Categories: Insurance Planning

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

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.

IRDA Incurred Claim Ratio 2015-16 | Best Health Insurance Company in 2017

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.

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.

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.

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.

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.

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.
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.
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.
Identify the company which offers the lifelong renewal option. Because your health insurance need is more during your old age.
Check for room rent capping.
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.
Check for exclusions. If you feel the exclusions listed may be uncomfortable to you, then skip that product.
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.
Read carefully the wordings of policy brochure. If you have doubts on any feature, then try to clarify it NOW itself.
Avoid all common features, which companies try to highlight.
Check for No Claim Bonus company offers.
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.

BasuNivesh

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View Comments

Chotu says:

March 19, 2018 at 10:36 PM

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.
- Basavaraj Tonagatti says:
  
  March 20, 2018 at 6:28 AM
  
  Chotu-Go for family floater.
Nida Hussain says:

January 17, 2018 at 2:42 PM

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
- Basavaraj Tonagatti says:
  
  January 17, 2018 at 4:51 PM
  
  Nida-Why not opt for Super Top Up plan with co-payment of Rs.3 lakh?
Abhi says:

December 11, 2017 at 8:08 PM

By which should i go for family floater health plan of 3 lakh for me nd wife...cigna ttk or future generali
Hiren says:

November 5, 2017 at 9:20 PM

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?
- Basavaraj Tonagatti says:
  
  November 6, 2017 at 8:01 AM
  
  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.
  - Hiren Mehta says:
    
    November 7, 2017 at 8:04 AM
    
    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.
    - Basavaraj Tonagatti says:
      
      November 7, 2017 at 12:47 PM
      
      Hiren-I respect your choice. They have family floater plan and please be in touch with branch nearest to you.
      - Hiren says:
        
        November 7, 2017 at 10:34 PM
        
        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?
      - Basavaraj Tonagatti says:
        
        November 8, 2017 at 9:00 AM
        
        Hiren-You can buy one more. But while buying the additional from same insurer, better to declare the existing one.
Jigar says:

May 14, 2017 at 11:40 AM

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
- Basavaraj Tonagatti says:
  
  May 14, 2017 at 12:03 PM
  
  Jigar-Opt for bank provided insurance if she is unable to get the health cover from health insurance companies.
  - Jigar says:
    
    May 14, 2017 at 12:40 PM
    
    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
    - Basavaraj Tonagatti says:
      
      May 14, 2017 at 12:52 PM
      
      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.
      - Jigar says:
        
        May 14, 2017 at 1:41 PM
        
        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
      - Basavaraj Tonagatti says:
        
        May 14, 2017 at 5:42 PM
        
        Jigar-Stick with public sector insurance companies tied up banks.
      - Jigar says:
        
        May 14, 2017 at 9:34 PM
        
        So u mean New India and the likes of it. Any reason why ?
      - Basavaraj Tonagatti says:
        
        May 15, 2017 at 8:06 PM
        
        Jigar-Public sector insurers are bit liberal in settlement than private players. It may be my biased view. But you might also be noticed the same.
LAXMI KANTA BARAT says:

March 4, 2017 at 1:00 PM

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.
- Basavaraj Tonagatti says:
  
  March 4, 2017 at 1:49 PM
  
  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.
Akash says:

February 10, 2017 at 5:45 PM

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 .
- Basavaraj Tonagatti says:
  
  February 10, 2017 at 8:21 PM
  
  akash-Refer my latest post "IRDA Incurred Claim Ratio 2015-16 | Best Health Insurance Company in 2017".
Laxmi says:

February 8, 2017 at 11:47 PM

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
- Basavaraj Tonagatti says:
  
  February 9, 2017 at 10:02 AM
  
  Laxmi-NONE KNOW.
AMIT GHOSH says:

January 14, 2017 at 5:33 PM

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
- Basavaraj Tonagatti says:
  
  January 14, 2017 at 6:51 PM
  
  Amit-They pay room rent as per the limit set and also the claim amount (excluding few expenses as per policy wordings).
AMIT GHOSH says:

January 13, 2017 at 3:43 PM

i found it in max bupas benifit table
- Basavaraj Tonagatti says:
  
  January 13, 2017 at 7:55 PM
  
  Amit-I am not sure to what extent they implement. But for better understanding refer this link of SSRN.