What Is The Difference Between Health Insurance And Medical Insurance?

Difference Between Health Insurance And Medical Insurance

You may have an understanding that buying insurance policies is important. But which policy insures which part of your life is difficult to understand. Hence, before buying policies, we must develop a fair understanding of ich policy caters to what. 

When it comes to health, two policies often cause confusion — Health Insurance & Medical Insurance. The terms “mediclaim” and “health insurance plan” have various meanings.

To get a better understanding let’s individually understand both Mediclaim and Health insurance. 

Related Blog: Health Insurance: Types, Benefits, Eligibility – A Complete Guide For You

What Is Medical Insurance?

The term “mediclaim insurance” refers to a sort of insurance that provides specific financial protection against medical bills. It’s a cost-effective technique to deal with any health-related issue. However, the coverage is restricted to hospitalisation, and the insured is responsible for all additional costs.

What Is Health Insurance?

The cost of medical and surgical expenditures incurred by the insured is covered by health insurance. The insured must either pay such fees out of pocket or wait for reimbursement from the insurer, or the insurance company pays the hospital directly. The benefit and features are given subject to the insurance policy’s terms and conditions. Most of the time, the coverage is substantial, and it is often more expensive than a Mediclaim Policy.

Health Insurance Vs. Medical Insurance: Types

There are different kinds of health and medical insurances that cater to different needs of people. Based on your budget and how much money you would like to invest, the offers change. 

Type of Health Insurance

Here are the different kinds of health insurance available in India: 

  1. Individual Health Insurance Plan: As the name says, this insurance policy is for a single individual. In the case of a medical emergency, this plan will give financial support. Individual policies must be acquired for each member of your family, with a different sum guaranteed amount for each covered person.
  2. Family Floater Health Insurance Plan: As the name says, this insurance policy is for a single individual. In the case of a medical emergency, this plan will give financial support. Individual policies must be acquired for each member of your family, with a different sum guaranteed amount for each covered person.
  3. Group Health Insurance Plan: It is a type of medical insurance plan for a group of employees at the same employer. An employer, business organisation, or startup often chooses this plan to address the health insurance needs of its employees. It is also one of the most crucial benefits that a company can provide its employees.
  4. Critical Illness Insurance Plan: It provides monetary benefits if the insured is diagnosed with a catastrophic illness or disease. Kidney failure, stroke, heart attack, paralysis, and a variety of other conditions are all addressed. Because treating these illnesses is so costly, the Critical Illness Policy provides a financial safety net if you are diagnosed with one of the diseases listed.
  5. Personal Accident Insurance Plan: Accidents can happen at any time, and the costs of treating an injury can quickly drain your financial resources. A Personal Accident Insurance Policy covers medical expenditures incurred as a result of an accident. Partially disabled, permanently disabled, and death as a result of an accident are all covered under the policy.
  6. Maternity Health Insurance Plan: A normal health insurance policy can be supplemented with a Maternity Health Insurance Coverage. All expenses spent during pregnancy, delivery, and the postpartum period are covered. Depending on the insurer, this plan has a different waiting period. As a result, this plan should be implemented as quickly as possible.
  7. Senior Citizen Health Insurance Plan: It is a type of insurance coverage designed to meet the needs of those over the age of 60. Because senior people require more medical treatment and are more likely to submit a claim, the premium for this plan is higher. The insurance coverage covers pre-and post-hospitalization charges, as well as medical care and other costs. Pre-existing conditions are also covered under this plan, albeit the level of coverage is controlled by the policy’s terms and conditions.
  8. Top Up Health Insurance: Any health insurance policy can be upgraded at any moment, depending on the insurer’s ability to pay premiums.
  9. Hospital Daily Cash: In the case of hospitalisation, a daily hospital cash plan provides a lump-sum payment that the insured can use as they see appropriate. He can use the money to pay such extra costs or even make up for missed wages while he is in the hospital.

Types of Mediclaims

Here’s a list of different kinds of mediclaims available in India:

  1. Individual mediclaim policy: A single person is protected for a set sum under an individual mediclaim policy. This coverage only covers one person for mediclaim and other hospitalisation benefits. When the insured individual has to make a claim, he or she can do so for the total amount insured.
  2. Family-floater mediclaim insurance: A family-floater mediclaim policy covers the entire family for a certain amount of money. This insurance covers you, your spouse, your dependent children, and, in most situations, your dependent parents as well. The insured amount might be used by the whole family or even a single family member.
  3. Senior citizen mediclaim policy: A senior citizen mediclaim insurance is a vital strategy for anyone over the age of 65. If you are going to retire or are nearing retirement age, you may have to rely on a pension or interest on investments to make ends meet. In the event of an emergency, you may find yourself in a financial bind. To avert such a circumstance, a senior citizen mediclaim coverage is recommended.
  4. Critical illness policy: When a person is diagnosed with a critical sickness disease covered by the insurance, the sum insured is paid as a lump payment to the policyholder. The policyholder can then arrange the rest of the therapy appropriately. A conventional medical insurance policy will only cover hospitalisation costs, however a critical illness medical insurance policy would cover all types of diseases that impair your employment and lifestyle. When compared to other plans, critical illness mediclaim insurance normally give a greater claimable sum.

Health Insurance Vs. Medical Insurance: Eligibility Criteria

To avail the benefits of avail the benefit of any kind of insurance, it is important to understand the eligibility criteria for the same. 

Overall most companies would only require the insurer to disclose all pre-existing conditions and there is no bar on the page. 

What Are The Benefits Of Health Insurance & Medical Insurance:

Insurance policies have many benefits when it comes to managing finance. Here we list down the benefits of purchasing Health and Medical insurance.

Benefits of health insurance

There are various benefits to buying health insurance. Here are a few: 

  1. Coverage for medical expenses: Medical insurance may be able to provide you with complete coverage for hospital, drug, and surgery costs. Depending on the design of your cover.
  1. Tax benefit: It helps you save money on taxes and can be claimed when you file your taxes. Showing health insurance premiums as costs can help you save money on taxes.
  1. Cashless transactions: Health insurance can help by allowing hospitals and insurers to conduct transactions without exchanging cash.

Benefits of Mediclaim

The following are the benefits of a mediclaim: 

  1. It allows for the convenience of cashless hospitalisation: Helps in providing from having to pay cash at the hospitals.
  2. You can choose to treat yourself or your entire family: Options to use the mediclaim for family or personal use.
  3. It protects you from financial hardship: Eases your financial burden from you and your family.
  4. The costs of hospitalisation will be covered by insurance providers: Helps ease the burden of paying all the money, as insurance providers share some costs.
  5. Purchasing health insurance through internet firms is simple: Ease of access is promised.
  6. It provides tax benefits: Helps claim tax benefits.

Health Insurance Vs. Medical Insurance: How Does It Work?

Health Insurance

The functioning of Health insurance is fairly easy and can be understood step by step. First, find the health insurance that suits you. After that, you will receive the insurance money and start paying the insurance premium. The policy has certain restrictions and can be used after that (usually one month). For emergency care, the insurance company will start paying your expenses once the deduction (the amount you have to pay before you can benefit from the insurance policy) is paid. If the policy becomes claim-free, the insurer may allow an extension of coverage each year.


A mediclaim plan covers just hospitalisation, accident-related care, and pre-determined diseases up to a certain amount. A health insurance policy provides comprehensive coverage for hospitalisation, pre-hospitalization, post-hospitalization, and ambulance costs.

Health Insurance Vs. Medical Insurance: What is Covered?

What a policy covers may vary according to the kind of package opted by the individual. There may be exceptions to what is covered by the policy and what is not based on this.

Let’s take a look at the scope of the policy for health insurance. 

  • Hospital Costs for Inpatients: The policy covers hospital costs. 
  • Pre- and post-hospital costs: Post-hospital care such as ambulance, initial treatment and nursing. 
  • Ambulance Fees: If an ambulance is needed to transport the patient. 
  • Childbirth or Newborn Insurance: All pregnancy-related benefits in the hospital. 
  • Health Exams: Health exams are often subject to the policy. 
  • Daycare procedure: If you do not need to be hospitalized for more than 24 hours.
  •  AYUSH Benefits: All Ayush benefits are also subject to the policy. 
  • Mental Health Insurance: Some insurance also offers mental health insurance.

Let’s take a look at the scope of the policy for mediclaim.

The Mediclaim plan only covers hospitalization, accident-related treatment, and certain illnesses within the set limits. 

Health Insurance Vs. Medical Insurance: What is not Covered?

Health insurance will not cover the following:

  1. Cosmetic procedures
  2. Fertility treatment
  3. Off-label prescriptions

A mediclaim will not cover the following:

These are illnesses and disorders caused by birth defects. Permanent Exclusions Wars, riots, strikes, and hospitalizations for nuclear weapons are considered permanent exclusions. Cosmetic surgery, cosmetic treatments and implants are also not covered by insurance.

Health Insurance Vs. Medical Insurance: How to Claim?

Here’s how to claim health insurance. 

The general procedure for getting health insurance is as follows: Completed application form Medical certificate/form must be signed by a doctor. Original discharge report or card from the hospital. All Receipts and Invoices (Original) Prescriptions and Receipts Investigation Report In the event of an accident, a police report or Medico Legal Certificate (MLC) is required.

Here’s how to claim a mediclaim

Step 1 Get all receipts, invoices, and medical reports in order.

Step 2 Request a claim form from your insurance company. Contains policy documentation. 

Step 3 Make a copy of all the original documents.

Step 4 Submit the document using the correct TPA.

Health Insurance Vs. Medical Insurance: Which One To Choose?

Choosing between the two can be a difficult option and hence needs to be a well thought out decision. To make the proper choice, it is important to study the below parameters and make an informed choice.

  1. Check the Scope of Coverage
  2. Adequate Sum Insured 
  3. Waiting Period Clause
  4. Policy Type 
  5. Co-payment Clause
  6. Room Rent limits
  7. Network of Cashless Hospitals 
  8. Renewability Option 
  9. Premium Loading Factor
  10. Claim Settlement Ratio

Which Are The Top Health Insurance Providers In India?

Here is a list of 5 top health insurance providers in India:

  1. Aditya Birla Activ Assure Diamond Plan
  2. Bajaj Allianz Health Infinity Policy
  3. Bharati AXA Health Insurance
  4. Care Health Insurance
  5. Digit Health Insurance


Health insurance is essential and helps to strengthen your readiness for various medical emergencies. Health insurance has several advantages that other investments may or may not provide. This means that you are ready for the future. However, it is up to you to decide about choosing between health insurance and medical insurance. 

Are You Looking To Buy Health Insurance? 

We hope that the Guide will help you understand the importance of health insurance and look forward to securing your future. LNG provides you and your family with advice and services to help you choose the right health insurance. Speak to our health insurance consultant for more information on any queries related to health insurance or medical policy.  


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