insurance is something that must be bought face-to-face. If this is the case with you, then remember that our branches are always open to you. Visit us during office hours and our insurance experts will be more than happy to hand-hold you through the buying process. However, if you are looking for a modern way to buy your Mediclaim policy, then just head on over to our website and make the purchase online. You will enjoy several benefits by doing so, some of which include

  • It is easier to be taken online as, you just have to check the eCRMS application of the work. You will not have to visit the office or go anywhere for taking the Mediclaim policy.
  • It is quick to be processed, as it only takes 10 minutes to take the policies of Mediclaim with the online portal.
  • It is convenient, as you do not have to go anywhere, everything is available at a finger to click for you. You can buy it any time from day or night all around the year. The internet gives you access to the Mediclaim insurance round the clock.
  • It is paperless, all based on the personalized software of eCRMS which will be helpful for the easy working and maintenance of the policies.

Health insurance

Health insurance can be considered to be a wider term than Mediclaim policy, as in the term health insurance n number of comprehensive coverages has been provided, with a special feature that the same is not restricted to the hospitalization expenses. In health insurance, all the conditions in the serious illness are covered which also covers the pre-hospitalization, post-hospitalization, and other expenses which are covered in the medical treatment of the illness for which the coverage has been taken by the customer.

Under health insurance, the expenses for any illness or accidents are covered in a better way than what you could have got covered in the Mediclaim policy. Moreover, the health insurance is considered to be more hassle-free while your request for the claim amount of the insurance and also helps in the treatment in the network hospitals of the insurer.

Now let us have a look for what are the types of insurance you can avail.

Health insurance policies offer wider coverage for covering medical expenses. Following are the features and benefits of the health insurance plan

The health insurance benefits offer higher claims of the coverage for which we have taken the health insurance and you are undergoing the treatment. The scope of the insurance can be widened for the critical illness by taking the extra benefits which are usually provided by all the insurance brokers for the better treatment of the client at the time of illness

Even if you pay a small premium at the start of the insurance premiums, the feature of the co-payment can be availed where you pay a certain amount of the treatment expenses and the rest of the expenses are taken care of by the insurance broker, who are the insurers of the customer.

The insurance holder can also avail of the legal and financial benefits of the premium they are paying which also includes the tax benefits under section 80D OF THE INCOME-TAX ACT, 1061.

In the same, more flexibility and choices are provided to the insurance bearer for the choice of the premium and the cover claims of their policy, for which they want to opt for. The policyholders can choose the premium amount according to the pocket-friendly options that are available for availing of the insurance benefits.

Health insurance benefits are not having an upper limit, the upper limit of the policy is not decided by the age of the policyholder, the assessment of the health policy is done and according to the same, the claim amount of the policy can be as high as 2cr, depending on the premium of the policy and the health status of the policyholder.

Health insurance coverage does not have an upper limit and depends on the policyholder's age, assessment of health status, and the capacity to pay the determined premium. It can even be as high as ?2 crores.

Now let us have a look at what factors should be kept in mind while we are going on the purchase journey of health policy

Your age, health report, the medical history of the family, dependents whom we are supporting, and the health status of the family.

A reasonable estimate of the coverage that one will be having when one requests for the claim of the insurance.

The dependability of the insurance provider has also to be seen at the time of taking the policy. It has to be checked for how many hospitals are in the chain of the insurance provider from whom we are taking the insurance policy.

The easy procedure for which one has to see the working pattern of the insurance provider. The insurance provider should be having easy steps to take the policy and also good assistance for which they have to be approachable enough to the customer.

Claim settlement ratio of the insurer is also one of the main factors that have to be kept in mind while looking for a health insurance policy.

Now as we already had a look on the primary features and importance of the health insurance plans, as it is considered to be a comprehensive policy, with a wide coverage then what is covered under the Mediclaim policy, here as it has to be mentioned that the Mediclaim policy can be considered to be one part of the health insurance that covers only the hospitalization part of the medical illness.

  • Pre-hospitalization expenses
  • Post hospitalization expenses
  • Maternity expenses
  • Day-care expenses
  • Pre-existing medical conditions after the waiting period
  • Cashless hospitalization
  • Expenses of the ambulance services
  • Co- payment facility
  • No claim bonus, in case of renewal

Different types of health insurance available in India are

Individual health insurance

They can be taken for an individual for his own, health in various situations for any period of time as per the needs and circumstances of the individual.

Family health insurance

This is available for the dependants of the insurance bearers, which will help the person to keep the family safe and secure from all the medical emergencies in the coming future.

Critical health insurance

here the critical disease like cancer and others are covered.

Senior citizen health insurance

this kind of insurance is available for the citizen above 60 years and for the benefit to keep them safe.

Top-up health insurance

it is seemed for by the individuals for the better claims at the time of claim reimbursement.

Personal accident

this kind of insurance is taken by the individuals for the benefits in case of the road accidents and other vehicle related accidents.


The main answer to what can be considered the better options for an individual, the person can choose the policy based on the choice and other things that are important to be taken into consideration when one goes to buy a policy for our health.

We can take a case when a person, is reasonably healthy and young with no health issues they can go for Mediclaim, where they can go for the cashless hospitalization, in case of unexpected emergency or hospitalization, and if in case you are in an accident-prone profession which involves day to day risks like firefighter you can go for Mediclaim insurance. Also, many companies provide you the medical coverage as a part of a bonus in the salary.

On the other hand, if you are suffering from some family health problem that has always been the family history, same can lead to the critical illnesses, in the long run, the importance of the health insurance is seen and the same can give us the better claims and help in having the ideal solutions for the same.

With square insurance, the health insurances you can claim are as follows

  • Individual health insurance
  • Family health insurance
  • Severe illness insurance
  • Senior citizen health insurance
  • Maternity health insurance
  • Personal accident insurance
  • Unit liked health plans

Now it is your choice and the proper choices have to be done according to the needs and circumstances of the family and other influencing things that effect the health of the individual and the family.