What Is Mediclaim? Meaning & How It Differs From Health Insurance

Quick answer: Mediclaim is a specified health insurance plan that reimburses hospitalization and medical treatment costs incurred due to illness or accidental injury up to a pre-defined sum insured. Unlike comprehensive health insurance, which can include OPD, wellness riders, and international cover, traditional mediclaim focuses specifically on in-patient hospital stays.

Key facts

Core focus: Direct reimbursement or cashless settlement of in-patient hospital bills.
Pre-existing disease cover: Individual mediclaim has 2-4 year waiting periods; corporate Mediclaim (GMC) waives waiting periods from day one.
Tax benefit: Premiums qualify for tax deductions under Section 80D.

Mediclaim Meaning and Structure

In India, "Mediclaim" was the original term used by public sector insurers for health insurance. Today, a mediclaim policy specifically denotes hospitalization cover that pays for room charges, ICU fees, doctor visits, and surgery expenses when an individual is admitted for 24+ hours.

Frequently asked questions

What is the difference between mediclaim and health insurance?

Mediclaim provides basic cover for hospitalisation expenses up to a sum insured limit. Comprehensive health insurance offers broader protection including OPD cover, critical illness lump-sums, maternity riders, and global emergency cover.

Does mediclaim cover pre-existing diseases?

Retail mediclaim policies have a 2 to 4 year waiting period for pre-existing diseases. Corporate Group Mediclaim (GMC) waives pre-existing waiting periods from day one.

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