Health Insurance vs Medical Insurance: Know the Major Differences

If you think health insurance and medical insurance are synonyms, you are absolutely wrong. And if you are planning to buy a health insurance policy lately, you need to be very clear about the concept of both of these. So, let us discuss health insurance vs medical insurance today and find out what they are.

What is health insurance?

When you purchase a health insurance policy, the surgical and medical costs incurred by you will be covered by the insured. You can either pay the bills from your pocket and get the amount reimbursed or inform the insurer and get it settled with the network hospital. The coverage provided by the health insurance policies is mostly extensive than hospital expenses.

What is medical insurance?

Medical or mediclaim insurance is an insurance product that provides particular financial support against expenses related to health. However, you can avail of the mediclaim insurance coverage only when you are hospitalized. Otherwise, the medical expenses have to be borne by you.

The other differences between these two are mentioned herein below:

Offered coverage

The coverage provided by a mediclaim insurance is only for hospitalization, pre-existing illnesses, and accident-related treatment up to a pre-decided limit. 

On the other hand, a health insurance plan comes up with comprehensive medical coverage against pre-hospitalization charges, post-hospitalization charges, hospitalization charges, ambulance costs, and many more. In addition to this, a health insurance policy offers compensation if there is any loss of income which is a result of an accident.

Add-on covers

With a mediclaim policy, you will not get any add-on cover.

As you buy a health insurance policy, you will get multiple add-on covers, which include personal accident, critical illness cover, maternity cover, and many more.


You will not get any flexibility with a medical insurance policy.

With a health insurance policy, you will get the flexibility of enhancing or reducing the coverage as per your need.

Critical illness cover

Mediclaim policies do not offer any critical illness coverage. 

With a health insurance policy, you will get coverage for over 30 critical illnesses, including kidney failure, cancer, stroke, etc. However, the coverage for critical illnesses depends on the exact health insurance policy you are buying.

Sum insured

The sum insured of a mediclaim policy mostly does not go more than INR 5 lakh.

The sum insured of a health insurance policy can go from INR 50,000 to INR 6 Crore.


When you have a mediclaim policy, you can file several claims until you exhaust the total insured amount.

As a policyholder of a health insurance plan, you can file claims as many times as your sum insured is not exhausted. However, when the claims are related to accident disability/critical illness, the sum insured will be paid to you in a lump sum amount. You can make one such claim only once in the entire tenure of the policy.


To avail of the mediclaim benefits, you have to be hospitalized.

To avail of the health insurance benefits, you do not necessarily have to be hospitalized. And for availing benefits like daycare treatment, you absolutely do not need to get hospitalized at all.

Before you buy a mediclaim policy or a health insurance plan, you need to know your needs. Once you are clear about your and your family’s requirements, you can go ahead with any one of these two. To find some of the best mediclaim policies as well as health insurance policies, you can visit the website of IIFL. You can also use the health insurance premium calculator to get an idea of the premiums that you have to pay in the future.

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