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Mediclaim Policy or Health Insurance: Which One is the Best?

Both mediclaim health insurance plans and health insurance policies provide coverage for expenses arising out of hospitalization. They can be taken individually or as a combination, depending on the requirements of the insured. Premiums are comparable, but mediclaim policies generally have lower premiums. Coverage amounts are also comparable, but health insurance policies generally have higher coverage.

Let’s Decode Mediclaim Policy!

A mediclaim policy is one that has coverage up to a certain limit. It mainly covers expenses related to hospitalization and treatment of critical illnesses. Mediclaim policies generally offer cashless/reimbursement hospitalization. It is better to avail of cashless hospitalisation rather than paying the hospital expenses from one’s pocket and then getting the expenses reimbursed from the insurer. This is because, in the cashless mode of payment, the hospital gets the expenses reimbursed directly from the insurer. The best health insurance in India plans to provide both options. Mediclaim insurance policies have a lower sum insured amounts than health insurance policies. But one advantage is that hospitalization can be availed for all contingencies, unlike health insurance policies that may have specified diseases or illnesses list.

What is a Health Insurance Policy?

Health insurance policies are more comprehensive in nature. They cover more than just basic hospitalization. Most health insurance cover pre and post hospitalisation expenses. Hospitalization and cover cannot be taken for all diseases. If it has to be taken, the add-on riders are available such as a critical illnesses cover. Sum insured is paid as a lumpsum amount, unlike a mediclaim policy that reimburses only the hospitalization expense.

A health insurance plan also may cover maternity expenses, new born vaccinations, alternativeemergency evacuation etc. There is no need to be hospitalized to claim the sum insured; even an outpatient procedure can warrant a claim from the insured. A health insurance policy can have additional benefits such as sum insured reloading, multiple claims, staggered premium payment, etc.

Common Points Between Health Insurance and Mediclaim?

Some of the common grounds under which the both terms can be used interchangeably:

  • Both are insurance policies varying in the degree of coverage offered. However, to avail the benefits under these plans, both require hospitalisation.
  • Premiums paid towards a health insurance policy, or mediclaim policy can be claimed as tax rebates under Section 80 D of the Income Tax Act.
  • Both policies offer coverage up to a defined sum insured only.

Tips for Choosing a Good Mediclaim Policy

The rule of thumb for selecting the right mediclaim policy are:

Know the Company

Check the insurance company’s background, management, and procedures. Check the social reputation of the insurance provider. Also, check for online customer reviews of the company from trusted sources. Choose the best health insurance in India plan based on proper research.

Know the Plan

Be aware of the various facilities and features offered by the mediclaim policy or mediclaim health insurance plan. Ensure that the features, even if not applicable in the current context, is applicable as a speculative need. Ensure that the mediclaim plan covers all diseases, including pre-existing ones. Another important aspect is the coverage for certain medical procedures. Mediclaim policies may not have coverage for procedures related to rectifying sleep disorders or dental procedures.

Premium Cost

Although the amount of premium paid towards the policy is a determinant to choose a policy, it should not be the sole one. It is recommended that the cost of the premium not be the deterrent to choosing a plan if the policy provides adequate cover for all diseases and procedures. Use an online premium calculator to check the premium to be paid. This will help you get an estimate of the exact premium to be paid and also help you compare mediclaim policies online.


A mediclaim policy with lifelong renewal benefit is an ideal one. There should not be any upper age limit. Mediclaim policies come in handy for senior citizens the most. So always plan for long-term and choose a mediclaim policy that does not have an upper age limit cap.

Claim Process

The simpler the claim process, the better is the policy. The best health insurance in India policies has straightforward claim processes. Nowadays, insurers are allowing their customers to make claims via mobile apps. The process has become even simpler for non-tech savvy people who can initiate a claim by simply sending an SMS. Understand the different ways by which claims can be made. Check if the claims process is lengthy or short. On average, the claim feedback time is 24 hours, and the claim deposit time is 72 hours.


Mediclaim policies usually have exclusions such as non-coverage for hospitalization due to alcohol, smoking, drug abuse, or suicide attempt. If there are more exclusions such as non-coverage for certain critical illnesses, then consider taking a health insurance policy or choosing another mediclaim health insurance plan that has no such exclusions.

Coverage Amount

There are many factors that influence coverage amounts of mediclaim policies. Insurers consider the rate of inflation, rising healthcare costs, location, etc. to determine coverage amount for a policy. In modern cities, the coverage amounts are higher as compared to semi-developed or suburban or rural areas. If you are seeking coverage not only for yourself but also for your dependents, then a higher coverage amount is needed. It is because, in a policy year, if one person avails mediclaim benefits, there should be enough balance to cover all other dependents for that policy year.

Credibility of the Insurer

One way to check the credibility of the insurer is to check their claim settlement ratio. A high claim settlement ratio indicates that the insurer is prolific at resolving claims.

Network Hospitals

One of the major advantages of purchasing a mediclaim health insurance plan is that the insurer has a wide network of hospitals spread across all cities, regions, and states in the country. The higher the network of hospitals, the wider is the safety net. It is very beneficial for those who have pre-existing diseases that may require urgent hospitalization, especially if these persons are on travel or have occupations that require them to travel to various parts of a country.

Tips for Choosing a Health Insurance Policy

In order to ensure the right health insurance policy, one must keep a check on the following pointers:

Check the Solvency Ratio of the Provider

It is not often that you get to hear that a company could not settle claims because of its poor financial condition. But even insurance companies go through crests and troughs. Although the insurance sector in India is strong, it is always a good idea to check the insurer’s financial backup and history of settling claims. Check if there are any negative reviews about the company’s claims process from trusted sources.


A high premium with minimal benefits does not create a win-win situation. The benefits could seem more veered towards the insurer. Check if the premium cost is proportionate to the benefits offered. Make a comparison of online health insurance policies. Use the premium calculator for this purpose. An affordable insurance policy is one that does not have a lower insurance premium. Rather, it is one that, even if the premium is high, it offers proportionate benefits. It is recommended that when purchasing a health insurance policy, you choose a comprehensive one. It is to safeguard oneself against all contingencies and possibilities.

Opt for Family Floater Policy than Individual Health Policies

A family floater health insurance plan covers all members of a family, including the policyholder. Instead of the policyholder buying a sole insurance policy, and then purchasing individual health insurance policies for each family member, a floater family insurance scheme is a better and wiser option. It is because, if in a policy year, the policyholder did not have to claim any insurance, the sum insured in the policy still covers the dependents. It means that at all times, the sum insured is use-able or may come into use, given that it covers not one, but many people.

Lifetime Renewability

Health insurance schemes should have lifetime renewability because people are more vulnerable during their older years, especially after 60 years of age. Although this is a broad generalization, as illnesses can strike at any age, it is recommended to choose a health insurance scheme that has no upper age limit.

Settlement Ratio

Similar to mediclaim policies, high settlement ratios are an indication that the health insurance provider is adept at resolving claims. It is common knowledge and a generally accepted understanding that a high settlement ratio is indicative of how efficient an insurance company is in attending to the needs of its customers.


Written By: Paisawiki - Updated: 22 February 2021

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