IRDA recently published the Annual Report for FY 2016-17. Let us find out the IRDA Incurred Claim Ratio 2016-17 and which is Best Health Insurance Company in 2018 in India.
Incurred Claim Ratio or ICR is a ratio of the total value of claims paid or settled to the total premium collected in any given year. This can be calculated as Incurred Claim Ratio or ICR=(Total Value of Claims Paid/Total Premiums collected)*100.
For example, let us say Company ABC settled the total claim amount of Rs.90 Cr in the year 2015-16. In the same year, it collected Rs.100 Cr as a total premium. In this situation, the incurred ratio stands to be 90%.
This Incurred Claim Ratio is applicable only to non-life insurance companies. For life insurance companies, IRDA publishes Claim Settlement Ratio. I have already written a post on the same. You can refer it at “IRDA Claim Settlement Ratio 2016-17 | Best Life Insurance Company in 2018“.
This is the one of identifying the financial health of non-life insurance companies.
# Incurred Claim Ratio or ICR more than 100%
It indicates that for every Rs.100 they collecting as premium, they are paying more than Rs.100 as a claim for a year. In simple terms, your income is Rs.100 but your expenses are Rs.100 or more. So instead of profit, they are into loss.
# Incurred Claim Ratio or ICR less than 100%
It indicates that for every Rs.100 they collecting as premium, they are paying less than Rs.100 as a claim for a year. Such companies are making a profit as your income is Rs.100 but expenses are less than Rs.100.
What it indicates that less ICR means the company is in profit or eyeing on profit. So either they may insure the less risky individuals or groups (customers rarely come forward for a claim) or rejecting the claims just to profit.
However, rejecting claims only on grounds to profit will not work out for any company. They have to look for reputation, future growth, and regular guidelines. Hence, simply for the sake of profit-making, they can’t deny claims.
In my view, going with companies of high ICR or low ICR is risky. Hence, always choose a company which is in between both these points.
Remember once again, ICR is not main criteria in selecting health insurance. However, it is one among many criteria.
Now let us concentrate on IRDA’s Annual Report for 2016-17. We will check the IRDA Incurred Claim Ratio 2016-17 and identify which is the Best Health Insurance Company in 2018 in India.
Here, I will divide the health insurance companies into 3 categories. One as public sector companies, second as private companies and the third one as standalone health insurance companies.
Below is the data for the public sector companies.
New India managing the healthy 103% of ICR whereas United India’s ICR is just concerning. Last year for National it was 110%, New India 115%, Oriental 114%, and United was 122%.
In below chart, I will show you the ICR of private sector health insurance companies.
I marked with red for those companies whose ICR is below 50% and above 100%. I marked with blue for those companies whose ICR ranges from less than 100% to 80%. I marked with green for those companies whose ICR ranges from above 50% to less than 80%.
In below image, I will share you the IRDA Incurred Claim Ratio 2016-17 for Standalone Health Insurance Companies.
Here, I marked with red whose ICR is below 50% and above 100%. However, Aditya Birla is the new entrant. Hence, we can’t judge or assume that this is worst data.
Now we understood the financial health of insurance companies. Let us move forward and identify the points before selecting the health insurance.
# Coverage Amount-Concentrate on Sum Insured and think beyond the current hospitalization expenses. If premium costing you more, then fill the gap with the super top-up plans.
# Buy early-Buying at the earlier age is best than postponing it. We don’t know the health issues. Hence, the insurer may reject your proposal. Hence, always buy immediately and never postpone.
# Understand the cover-Identify the features you want to cover. Covering all NOT POSSIBLE. Hence, try to identify the product which covers many illnesses.
#Individual or Family Floater-Decide whether you want to go for individual or family floater. It is always best to go for an individual if the age of any one member of the family is so high than the others. For example, in a family of 4 the oldest person’s age is 65 years and rest of other 3 members age is less than 50 years, then better to buy an individual plan for that 65 years old individual and rest 3 members can buy a family floater.
Because the premium is fixed based on the age of oldest person also.
# Entry Age and renewable clause-Check the entry age and for how long one can renew it.
# 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.
# 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 a 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.
# Check treatment wise limit if any.
# Check the premium rates. Especially check the rates for older age rates as few insurers jump the rate drastically for older age coverage.
# 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.
Hope this much information is enough for you in shortlisting the health insurance product.
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View Comments
Dear sir , Iam having a Star Health insurance mediclaim policy, and want to switch over to Religare Health Insurance, please advise, it's good for future or? Thanks OP sharma
Dear OP,
Check with Apollo or Max Bupa too.
hi basavraj,
need your help in selecting policy , as am existing policy member of Apollo Munich ( 3year old) for 10 lakh , which I bought in 2016 , but not used any claim so far and now my policy is , I am looking for policy portability in max bupa or ICICI Lombard policy but feature wise Max Is better and premium wise ICICI , am already insure through company policy for 6 lakh for my company and 7 lakh through my wife company which means 13 lakhs
need suggestion for below
1. How much amount I should go for slection for SUm insured - 5 lakh or 10 lakh as per current Hospital expenses ?
2. to go for ICICI or max bupa ?
3. which one is better in claim settlement as per IRDA ?
4. Should I go for Portability from Apollo munich or no need ?
5. should I go for any government policy or private ?
6. what kind of loss I am going to make if I switch from Apollo to another policy , as I have not claimed any claim for last 3 years apart from no claim bonus ?
7. is there any other private company policy better like TATA AIG ?-- pls suggest as per company performance and reputation in claim settlement
Amit Bathla
9871005094
Dear Amit,
1) 5 lakh base plan and then go for super top up for 10 or 15 lakh.
2) Both are same to me in terms of claim settlement and business module.
3) Replied already.
4) But why?
5) First look for your need, then the question of which company.
6) If port, then no loss but the features changes as per new policy.
7) Why such in-depth research?
dear basavraj,
1. as I have already policy of 10 lakh of Apollo so I cannot port less than 10 Lakh , so 5 ;lakh base plan I can only buy as new policy not through portability - can you clarify more about this
2. what is claim settlement ratio of Max bupa
3. which plan Is better in max bupa for portability for 10 lakh and with better features
4. pls suggest if any other better policy with good feature like Max bupa but premium low and also good claim settlement
Dear Amit,
1) If idea is to port, then go for 25 lakh super top up with 10 lakh co-payment.
2) It is there in the above post.
3) MaxBupa Heartbeat.
4) Hard to say with the limited sharing of your requirement.
Hello Basavaraj!
Can you please share your thoughts on Cigna TTK Prohealth plus policy?
I'm 30 and about to get married, looking for a good beneficial family floater. Thanks in advance.
Dear Paresh,
If the features are looking good for you, then what is the doubt?
Hello Basavaraj !
I am looking for 2 health insurance policies
1) For myself & my wife - Age 33 & 31
2) For my Mom - Age 54
1) For myself & my wife : No Pre-existing disease till date.
2) For my Mom PED is Diabetes.
What i am primarily looking for is :
i) Insurance companies who settle the claims without creating any issues, with good claim settlement ratio & At a later stage, increase the premium only as per age slab & not as per the past medical / claim history or as per their wish.
ii) Maternity cover (Only for policy covering myself & wife).
iii) No capping on room rent & ICU / ICCU.
iv) Covers OPD.
v) Restore / refill benefit in a policy year after exhaustion of sum insured + Acquired bonus coverage.
vi) Covers almost all day care treatments.(Waiting Period applicable)
vii) Less waiting period for PED.(In most of the cases it is 4 years)
I have shortlisted 4 health insurance companies getting close (but not all in one) to my above listed criteria:
1) New India Assurance - New India Mediclaim Policy
Fulfills : i), ii), v) & vi), Doesn't fulfill : iii), iv), vii)
2) National Insurance - National Parivar Mediclaim Policy
Fulfills : i), ii), iv), vi) & iii) * Only in case of network hospitals,
vii)* Covered from Day 1 if opted for optional PED cover of Diabetes and/or Hypertension with additional premium of 13 to 30% depending on which one needs to be covered. Doesn't fulfill : v) * Major drawback
3) Star Health & Allied Insurance : Star Comprehensive
Fulfills all the above except criteria iv) & vii)
4) Apollo Munich : Optima Restore
Fulfills all except ii), iv) & vii).
Major advantage is with criteria v). Optima Restore covers for same person, same illness in the policy year.
For myself & wife policy, i think i should go ahead with 10 lakh coverage from Public Sector with New India assurance - New India Mediclaim Policy & Super Top up from either Star or Apollo.
What do you say ?
For my mom : Already has Star Comprehensive policy of 7.5 lakhs coverage with 1 year completed & no claims made yet. 3 years more to go to cover Diabetes as PED.
Thinking of having a Super top up for her as well from may be New India assurance or National Insurance.
Is this the right time to go for Super top up ?
Your views / suggestions on the same will be helpful.
Looking forward to hear from you.
Thanks in advance
Regards
Amit
Dear Amit,
Your WISH list is LONG and you will not find all the features in a single product. Regarding your health insurance and your mother's health insurance, you go ahead with the companies you are comfortable with. However, try to buy super top up also from the same insurance company where you have the base plan.
Thanks Basavaraj for your inputs.
You mentioned in your comment to “try a super top up from the same insurance company”
My Questions : 1) Does it gives any specific benefit ?
Also can you throw some light on important aspects to be looked for when selecting a super top up ?
2) Is it recommended to have 2 health insurances from 2 different companies ? If yes, 1 from public & another one from either private or standalone sector is Ok ?
Thanks & Regards
Amit
Dear Amit,
If your base plan and super top up plan is under same health insurance company, then the claim process will be easy.
Thanks a ton Basavaraj !!
Hi. Will i be able to avail tax benifits if i buy a 2 or 3 year health insurance policy at a stretch? (with a max of 25k pa)
Dear Sanjay,
Yes.
Basu Ji,
I am planning to take health insurance for my father. He is 70 years old and has hypertension, so I dont have much options. I find that Aditya Birla is offering me the policy closest to my requirement and within my budget. I was preferring Religare but it's expensive and for Cigna TTK, I have received some bad reviews.
How is your assessment for Aditya Birla health insurance? For ABHI the premium is around 34,000 whereas for Religare it is 42,000 for similar (not same) terms and conditions.
Dear Praveen,
If it is matching your requirement, then go ahead.
Hi.
I want a mediclaim for myself(45), spouse(49), son(18),daughter (15).In 2017,we opted for MaxBupa with a premium around 18000.But next year they increased it to around 24000(they said due to some change in govt. slabs). But I discontinued it as they couldn't stand on their words of premium increase. Their representative told me that it would only increase around 600-1000 rupees. So, now i want to go for another health insurance for 4 of us. Please suggest which would be better-MaxBupa, Religare, Apollo Munich, HDFC Ergo. Or some Public insurer.
Dear Ritu,
Check with Apollo or Maxbupa (even though you have earlier with them).
I have a family of 3 in need of medical policy. Adults 2 (55 & 46) and one son 8. Cover Rs5 lakhs and premium not more/around Rs24000.I have been studying policies/companies for the past one month(!) and the conclusion does not seem to be in sight.Health insurance laws rules seem to be more complicated than income tax!
I am desperate (age 83!). Would like to end the search soon. You sound very thorough and knowledgeable.
Can you suggest some companies in order of preference
P. Ranganathan IRS (RETIRED)
9449038493/7349310550
Dear Ranganathan,
You will not get everything in a single policy and that also within your budget. Check with Apollo Munich or MaxLife.
Thank you very much.
Hello Basu,
Again thanks for this post..
Just wanted a little help...
Based on your research on this post, i was planning to take a health insurance floater policy for a family of 3.. (Myself, my wife and my daughter). I was planning to for a 10 Lakh base policy and also opt for a super top.
I had shortlisted
1. New India Assurance
2. Max Bupa
If its just the base policy then New India was working out cheaper... However with TOP ups from the respective companies, the total premium (Base + Top up) .. Max bupa was working out better..
And as we understand all these Health insurance companies nearly have the same type of exlcusions etc..
Advantage of Bupa Vs New India what i could see
1. Room Rent Capping :
Bupa no capping (Except for suite and baove category )
New India it was max 1% of the Cover.. SO basically 10000 in this case
2. NCB :
Bupa has this NCB of 20% every year.. to max of 100% accumulation
New India doesn't have any.
3. Health Checkup: BUPA provides Annual Health Check up for all members) .. New india doesn't..
Healt check up for 2 members would atleast cost 5k min.. so in a way its benefit..
4. Refill Benefit : Possible in BUpa.. (If we have exhausted our Base Sum Insured, you are entitled for an additional sum insured equal to the base sum insured for a subsequent claim in the same year, provided it is for an unrelated illness) ..
5. One Advantage of NEW INDIA :
The age bucket of new India was quite large.. and for that bucket the premium would be same or very nominal change.. The have age brackets of 36-45, 46-50, 51-55,56-60, 61-65..
When we compare this with Bupa.. they will give a policy for 2 years at a strecth, however the premium after 2 years would be prevalent at that time.. and this difference looked large to me.. if i consider even a agre bracket for 5 years..
I currently fall in 36-45 bucket and i would still have another 5 years before my premium drastically changes..
These were some major differences i could see..
Just wanted to get a quick opinion of yours.. and see if i am in the right path..
Please let me know, what would you have looked at based on your experience..
Regards,
Munna
Dear Munna,
Well researched :) Go with MaxBupa.
Hello sir...I am 34years old having wife and a baby of 9months, I am working in a private company. My job is not constant in one particular location.
Q.1) Through my company I have my medical policy with IFFCO TOKIO.
Is it possible that after changing the company will this policy be continued?
Q.2) I need health policy which having easy claim settlement method. Policy bazzar suggested to take RELIGER, but after reading various reviews now I am totally confused/afraid to take it. What should I do kindly suggest me the trustee policy.
Deepak
7069184885
Have one policy of your own, atleast of 3 lakhs , Family floater , this will keep you safe , dueing transition from one company to other , and other part is , it will also go on acruing No CLaim bonus , my 2006 policy of 3 lakhs has now become over 5 lakhs , due to No Claim Bonus .
Dear Deepak,
1) Sadly NO. That is the reason it is always best to buy on your own one also.
2) Those who can claim EASY may not be EASY at the time of claim. Hence, it is hard to say so which is EASY settlement company. Look at features at first and then decide.