Best Health Insurance Company in India-Based on IRDA 2014-15 Incurred Ratio

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Which is Best Health Insurance Company in India for 2016? Hard to list it. However, let us try to shortlist based on IRDA’s Annual Report for 2014-15.

Note-IRDA released the data for FY 2015-16. I published the same in my blow post. Refer this below post for latest data.

Before proceeding further, let us first understand the term called “Incurred Ratio”. It is the total amount of claims paid by insurance companies to total amount of premium collected during the same year. This ratio shows how generous is the company in settling the claim or whether the company is in profit or loss.

For example, let us say Company A settled the total claim amount of Rs.90 Cr in a year. In the same year, it collected Rs.100 Cr as a premium for that particular year. In this situation, the incurred ratio stands to be 90%.

Hope you got clarity now about incurred ratio. Let us move and look at the recent IRDA Annual Report for 2014-15.

Below is the Incurred ratio of public sector companies for a period of 2014-15.

Incurred Claim Settlement Ratio-2014-15

You notice that, when it comes to claim settlement ratio, public sector companies are more generous. They are paying more claim amount than what they receive as premium for that particular year (except for New India).

I highlighted the companies with green whose claim is more than 100% and red whose ratio is less than 100%.

Let us look into the non-life private sector companies data.

Incurred Claim Settlement Ratio-2014-15-2

You notice that you get all data ranges in public sector companies. Ranges differ from as high as at 117% to low at 52%. For a moment forget about the new entrants like Magma QBE and Liberty Videocon. Look at the existing players. This gives you an indication of how to select the “Best Health Insurance Company in India for 2016”.

Let us move towards the standalone health insurance companies data.

Incurred Claim Settlement Ratio-2014-15-3

You notice that data ranges from 64% to 55% ONLY.

Why there is such a huge difference among Public Sector, Private Sector and Standalone companies incurred claim settlement ratio?

There may be a few reasons for it. We can’t assume what went wrong. But the company whose incurred claim ratio is high may not look at its profitability. If the claim amount is less than what they collected as a premium, then it indicates that they are into profit and eyeing at the profit.

One more reason is that, if the company paying more claim amount than what it collects as premium, then it may have pools of high-risk profile insured. Mean old age people who have a probability of hospitalization are more.

You notice that standalone insurance companies manage the best within a range of around 60%. They are into profit and we may consider them for our health insurance need. However, what about public sector companies? They may be under loss from the health insurance sector. However, they are compensating from other types of insurance. The same applies to private sector companies.

The above-incurred claim settlement ratio is one type of indication for you to choose Best Health Insurance Company in India.

How about complaints against health insurance companies?

IRDA not indicate whether the grievances are particular to health insurance or for all types of insurance. Especially for Private and Public Sector companies, the grievances are clubbed which ranges from Fire, Motor, Health or other types of insurance. However, for standalone companies, we have a perfect data of grievances raised by customers. Below are the data available with us.

IRDA Grievances Data 2014-15

Look at the % of resolved complaints and also the status of pending data. You have to identify how old are these pending grievances. Based on that you can assume how fast are your insurance companies when it comes to customer centric.

The above IRDA Annual Report for 2014-15 data will not give you a clear picture of which company is best in India. But definitely a hint in choosing a company.

Apart from these above indications, you have to look for some more specific data to arrive at your health insurance products. These points are listed below.

  1. Identify whether you need individual or family floater health insurance. Remember that in family floater insurance, the premium will be based on the oldest person in the family and also depends on the number of members. Individual plans cost more than family floaters.
  2. Identify the sum insured you are looking for. Today Rs.5, 00,000 may looks a great and comfortable health insurance. But the same may not be the case after a few years. Hence, chose a sum insured amount based on future need.
  3. Identify the company which covers existing diseases at early. Usually, all insurance companies have a waiting period 3-4 years for existing diseases. However, if your concern is to cover the existing diseases, then give first priority to this point. L&T Health Insurance product offers 2 years of waiting period, Apollo Munich offers 3 years of waiting and rest of companies offer 4 years of waiting period.
  4. Identify the company which offers the lifelong renewal option. Because your health insurance need is more during your old age.
  5. Check for room rent capping.
  6. Check for the co-payment clause. Higher the co-payment means lower the premium for you. Co-payment means how much you also have to pay in total bill. If the co-payment clause states 20% co-payment, then for all bills claimed, you have to 20% and the rest 80% will be payable  by health insurance company.
  7. Check for exclusions. If you feel the exclusions listed may be uncomfortable to you, then skip that product.
  8. Check for hospital network availability in your city or town. The cashless hospital benefit is better than producing the bills and waiting for claim settlement.
  9. Read carefully the wordings of policy brochure. If you have doubts on any feature, then try to clarify it NOW itself.
  10. Avoid all common features, which companies try to highlight.
  11. Check for No Claim Bonus company offers.
  12. Finally, if you feel the sum insured you opting is not within your budget, then go for sum insured according to your affordability and opt for a super top up plans.

This checklist may not be big to include everything. But gives you an indication in selecting the Best Health Insurance Company in India for 2016.

Conclusion-Each individual is different and his/her needs also. No one can perfectly claim that the particular company is the BEST or its product. But we can help him or her in identifying the that BEST which suited to him or her. Hence, this post won’t give you the result you may looking for ready-made answers. But definitely will help you in short listing the product. Also, I am personally not associated with any particular company. For me, all companies are same. Hence, I am not naming any one company. But forcing you to choose the product based on your comfort with company, features you are looking for and budget.

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271 Responses

  1. Sir ,

    I want to buy health insurance plan but confused which type to buy: family floater or group or individual. I have one corporate plan but its not good. My age is 40 years wife 36 and kids 8 yrs and 2 yrs. Please suggest how to decide.

  2. Hi Basu,
    Thanks for your detailed analysis .

    Looking for your guidance in buying a 2nd health insurance policy for my parents.

    I was not aware about it till now but my parents hold a ORIENTAL family floater health policy of only 3 lacs and they have already renewed it this month. In this policy my father (aged 55), mother(aged 53) and brother (23) are covered.
    This policy has been active since 2012 , almost 6 years now.

    BUT Now I feel this amount is very less considering the future and also the place Delhi where we reside.
    Now I cant modify the cover amount in the same policy , so I have decided to go for a another one of 10L .
    I know that existing diseases wont be covered till the waiting period is over. But I am also looking for hassle free claims and good customer support.

    Do I need to again go for a new Oriental family floater policy of 10L to make the claim process easier (because of same companies) ? Or I can go for Apollo Munich as well ( based on customer satisfaction and 3 y waiting period) ?

    I am personally inclined towards going for Apollo. But will that make things tough during claim settlement?

    Thanks,
    Nida

  3. Hello Basavaraj,

    I am planning a health insurance for a family, I am 38 years, wife is 36 and kids are 5 and 10.
    I am targetting about 10 lacs sum assured, with minimum co-pay, regular health check up available, regular doctor visits covered (consultations, prescription medicines); Sum Assured keep on increasing at least to factor the increase in cost of medical expenses year by year. I also want lifetime coverage. If possible unused amount from one member can be added to another member who need it within a year. for example, out of 8 lacs coverege- I did not use any but wife needed 10 lacs, then I can pass on 2 lcas from my coverage it should be possible.

    Can you please suggest?

    1. Hiren-Regular doctor visits covered?? NONE on this earth are here for a social cause. They are into business. Please cross check your expectation about the meaning of insurance. Also, refer my above post to shortlist your health insurance. Be realistic.

      1. Hi Basavaraj,
        Thanks for the feedback.
        I have decided to go with public sector companies, as I am looking for long term-life long.
        For New India Assurance- can you suggest a best policy for up to 6-8 lacs coverage? For a family of 4.

          1. thanks so much, upon checking I learnt that the maximum coverage is only 5 lacs with family floater, is there a way to increase the maximum coverage to 8 lacs, OR you suggest to take one extra policy worth of 3 lacs with other insurers? Can I take two polices with the same insurer? one 5 lacs and one 3 lacs?

  4. hi,

    I want to cover my mother, age 60 having diabetes through health insurance.
    Can you please suggest if any of the following policies through the bank will be good for her,

    Federal bank Max Bupa – Health Companion Health Insurance Plan
    Bank of Baroda National Insurance
    Union Bank New India Insurance
    SBI General Group policy for SBI bank account holders

    Or would you suggest a policy through a private Insurer

    Regards
    Jigar

      1. Thanks so much for your prompt reply.

        Yes I am looking for a cover from bank provided insurers. Which are the best amongst these,

        Federal bank Max Bupa – Health Companion Health Insurance Plan
        Bank of Baroda National Insurance
        Union Bank New India Insurance
        SBI General Group policy for SBI bank account holders

        Or is there any other better suggestion that you have apart from the above.

        All the above have a health insurance plan for bank account holders.

        Thanks again for your advice

        Regards
        Jigar

        1. Jigar-What I am suggesting is first try to buy the separate plans (not the bank provided), if she is unable to get that due to her health issues or age factor, then you can look for these bank provided health insurance products.

          1. Yes, I have tried the normal route but due to her medical condition she is not eligible. Hence now I am trying the bank plans, but not sure which ones are the best. Based on my own research, I have shortlisted few where she can get the policy. But amongst these not sure which are the best ones.
            – Federal bank Max Bupa – Health Companion Health Insurance Plan
            – Bank of Baroda National Insurance
            – Union Bank New India Insurance
            – SBI General Group policy for SBI bank account holders

            While checking online I came across your article. Since you are an expert and would have answered many queries, looking for ur advice

  5. Sir,
    I am 37 years old primary teacher with my wife of 26 yrs and only daughter of 3 yrs + and I want to buy a family floater policy of 5 lkhs coverage. I want your suggestion which company has no co- pay and claim load. and give claims multiple times and opd cost. I am always concern about claim settlement. pls suggest whic to buy.

    1. Laxmi-Each product will bear some positives and negatives. Because they are into business not for social cause. Hence, it is hard for me to say ONE product which fulfill your all requirements.

  6. Sir i need your help please suggest me the best health policy for me & my wife
    My age is 26 & my waife age is 20 .
    I m from bhopal M.P
    telll me the which covers new born baby planning also tell me the sum assured amount is good for me .

  7. Sir India mein koi bhi doctor kuch bhi fees charge kar RHA hai.yahan par charges KO lekar rule nhi hai.Maine physiotherapy karayee jisme doctor ne mujhse 5000 rupaye charge kiye jab Maine bill submit kiya toh unhone mujhe 1000 bazaar rupaye diye aur bol rahe hain yeh customary and reasonable charge hain.policy Dene ke time par bolte hai koi capping nhi hai hamare doctor fees ya professional fees mein ab claim kar diya toh chutiya bana rahe hain.aap kripa kar ke batyaein yeh customary aur reasonable charge kya hota hai

  8. if i have a health insurance policy of 5 lakh with 1% room rent capping and with no co payment, and i have to hospitalize for some reason which the health insurance company cover for 5 days. i choose a room of rs 10000/day and the total hospital bill is 2 lakh including the medicine bill of 25 thousand at the time of discharge. then how much amount i will have to pay

        1. in max bupa heartbeat also no co payment is available, it is for those person whose age is greater then and it will decrese year by year.

  9. Hi Basavaraj,

    Thanks for such useful information. I’m planning to buy a family floater scheme(Myself & Wife) with around 15 Lacs cover. I’m thinking of buying the same from 2 different companies 7.5 lacs each. What would be your suggestion i.e buying from a single company(15 lacs) or from 2 different companies(7.5 lacs each).

    Also, does a family floater scheme cover’s a new born for any critical illness from the day of birth itself?

    Thanks

  10. Sir Maine health policy khareedi hai future generali se .mujhe dokha diya gya sir mujhe policy wordings Jo beji hai who incomplete hai .sir prospectus mein likh hua hai hai ki renewal par aap polucy amount ko bada aur ghata nhi sakte par policy wordings mein iske baare mein much nhi mila.sir mere saath miselling hui hai.

      1. Sir mujhe inhone Jo contract bheja tha usme prospectus nhi tha.inhone baad chalupanti kari hai .jab Maine policy khareedi toh bola policy wording hi hamara contract hota.mera saath miselling hui hai kahan jaun

  11. As per my knowledge and product taken from Max Bupa Heart Beat Gold and platinum plan, Pre existing disease are covered after two years. Where as you have mentioned in point no.3 that only L&T is covered PED after two years.

      1. Thank you so much for wiriting to me personally as well.

        MAX BUPA’S HEART BEAT GOLD & PLATINUM PLAN which cover PED after two yrs. was launched on JUNE 2nd, 2014 and your blog/column was written in 2014-15. which means homework was not done properly which is creating confusion to me as well as other friends who have bought this policy.

        Besides this Claim settlement Ratio for MAX BUPA is 87% and as per your comment it is 56-57% which is another reason to get disturb. So i would request you to update your column which is creating lot of confusion.

        Above data taken from MAX BUPA CUSTOMER CARE and is also available on MAX BUPA website

        1. Satish-The product launched in 2014-15 does not mean they can’t revamp the features. It may happened so. Also, regarding Incurred Claim Settlement Ratio, it changes yearly. Hence, refer the latest data.

      2. Suggest you to kindly update your blog and put latest information. I am shocked to hear from MAX BUPA that their claim settlement ratio is much better than what you shared, which is 87%. People normally trust on such data shared by you but when such false and negative results came, they stop trusting.

        you have not mention about SOURCE of INCURRED CLAIM SETTLEMENT RATIO whereas on claim resolution you have clearly mention Source IRDA ANNUAL REPORT 2014-15

        I have also informed about this info to MAX BUPA too as being customer of co.

        Now my humble request to you is kindly update it.

        1. Satish-As per me, the incurred claim ratio is perfect and as per IRDA Annual Report. If you so scare about that data, then cross check the same with IRDA Annual Report (not with MaxBupa claim).

  12. My husband took a surgery oct 2014 and now im looking for health insurance for my family. But as he had taken surgery for Papillary serous cystic neoplasm pancreas I couldn’t take it. Though he is hale and hearty none of the insurance companies try to get documents atleast for verification. Hi spathology reports are normal and no ongoing treatement as well.Can you suggest on this situation

  13. Very useful article.

    My father is 62 yrs old and my mother is 50 yr old. Should I buy separate policies for my father (who is 60+) and my mother? or is there any policy available which can provide cover for both of them.

    I feel helpless and no one was able to provide any suggestion.

    1. Karthik-Better you separate. There are many policies which cover both. But buying separate will reduce your premium in your case (probably, but check the premium by calculating based on their age).

    2. Please buy Rbl bank policy of max bupa .u can buy for the age of 52 and 62 and no medical test.kindly make sure that u can claim for all diseases after 2 years.max bupa is a great company

  14. Dear Basavaraj. Need your help on a situation we are in. One of my Aunt had an heart attack and subsequently under went preliminary treatment at one hospital and within hours moved to bigger hospital for Angiograph and angioplasty. The total bill amounted to 3.5 lakh. 6k for initial treatment and about 3.4 for angioplasty and hospitalisation. We have two insurance policy one with ESI ( central govt entity) and other with united for 1 lakh. Because of outstanding payments to the hospital by ESI, they did not provide cashless facility. Now when we are claiming, ESI representative says we can get only 2.5 lakh for a bill of 3.5 lakh. So was wondering if we can claim the rest of 1 lakh with united ( I believe we can ask both to pay a proportionate but I do not know how) We had informed both companies while getting admitted and ESI is demanding all original bill. And we have just one original

    1. Srinidhi-You can claim from both. You inform ESI first and also provide the photocopy bills to United mentioning the reason for providing photocopy. You take signature on the photocopies from the hospital. It can be claimed from both.

  15. hi can you suggest a health insurance for plan for me .

    I have zeroed on max bupa health insurance and star health insurance with a cover of 7.5 lakhs which includes no limit on room rent and zero copay.

    any Pother policy that you can recommend

  16. Hey Basu, the apollo munich insurance website gives stats of 95% claim settlement ratio.
    Can you clarify what is actual and if both are right what is the difference for which they are stated.

    I am thinking about buying a policy for my parents (48 and 46). Can you provide some tips or suggestions.
    Thanks in advance.

    1. I think claim settlement ratio is not playing an important role to decide a health insurance policy, we should keep in mind our requirement and select the plan accordingly.

  17. Sir I have my all family members who have taken insurance from all companies.believed my words the best company in health policy cashless is national insurance and Bajaj Allianz.the worst is reliagre , star health and royal Sundram .its my true feedback because family is very big and they have used all health policy services.it is my feedback to all who want to buy health policy for their family .u will lose your money in most sensitive health issue.its my true advice .the company will show its agressivness in claim when claim amount is big .

      1. My family is very big some taken health policy Lombard .other from star or from other company.I would like to tell you now days insurers are giving not satisfactory services.I would like to ask a question from u Mr basu.when claims are repudiated from a premier company why customers don’t get claims from grievance officers and they get their claims from courts and obdusman.I mean to ask why quick transparent settlement is not given at company level?

        1. Laxmi-There are many reasons for illness and same way there are many reasons for accepting or rejecting the claim. Hence, we can’t generalize and say that “now days insurers are giving not satisfactory services”. Do keep it in mind that if majority of claims started to settle at the level of “courts and ombudsman”, they it really hamper the business fame of any insurer. Considering that aspect also they act. Hence, generalizing the views about whole industry is wrong.

          1. Sir if company do miselling .what can u do ? Irda is sleeping and company is saying go to obdusman.I’m a professional women .can u believe the company is miselling on mail and phone.but laws are very weak and their is no strict penalty on general insurance company.sir practical things are very different from real things.even if a consumer gets claim from court penalty is very less.I’m asking u if company has such expertise in claims settlement then why consumer win cases from court.

  18. I am 28 years old and i have my mom who is 72 years old, basically i am looking for her a health insurance as she is healthy and diseases free for further backup.
    I just shortlisted Star health red carpet plan as with low premium and 70% claim benefit but i am still not feeling satisfaction with this so
    kindly suggest me a good insurance company with low premium .

  19. About health insurance Grievance Status 2014-15 please clarify resolved no. of cases & percentage includes both no. of cases paid & rejected.

      1. Please give exactly where I can see this information. I think you should have given simple answer in yes or no whether it is only paid or it includes paid & rejected cases. The answer you have given is vague.

  20. Sir, Kindly guide me whether going for a standalone health insurance company has some cons? The Claim Settlement Ratio for the public enterprises are undoubtedly higher but at the same time the premium to be paid is higher as well for a sum assured of Rs. 10 lakhs, even they no claim bonus on Sum Assured (5%) is far less than what private companies are offering (50-150%).
    Going by your article it seems okay to go with a company like Religere or Apollo Munich, but at the same time Sir, I am a little confused regarding the Claim Settlement Ratio factor. What if my legitimate claims are turned down under some hidden clause! kindly inform what are the reviews of the general public about these private players.

  21. Hi,

    I am a 47 year old type-1 diabetic for last 16 years (on insulin for last 6 years). Can I get health insurance either under individual health plan or family floater. I want to cover my wife also 43 years in good health.
    Pl. advise.

  22. Hi sir.
    Bahut achhi information mili hai. But mera 1 daut hai kya ek insan alag alag company ke health insurance nahi kar sakta ? Aur kar sakta hai to claims kaise kare? Jaise hum life insurance se alag alag policy lete bhi hai aur unke claims bhi milte hai.

  23. Hi sir

    what if i take base plan with one health insurance company and top up with other. like SI of 8 lakh with new india and top up of 12 with religare.

    Please advise.

  24. Great article. Sir I am looking forward to take a family floater health insurance policy for my family of sum insured 5 lakhs rupees. My age is 40 wife is 31years and son is 7 years. We don’t have any existing diseases except minor uterine fibroids for my wife. My priority is no capping on room rent and other bills,no copay, maximum daycare procedures . If daily hospital cash and opd facility will be icing on the cake. Most importantly hassle free service experience.
    I have shortlisted afew policies. I need your guidance to select an optimal option

    1 Appollo Munich optima restore
    2 Max Bupa health companion
    3Future general health total vital plan
    4 ICICI complete health insurance

    Somebody mentioned. Max Bupa health companion is having capping on room rent , kindly clarify sir. If that is the case, that is deleted from the list!!

      1. Thank you very much for your timely response. I know you are always for stand alone companies rather than general. I believe my short listed policies are good in connection with my requirements as advised by you. If you can kindly advice me which is best among them would be a pleasure.
        Thank you

            1. Mr Bijeesh, I have done a through research on these products and I feel Health companion is the best at this moment. I can mail you the spread sheet which talks about each benefit in detail.

  25. I want to buy mediclaim policy for my parents, maximum age 48. Which is best company for me? which provide better claim settlement?

      1. Dear Sir,

        I have shortlisted for family floater health insurance Maxbupa,National Health Insurance, Could you please suggest me from this

  26. Sir i want to first say u that thanks for your precious advise for us,it’s very helpful to all.

    Sir I’m 32 year old with spouse 24 yrs and daughter 11 months,I want to purchase 5-7 lakh health insurance policy.
    Which one health policy will be good
    For us. Sir please kindly guide me I’m totally depend on your suggestion and I want to go with ur suggestion.once again thanks sir.

  27. I AM 40YEAR OLD AND MY WIFE IS 31 AND MY SINGLE DOUGHTER IS 2 YEARS OLD . PLEASE ADVICE ME A BEST HEALTH POLICY FOR ABOUT 5 LAKH ME AND WIFE. WE ALL ARE NOT SUFFERING FROM ANY ILLNESS.

  28. I am 40 yr with no PED. But i want to go for IndividualHealth Insurance. I had previously PSU 7.5 lac cover from UnitedIndia.But it got lapsed.
    Few Q:-
    For person residing in Mumbai, is it important that you stick to Insurers who have Main Office in Mumbai rather than outside of Mumbai.? Does it make any different w.r.t Claim Settlement and other stuffs.
    I want to go for cover betn 10L to 15lac so that i can be covered sufficiently as i pass betn 40-45.
    In those aspects, which Insurer does Not Load the premiums every Yr and is flexible.
    a]Apollo OptimaRestore v/s exclusive Heath Premium/Exclusive.
    b]Religare NCB of 15lac cover.
    c]STAR plan but surprisingly it does not have AMBULANCE coverage.? but covers some 404 day care procedures.
    d]CIGNA TTK.
    e]New India Plan/UnitedIndia/National.
    Please enlighten me with which one to go.
    f]Can a Copay policy be converted to WithoutCopay lateron as u age.
    g]Also i would like to know how Apolo treats Pre-diagonises charges it says that if its paid then you will loose post hosp benefit.? same is case with their daily cash which is just 800 within network hospitalI.
    h]Can we make lets a basket of MF SIP with same premiums amt you are giving to those Insurers and bounded with their terms and condtions and make your own HealthWealth and use as you require. Is this good idea.?

    Swapnil

    1. Swapnil-Main Office does not matter for your claim speedy claim settlement. Hence, you no need to worry. All insurers based on the oldest person’s age slab, changes the premium. Go with either Apollo or Religare. Investment is different and insurance is different.

      1. Hi Basavraj, I was checking this for my 63 yrs old father, you are right. I found Max & Apollo claiming to change premium from next year itself. Only Star saying till 66 yrs it will be same. Any view on Star Health floater plan?
        I also read last month that Star investor are speculated to venture out… so isnt it good to stay away from Star?

  29. i Am 33 yrs old
    wife_31
    Child _5 yrs

    I Want to Purchase health insurance of 5 lakh sum Assured
    Max Bupa
    Religare
    star Health

    which one is Better for My family..Pls Suggest

  30. Hello Sir,

    I wanted to know if there is any option to buy 5L + health insurance for my mother who is turning 70 soon. She already has a 2 lakh insurance cover from a PSU that she used to work for, but considering how expensive health care has become, I want additional cover. She has high BP (under control, at normal levels, with meds), an unexplained, enlarged spleen, for over 4 years (all during period of uninterrupted health insurance cover, no claims made other than ultrasound scans/other opd visits)

    Thanks
    Murthy

      1. This is a fixed, PSU (SAIL) provided health insurance for all retirees, there is no option for upgrade. We have to look for outside insurer to enhance the existing cover.

  31. I am 40 year in sep, 2016 & my wife 38 & child 5yr and i have decided to go with Oriental happy family floater Life Insurance policy through Online. Is it better to apply online or purchase it through their agent. Is their any risk in future in term of health claim.

  32. I am looking forward to a Super top up plan. I have shorlisted L&T, Apollo and Cinga TTK. What is your advise. With which of these should I go ahead with.

  33. Great article Basu!

    I am a 40 year old man and have a small family (wife 33 and son 5) who wants a personal health cover.I have proposed for a floater policy to a few private companies but when I declared our preexisting conditions (allergic asthma and a neurological trouble because of viral infection which is fully cured), Star Health said that if I declare such conditions, I would be denied policy altogether.

    1. Can the health insurer deny total health coverage because of the preexisting conditions? Does IRDA allow that?
    2. They may totally exclude coverage of declared conditions/cover it after waiting period/load premium but can they decline to cover diseases I am not even suffering from?
    3. I am unwilling to accept that at this age, I can’t get myself and my family a health cover because these preexisting conditions do not prevent us from leading us a normal life.

    1. Raja-1) No, they can’t. But with waiting period they can consider the existing diseases.
      2) They can’t. But you can’t question also. Because it is entirely the underwriter decision.
      3) Why can’t you check with other insurers?

      1. Thank you for such a prompt response Basu! Your blog provides unique insights and you are so responsive.

  34. Hi Sir,

    I am planning to buy a health insurance for my mom aged 42 years.

    I have shortlisted Max Bupa Health companion and Cigna TTK Prohealth Plus.

    Kindly suggest me the best one.

  35. Hello Basavraj,

    Hope you are doing good.

    I have a question on life long renewability clause of health plan:

    1. My question is whether all the plan will give me cover at the same premium or the premiums will increase year on year.

    2. If answer to 1. yes, are there any plan that assure fixed annual premium for long time. If not what is the benefit of buying a health insurance early and sticking to the provider for long period of time(apart from existing health condition)

    3. And my other question is if the health insurance premium increases with age. Which insurance companies are best in your opinion. Or what would best strategy to follow for my age of 33 years and spouse with 31 years and planning for a child in the near future. I was looking for my child to added to same policy at Birth. I am inclined towards Oriental Insurance or STAR (but star has waiting period of 36 months for catering to Child Birth care)

    Thanks
    Shri

    1. Shri-1) Premium will increase based on the age slab you fall in. Older the age higher the premium.
      2) There are no such plans as of NOW.
      3) If your concern is include child birth care expenses, then opt for the one which offers minimum waiting period.

  36. Hi

    Can you please let me know which companies offer health insurance for diabetic people age group 35-45 without any top up? We are ready for waiting period 4 years.

    Thank
    Khan

  37. Hi Basavaraj,

    Nice comprehensive and comprehensive overview.

    I have a small doubt here. Which one would you prefer between non-life insurance vs. stand-alone private insurers, given that non-life insurance companies have better claim settlement ratio as a plus point, whereas stand-alone companies have relatively better service (being focused only on health insurance segment, unlike their counterparts) as an advantage? Albeit, I am little skeptical because of their low claim settlement ratio. Please advice.

      1. Hi Basavaraj,

        Agreed. They mean only business but I am looking for at least a few companies that might have the “humane touch” as well:)

        Anyways, the onus is on us to choose the appropriate one, wisely…!! Thanks for the reply.

  38. Please send reply immediately THANQ which is better for my family members or individual my age 37 and I want to health insurance but which company is better from these companies like Apollo Munich health, Maxbupa, Riligare and Star health insurance and cignattk health insurance

  39. sir , i have seen u r messages , what i have seen u people talk only Appolo , max & religer,

    i want to know how is Bajaj Health insurance..my question people will not take bajaj health insurance

  40. sir,
    i am 27 year old single girl. i will get married in 1 year or so. and will plan child in next 3 years from now onwards. in my family noone has ever taken any health policy. so i have no idea about factors consideration for policy.

    i am doubtfull about choosing policy on basis of benefits they provide or on basis of claimsettlement ratio of company. please guide. share your contact detail

  41. My mother age is 53 and she is diabetic patient, due to which she has problem related to heart, so will this heart problem due to diabetes will covered after waiting period. And sir I am confused between max bupa and oareintal. Please guide sir

  42. A very good Article, Thanks for sharing..

    I am looking for family floater plan for I and my wife. The sum insured will be Rs 3 Lacs. I am in a confusion between public sector and private sector companies. I am from Kolkata. I have heard that National Insurance Company in Kolkata have very good Reputation in terms of claim settlement. But your article about claim settlement ratio is leaving me in a confusion. I do believe private sector companies are also very good in terms of quick services and wide benefits. I am 34 yrs with no major existing disease.

    Please suggest me a company which is best claim settlement, low premium, wide hospital network, cashless hospitalization and lifelong renewal option available. Please help me for choosing right and good company.

    Thank you in Advance

    1. Sujit-Don’t rely too much on claim settlement ratio. Because for an insurance company, each claim is different. In which side you fall is not known. Hence, first understand your requirement, budget comfort with company. Based that go ahead.

      1. Thank you for your prompt reply..

        I want to know in terms of benefit,service & faster claim settlement which sector is better for family floater policy; Public or Private???…

  43. I am looking for family floater plan and I plan to have a baby after 3 years. I would seek a cover of 10 lacs. Based on the ease of claim settlement, lower premium, wide hospital network, which company’s plan should be chosen

  44. I Sir I want to take One heatlth Policy for my Sister family . I have done research and got confused which One to take ( 5L policy.
    My Priority is
    1) Claim Settlement without any Issues.
    2) No copayment
    3) LiFE LONG RENEWAL
    4)Renewal bonus

      1. Hi Sir,

        Thank you for Suggestion. Can you please help me if these Religare is better than starhealth Family Health Optima and Royal sundaram Life Supreme plan.

        Regards,
        Santosh

  45. Dear Mr. Basavaraj
    I am 58 years old and looking for a health insurance policy. Due to my old age most policy premiums are very high. After checking many policies I have selected Easy health group health insurance from Apollo Munich through Canara Bank. The premium for Rs.5.0 lakh policy works out to be Rs.4565/-.
    Pl suggest whether this policy is good. You can also suggest any other policy for me.

    Sabyasachi Das

  46. I am 52 years old bachelor without any dependents.I would like to have a medical assurance with following featurres.
    1) lifelong renewal
    2) Cashless settlement preferably from PSU. I can also avail the service of the private companies but who knows they will be around in the future when need arises. Hence going for PSU purely from the fear factor.

    Please suggest the amount considering the soaring cost of treatment. I do not mind higher premium

    I am confused withe plethora of options, hence the need for expert advice from a competent person like you.

  47. Dear Sir,

    As i understood, Claim ratio of Stand Alone Health Insurance is in medium range with profitability. I would like to go with them.

    We want to go for Family floater (4 members) with maximum age of 34 years long with life renewal option, lower co payment option, No Claim bonus benefits with minimum 5 lakhs Sum Insured.

    Please suggest any one out of 3 company
    1. Religare
    2. Star Health
    3. Apollo Munich

  48. Hi Basavaraj,

    I am 29yrs with no medical history. I want to buy Rs 10 lakh individual health insurance. I have done a lot of research and now I am confused between Apollo Munich and Religare Care. Both the plans have their own pros and cons. To be very honest, my highest priority is hassle-free claim settlement, when I would require it. Minor difference in premium is not an issue. Which one would you recommend. Please don’t tell both 🙂

  49. Hi Basu Nivesh

    My mother’s age is 53, on date 05/05/2016 I purchase a mediclaim policy from Cigna TTK through policy bazaar. I want your suggestion about this is this right decision to buy a mediclaim policy from Cigna TTK or I should choose Apollo Munich for Mediclaim. Please reply ASAP
    Thanks in Advance
    Karan

          1. Yes, They told me that Claim settlement will not be a problem if there is a genuine Claim. Please Suggest if I should cancel this policy and purchase another company, mediclaim

  50. Sir, I want health insurances for my father aged 60 yrs 2 months and mother 58 yrs with no major existing disease. I selected L & & due to No copay and sublimit waiver option. PSU companies are offering with limiting option on room rent. Can u suggest better option for 2 seperate insurances.

          1. Hi Basu,

            I spoke to the Religare customer care today and they definitely seemed very good with no co-pay or room rent cap and it covers both critical illness and accidental cover. They also mentioned they cover existing illness (but with 4yrs wait period) and they have something called auto-recharge which is an additional sum insured for the same premium amount paid each year. That is if I buy individual policy of 5 lac each, they will fund another 5 lac if we exhaust the sum insured in a given year!

            My father is going to be 60 and mom 53 soon and the premium they quoted was about 18k and 14k respectively with a caveat that the premium could increase for my father who smokes depending on the medical tests.

            Is there any other plan in the market that could be on par with Religare and is their claim settlement ratio one of the best in the market?

            1. sorry, the wait period for existing illness is 2 years and room rent is capped at Single Private room for SI from 5-10 lac and up gradable to the next level beyond 10 lacs

            2. Isha-In terms of features, it is best option for you. Yes, including Religare all will ask for medical report of your parents. Then only they decide the premium. Check with Religare at first.

              1. thanks Basu! You had once mentioned to go with public sector companies so wanted to be sure that Religare isn’t sugar coating everything they said. Also, is this option good for me and my husband (ages 33 and 40 respectively). Should we opt for family or individual plans?

                1. Isha-I personally having health insurance with Religare. But it does not mean that I recommend to you also. If you are not comfortable, then YOU MUST NOT. Try with public sector companies.

                  1. Hi Basu,

                    I opted for insurance from Religare for my Dad who;s turning 60 in two days but I applied for it few days ago to avail the benefit of the low premium in the aged slab. However, they came back today saying he’s borderline diabetic and the premium will need to be increased by 25% (which is the maximum load slab) 🙁 How can they add the maximum load as my father’s sugar levels are not very high and in control. I’m okay to pay the additional premium but they seem to be charging me the maximum amount which I feel is not justified. Need your advice if this is still a good plan to move forward with? I have opted for INR 5 lac cover for my Dad and it comes with additional 5 lac benefit if we use up this sum insured (Religare Care Plan)

                    1. Isha-Neither me nor you can change their quote. Because when you propose, then they calculate the risk they have to take and based on their underwriting calculation, they quote the price. Hence, only option for you is either to accept or reject. Before saying them YES, what I suggest is to propose with some other companies. If other companies accepted less than this company, then you may under profit. But strictly check for features and exclusions or waiting period.

                    2. Thank you for your quick response Basu! Appreciate it 🙂

                      Could you kindly suggest any other company that has very good benefits on par with Religare? I have already paid the initial premium based on my dad’s age and they’re looking for the additional payment now. The Religare plan seems really good but would like to know if you have any suggestions for me?

  51. Hi Basunivesh,

    I am from Bangalore and would like to take health insurance for my father and mother with SA value of 5la. Can you suggest any of the good health insurance plans so that i can refer them

    thanks,
    Phani

  52. Dear Sir,
    Basavaraj Tonagatti

    My name is Madhav, I want a health insurance for my family, me (50 age), wife (48age), two son both (22 age )
    pls suggest me how much insurance coverage I should go for?
    and health insurance company would be good?

    1. Madhav-Ideally you must have minimum of Rs.5 lakh. But it again not a standard formula. It depends on where you stay how healthy you are and what type of service you expect during hospitalization. Regarding companies, I already listed above.

      1. Dear Sir,

        Thank You Sir for your Reply,

        I have shortlisted some Health insurance companies,
        1. Oriental
        2. United
        3. HDFC Ergo
        4. Religare
        5. MaxBupa.

        Pls Suggest me which one is good, Or suggest any other which according to you is better than all these.

      2. Hi Basunivesh,

        I am from Bangalore and would like to take health insurance for my father and mother with SA value of 5la. Can you suggest any of the good health insurance plans so that i can refer them

        thanks,
        Phani

  53. Basuji
    I would like to take a health insurance policy for my parents(aged 62 and 58) and also for myself and my husband. Should I take the policies for my parents separately or take as a single Policy.
    Thanks in advance.
    Regards,
    Tara

  54. Hi,
    I would like to purchase health insurance for my family (me, wife and two kids).
    I am a NRI & having free medical care by company.
    Could you please guide me to choose a health insurance plan for all means?

    Thanks & best regards
    Pranav

  55. Very very helpful blog.
    What I understood from blog regarding insurance is that
    1.Take life cover first.
    2 Accidental Policy separately. similarly
    3.Medical insurance first similarly
    4 Critical illness should be a different product.
    If anything is wrong pl correct and guide me.
    Only one question arises shall I take all product from same company or different one.
    Pl guide .

  56. Hello Basavaraj,

    Want to buy for Parents, Father (63), Mother (60). Father had a slip disc surgery but now 100% cured. Mother has Thyroid. So I assume both healthy no existing diseases.

    Request for your expert advise to choose among these,
    Apollo – Optima Restore
    Religare – Care NCB Super

    Please help to take decision on below points,

    1. Optima Restore is costly then Religare. But Religare has copay which Optima don’t have.
    For 20 lakh floater => Premiums are Optima – 80k, Care – 57k => 23k costly. So is Religare better with 20% copay and 23k cheaper premium?

    2. Although Apollo has 4 times more market capture then Religare but ICR is same. So Apollo gets +1 for reliability.

    3. Auto restore in Apollo is tricky, the insured cannot use the extra sum insured until the basic sum insured plus all bonuses completely exhausted. So may be for 2nd Surgery costing 5 lakh and with 2lakh balance in Optima, I will not get 3 lakh from Optima as auto recharge. For 3rd Surgery I will get auto recharge amount to SI.
    While in Religare in case of 2nd surgery (for different ailment) recharge benefit automatically reinstates the basic sum insured even if you have not exhausted your base sum insured. So Religare gets +1.

    Rest most of the things I found same in both the products. I found MaxBupa also good candidate. Do you suggest it over these two?

    Correct me if any of above concepts, I have misunderstood. Your verdict will be valuable.
    First priority is better product and not premium cost.

    Thanks in Advance.

    1. Hi Vivek,
      1) So which one did you go for finally? Religare CARE or Apollo Restore. Even i have shortlisted these.
      2) Also did you consider Super-top up plans?, they seem to give similar benefits with a very-very low premiums

      Regards.

  57. what are the best health insurance plan for 54year aged person with diabetic which is better between star diabetic and icici diabetic plans with pros and negatives

  58. can you suggest a health insurance plan for 53year aged person with diabetic which is better between star diabetic and icici diabetic plans with pros and negatives

  59. i want to take a term insurance policy and health insurance policy to my 53 years old parents for term insuarnce i want to go for icici i protect or max life online term which one is preferable

  60. How is L&T Medisure Classic Insurance??
    I want to take it for my dad whose age is 47.
    I am looking for better Claim Settlement Ratio, Critical Illness, Room rent waiver.
    Is there any other better policies??

    1. Mithun-Forget claim settlement ratio, but there is a room rent cap of 1% of sum insured in this plan. Also, don’t combine health insurance with critical illness. I suggest why individual plan than family floater?

  61. Hi ,

    Very help site clarified most of my confusions.
    Request you to advise me which Medical Insurance company and which plan would be better for me considering below factors:-

    I Can afford 10-15 thousand for health insurance.

    Want about more than 5 lakhs coverage

    We are not having any diseases present but my wife’s mother is a diabitic and paitent.

    I want a floater plan for me and my wife only

    We want to have plan with mental and gentic diseases covered, with all other diseases mean to say I don’t want to miss any diseases, as we know future is not certain.

    I use to smoke daily and drink offen.

    Thanks in advance

  62. Hi sir I am looking for a smal health insurance for me 28 my wife 22 and my 4 years old san up to 3 lakhs S.I. Plz suggest me which one would be better for me star health or new India.

  63. hello,
    I have Star Health comprehensive plan for my self SA 7.5 lac.
    now I want to add critical illness cover. should I take critical illness policy from ICICI lombard/HDFC Egro or others ?

    also suggest about my existing comprehensive plan of Star Health.

  64. Also Basu, if I have ICICI Lombard and say if I am taking Star or Apollo, do I have to tell them I have ICICI Lombard existing. what use is it of them?

    Is it worthwhile splitting amounts between multiple (say 2-3) or sticking to 1?

  65. Hi Basu,

    Torn between Star health, Apollo Munich Easy care premium with critical illness rider, apollo munich optima restore

    I am 40 and looking at 10 lakhs insurance cover.

    Any suggestion?

    All 3 look good and each have sum pluses/minuses with respect to each other.

    Also how does ICICI Lombard iHealth compare with these 3? I find it expensive

    Kindly reply
    Sanju

  66. Dear Sir,

    I am 29 years working women planning to buy an individual health plan of 5 lacs. Can you please guide me in choosing a comprehensive individual plan for myself? Also if you can help me to choose a critical illness and personal accident plan, i would be grateful.

    Regards,

    Shilpi

  67. Dear Basu,

    My age is 25,I am planning to buy a health insurance purely for tax benefits and health purpose.I am a non-smoker–non-drinker.Please suggest me good health insurance plan.I am also covered under group insurance plan from my company.But my colleagues suggested to buy a health insurance plan.

  68. Hi Mr. Basavaraj,
    Thanks for your valuable analysis.

    I want to clear my doubt that I have oriental insurance policy of 4 lacs for more than 5 years with no claim I am now 40 years and seeing the extra benefit of Religare for no room caping and yearly health checkup I was thinking portability, will this decision good to choose from public sector to pvt sector in regard to get claim easily in case of any emergency.

  69. I am 52 yrs.Assume general major hospitalisation requirement in a metro city on date as Rs 7 lacs.How much health insurance is required to be taken today to ensure at 75 yrs I do not pay for such requirements, if arises.Increase of insurance amount at a later date possible with increased premium but without adding additional premium due to change in health?

      1. Hi Basavaraj sir,

        Need a clarification in choosing the sum assured, For example

        At 32 years old, required sum assured = 8 lacs
        When 60 years old, based on 10% inflation every year required sum assured = 1.05 crore

        What is the right sum assured while buying a medical insurance at the age of 32?
        Could not imagine 1.05cr insurance amount now,

        Thanks

        1. Vinod-Buying health or life insurance is not one time process. You have to increase them once in 5 years at least. So now you can start with Rs.8 lakh and increase as and when you need. Buying Rs.1 Cr health insurance NOW is not feasible idea.

  70. Hi Sir,

    I’m a follower of your webpage and it is really very useful. Thanks for that. I have the below question.

    If i buy a Health Insurance Plan now for 1 year term, say on 2016 at 10,000 Rs based on my age and family members, Will the amount be the same through out my life term, say 10,000 Rs (ex: till i reach 60 years, assuming i keep paying the premium every year)? (or) will it get changed every year based on the company policies?

    Thanks in advance.

    1. Guru-No it will change but not on yearly base. There is a age slab like 30-40 years of age one slab and 41-45 years of age another premium slab like that. So up to same slab there will not be premium hike. But once you jump to next age slab, then they increase the premium. Also, in family floater, the premium will be fixed on the age of oldest member of that family.

  71. Someone here said that Max Bupa Companion (Family Floater) of 10L SA have room rent capping. But I have the same Policy of 15L SA and it is clearly stated in the Policy Document/Wording that there is no limit in Room Rent. Also Max Bupa have some excellent Feautures like –
    If someone is not claiming for 1st 5 years then its SA will increase to double and it will not reduce even if you claim for any particular year after the five year period.
    Please Clarify if I am mistaken.

  72. Thanks , very good article.
    i need a help to decide which insurance should i go for.
    my age-36, my wife-36,son 7 years,initially my current company is giving 1 lacs per annum,but when i leave the company will loose this.
    i have to get my own- initially i have decided for max bupa health companion, star health and religare.
    my require is for long term with good sum assured, no deduction on sum assured on claim, guaranteed bonus with no reduction.
    i have thought for max bupa health companion.
    please suggest.

      1. Please ignore the earlier message.

        Thank you so much!!

        Both the company will tell now what will be the premium at the age of 55 /65 / 75 years.
        As per your knowledge which one,s premium( religare / max bupa health companion) will be cheaper in future.
        Please guide !

  73. Hi,

    I am looking for family health insurance. I need to decide between HDFC Life and Apollo Munich.
    Which one is more reliable?

  74. Genuinely appreciate your efforts, Mr Basavaraj!Your blogs are always informative and yet crisp.

    Wanted to know what is the ‘ideal’ health or life insurance cover for an individual ? and when we consider our expenses to calculate, what all would you consider in this?

    1. Kumar-Ideal life cover must be around 15-20 times of your yearly income+existing loan amount. For health insurance, there is no such guideline. Because it is purely depends on where you live and the cost of hospitalization. But I personally feel an individual must have around 5 lakh of coverage. Expenses for what?

  75. In health insurance, companies giving no claim benefits approx. 5%, so is it affected on premium for the next year when sum assured increased by 5%?
    If yes than how much?

    Thanks

  76. Hi Basu,

    is it good to buy pension policy. if yes which one to buy?

    my details are – 29 yrs, Employment – Private Service (No PF & Gratuity option).

    Thanks in advance.

  77. Hello Sir, My Rs.5 lacs. group insurance policy is given by my company of united india insurance, my age is 48 years, my wifes age is 44 years, After my retirement at 58 years means 10years later from now the company policy of rs.5 lacs will get stopped, So I want to take one policy of Rs.15 lacs for my Life time which should cover all the critical illness also & that policy should continue till the last day of my Life. Pl. suggest.

    Ganesh

  78. dear basu ji

    still i wnat to know from you which will be 2 best health insurnace for 48 yrs of age and individual policy and must less premium and no problems in settlement pls suggest me

  79. Hi Basu,

    Very good analysis. I currently have Apollo Restore 3 lakh and L & T Super Top up with 12 lakhs coverage..
    I also have one Apollo Personal accident premium policy for complete family.

    I am looking for Critical illness policy , where as i have currently high BP. age 38.. with wife 32 and (2 kids- 5 years and 6 months )
    Also I am looking for better policy in case of Personal Accident- How about Bajaj Alliance Personal Guared compared to Apollo personal accident premium policy.

    I may want to switch to PA policy for self rather than entire family to reduce the premium.

    Also do we have better plans compared to my existing policy, do you recommend any swith to difference insurrer based on Porting..

    I have been paying premiums from last 4 years with no claims so far.

    Please suggest.

    Thanks,
    Shravan

    1. Shravan-Check for critical illness with Apollo or L&T. I feel Bajaj accidental insurance a better one. I suggest to shift whole family to new accidental insurance than your alone. This creates simplification. If you are already having plans since 4 years with no issues, then don’t think too much. Continue with same insurance companies.

      1. Thanks Basu!

        As i currently have high BP, which insurance company would be able to provide critical illness for pre-existing disease.

        I think Apollo is very struct about pre-existing dieseases, they might not willing to give insurance for Pre-existing disease..more over the premium is quite high compared to other insurers..

        Please suggest.

        Thanks,
        Shravan

  80. Very good analysis Basu.

    Actually, I am planning to buy a family floater for 2 adult and 1 kid for sum insured 10 Lacs. Based on the above article, I have shortlisted 2 plans as below

    1. Religare Care
    2. Max Bupa health companion

    Need your advise finalizing from 2 of above. The couple of factor which I feel is the only limiting factor for the policy.

    1. Room rent capping – for max bupa and religare, there is a capping on room rent type which states as per policy wordings that the company can only cover the single private room which is the most basic and economical in the hospital. I checked with customer care and asked what if the most economical private room is not available at the time of admission to hospital, would it be allowed to upgrade the room to next level. In this case, the insurer has to bear the marginal cost in proportion to upgraded room. I am aware we generally admit to hospital for better treatment and not for comfort however with this capping of room type, it is always subject to availability of basic economical room in the hospital.

    2. Pricing after 45 and 50 – Religare pricing increases steeply compared to Max bupa during 45-50 age and it is reversed during 60-65.

    I agree that every individual is unique and would require different plan however Need your insight choosing the right plan for me as above 2 factors are not suitable for my requirement.

    Suggest me if there is any better plan.

    1. Sameer-1) In Religare it is % of sum assured up to Rs.5 lakh sum insured. Later on they pay the actual charges of applicable single private room. In MaxBupa it is true that of what you said. Hence, if your concern is that one, then switch to Religare.
      2) Pricing may be bit higher as you grow older in Religare. But comparing it’s unique features. I suggest you to go with Religare.

  81. Thanks for the article. Very resourceful. Can you also share something similar for critical illness policy?

    Regards,
    Tanmay

  82. Sad to see religare performance, i was going to buy next month, people trust on private sectors due to fast and excellent services, but only 60% claim settlement makes us sad, suppose i will pay 16000 Inr/year continously 3 years and when i will need they can reject, hard to trust and i was in love with religare ….and people thinks that public sectors can delay in claim, so many people including me stuck between claim ratio and service when u need it in emergency….actually most people preffered private companies due to quick service but claim ratioo of these hurting , thnx

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