Recently I wrote a post regarding best term insurance available in market and claim settlement ratio of Life Insurers. Few felt that they need the same data for Health Insurance Companies too. So let us try to analyze these things from the available IRDA Data.
Note-IRDA released the Annual Report for 2013-14. To know more about the latest Best Health Insurance companies, visit below link.
First of all let us understand the business model of Life and Health Insurance. Both are entirely different businesses when it comes to managing. In Life Insurance your contract with Insurance company is for long term whereas in Health Insurance your contract is on yearly base. So here in health insurance claim settlement we need to consider the yearly premium collection too. That is the reason it felt by many that claim settlement ratio is not so important. But I tried to sum up all the data available from IRDA to arrive at insurance company business.
How many Health Insurance companies are there in India currently?
According to IRDA report 2012-2013, there are 17 Private Insurance companies who do business in General Health Insurance along with Health Insurance, 4 Public Sector biggies and 4 standalone insurance companies who’s core business in only Health Insurance.
Below is the table which describes the business volume and claim settlement ratio of each individual health insurance companies.
(Note-All figures are in Lakh, data based on IRDA Annual Report 2012-2013)
Here in above sheet I differentiated companies in 3 categories as I said above and coloured differently for each category. Next I considered Group Insurance Schemes (excluding Govt sponsored), Family floater and Individual Health Insurance Schemes.
You notice that in group insurance segment private insurers are aggressive in claim settlement. But when it comes to family floater then general insurance companies and public sector companies are way ahead than standalone health insurance companies. Finally for individual health insurance category again public sector companies are very much aggressive.
Surprising part to me is, standalone companies claim settlement ratio for family floater and individual health insurance policies were low compare to others. This may be due to more scrutiny in settling claims due to their in house TPA.
Hope above table will be helpful for you in choosing a best health insurer.
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Hi sir.hope all good at your end.this is MAHESH here,iam about to renew my max bhupa health insurance policy family floater companian with base insured for 7.5 lks to myself,spouse and one daughter (45 ,45 and 18 years subsequently) .today is last date for renewal.premium is 20,917/- per annum.kindly advise me.
Dear Mahesh,
Why a doubt?
hello sir
am mahesh planning to purchase health insurance policy for parents of age 60 ,50 and also brother ,me of age 30 and 25 years which is the best health insurance plan for us please suggest us
Dear Mahesh,
I suggest you to go for senior citizen policies like Star for your father. For your mohter, you and your brother, you can go with HDFC ERGO, Max Bupa or IICI (individual plan).
Is it wise to take any New India assurance mediclaim policy online as their local branch is advising to get it from them to get better support..as per their statement one may get difficulties during claim time..
so , what's your take on this.. shall i opt for online or Offline?
Dear Deep,
For the claim process, online and offline are the same. It is few guys who create fear inside you.
I would like to take Mediclaim through New India assurance for my Wife & Son (New India Floater policy) so need some solutions which are cited below
1) In my Son's Birth certificate my wife's maiden surname is mentioned along with her paternal address as she has not yet changed the same in any of the govt I card like Aadhaar , Voter ID but she has Marriage certificate with my surname and address
2) So, during taking a new policy online which surname & address shall i mention for my wife is it her paternal one or post marriage one
So, incase of any hospitalisation case of my son (hope not required at all) whether relationship of ,y son & wife can be proved based on the basis of birth certificate of my Son.
Dear Deep,
Let her first update by producing the marriage certificate in all records along with using the name as it is in Marriage Certificate.
Hi.. i would like to go for health insurance for my spouse and my baby 1 year..
which one is the best
NEW INDIA FLOATER MEDICLAIM POLICY (SI 5 Lakhs)
Star Health FAMILY HEALTH OPTIMA INSURANCE PLAN (SI 4 Lakhs)
which one has the best chance to get the claim?
Dear Deep,
How you shortlisted these two products?
Dear Basu,
Could you please publish an article or advise on Cancer Insuranec plan.
Whether it is required and what are those available in India.
How to choose the best one And how to choose from, among different companies.
Thanks,
Pradipta Sahoo
Pradipta-I published one already. Refer the same "LIC Cancer Care (Plan 905) – Features, Benefits and Review".
Sir, First of all God bless you for enlightening the aam admi with your in depth understanding in Health Insurance segment. Very honestly its extremely difficult for common man to decide between the zillions of options to choose from
my questions,
i happened to read the below link, can we rely these stats.
http://www.livemint.com/Object/1XhvIv1t7ce1r1WiQ4BoyJ/mediclaimrating-2017.html
from these reports, i find icici lombard to be a good choice, based on their track record and irda data
please comment
second q to you
i am occasional drinker [ once in a week] and smoker [once in a month]
do i declare these while filling the forms
what if, i declare, will they reject all claims in future related to the above
what if, i dont declare, will they still reject all claims in future related to the above
Please comment
Jestine-You can rely but the decision must be taken with both eyes open. You must declare your habits. If you do not declare, then you give enough room for insurers to find the faults and reject the claim. Why to take the risk?
Hi Basunivesh,
I have a pre -existing psychiatric illness(very minimal) and using tablets for the same.When i approached insurance companies to take medical insurance, theu rejected without issuing the policy stating that because of that illness.
Almost 3 insurance companies rejected the same.Now how to take a medical insurance for me?
Krishna-Hrad to say but only option is to search others.
Hello Basu , I have Apollo Munich optima restore health insurance (3 lac) + top up policy apollo Munich 6 lac for last 4 years.I have claimed insurance in first year for my surgery which they denied indicating it was preexisting condition which was not revealed during application and they add it as permanant exclusion from policy.I want to know should i change my policy now using portability option as 3 yrs are passed post surgery(its shoulder surgery ),or even new policy from other insurance provider will have same clause.Also,what will happen to top up policy if I change the base plan.Thanks for answer in advance
Kunal-It is hard to suggest whether your new insurer will consider this as permanent exclusion or provide some relief of clause with limitation. I think it is better to stick with the existing insurer. Because such surgery is not again repetitive in nature (as per my knowledge).
Dear Basu, my family is health covered under my employers group policy. I intend to retire in couple of years at the age of 50. will I be able to port out from the group policy then? or should I buy another policy separately? thanks. Naresh
Dear Naresh,
Regarding porting, check with your existing insurer. However, I suggest you to buy separate one for you.
Hi Basvaraj,
Finally I zeroed down on MaxBupa. But I am concern of its poor Claim ration. Policybazar website says its overall is just 57%. Should I worry about these figures? Can you please comment guide on market reputation of MaxBupa and latest claim ratio? I copmared it with Star and Apolo.
Nadeem-Claim data is RAW. Hence, if you liked the product, then go ahead.