With so many individual health insurance and group policies floating in the market we often get confused as to what should we choose over which. The decision lies entirely with you as per your requirements. Let’s see what mediclaim has in store for us.

A Mediclaim policy provides coverage against medical expenses that one might incur. Individuals who have a Mediclaim policy can either raise a cashless or reimbursement claim. These policies also provide tax benefits to policyholders.

A Mediclaim policy provides the policyholder with financial assistance through cashless facilities or reimbursement during medical treatments and hospitalization. It covers the insured against any medical expense that might occur during the policy period and also offers tax benefits under section 80D of the Income Tax Act of India, 1961.

A Mediclaim is a form of insurance wherein the insurance providers reimburse the policyholder for any medical expenses that he/she might have incurred in the policy period. The insured can either submit the relevant bills to get reimbursed or avail completely cashless facilities at the insurer’s network hospitals.

Skyrocketing medical inflation rates have made Mediclaim policies or health plans a necessity to make healthcare affordable for the larger masses. Mediclaim policy is a type of health insurance that offers a health cover for illnesses and hospitalization up to a specific sum insured. Such policies are valid for a particular period after which the policyholder has to renew it to enjoy the benefits.

Some important aspects of a Mediclaim policy:

  • Premiums:The premiums paid for Mediclaim policies differ from one insurer to another however, the factors that influence the amount are constant. Age, sum insured, policy period, etc., are a few of the factors that affect the premium.
  • Age:Mediclaim policies can be bought only if the consumer falls in the specified age group. Usually, insurers have an entry age of 18 years and an exit age of 65 years. However, sometimes the age group can start at 5 years and go up to 80 years.
  • Family cover:In a family cover, the policyholder can pay a master premium to cover his/her entire family instead of buying individual policies.
  • Overseas Mediclaim policies:Many insurers provide overseas Mediclaim policies under which the insurer can seek treatment in both India and abroad. However, such policies have certain conditions attached to them.
  • Claims:Claims are usually made through third-party administrators (TPA), but some insurers deal with claims in-house.
  • Types:Mediclaim policies cater to different needs and different individuals. One can choose from individual policies, group policies, critical illness policies, senior citizen policies, and maternity policies.
  • Tax benefits:Under section 80D of the Income Tax Act of India, 1961, policyholders can claim a tax deduction of Rs.25,000 against the premium paid for Mediclaim policies. The exemption limit is Rs.30,000 for senior citizens. Policyholders can claim an additional exemption of Rs.25,000 if they are paying the policy premiums for their parents.

Difference Between Mediclaim Policies and Health Insurance

The terms health insurance and Mediclaim policy are often used synonymously, however, both of them are different in nature. A Mediclaim policy works on an indemnity basis which means that any medical expense incurred by the policyholder will be reimbursed by the insurers. On the other hand, health insurance plans function on the benefit principle where a certain lump sum is paid out if the policyholder meets with a certain eventuality like critical illness, accident, etc.


The major difference between the two is that mediclaim limits itself in particular to the hospitalization expenses. However, health insurance is far more complete. It offers a comprehensive cover that extends further than hospitalization expenses.

Mediclaim covers your hospital expenses which you can claim while health insurance though is far more complete has a lot of conditions attached.

You can choose as per your requirement.

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