By Ritik Bhagat
Health Insurance Policy protects you from physical and financial troubles in the event of serious illness. But, it is also important to choose a good health insurance plan for immediate and adequate help on these problems. For this, understanding of some basic facts is necessary. Also, comparisons of various insurance plans and their companies should also come. In this article we will explain how to choose a good insurance policy. Also, some good companies are suggesting names, which may be a better option for you.
5 factors consider to buy best health insurance
We have taken 5 factors into consideration in selecting a health insurance policy. What is their usefulness in choosing an insurance policy and its company, let us first understand them-
Claim Settlement Ratio
Claim Settlement Ratio is the percentage of claims settled out of the total claims received by the company. Keep in mind that no company pays money on all claims made on behalf of its customers. The company first investigates claims. Settlement is done only when the claim is found appropriate.
The Claim Settlement Ratio is calculated by dividing the total settlement by the number of total claims, and then multiplying the quotient by 100. Its formula is-
Claim Settlement Ratio = Total Settlements * 100 / Total Claims
For example, the insurance company received a total of 100 claims in a particular period and out of them the company settled 90 claims. So that company’s Claim Settlement Ratio will be 90 percent.
A good Claim Settlement Ratio shows that the company is sufficiently interested in and willing to deal with its customers’ insurance related matters. In case of health insurance or life insurance, auto insurance, in any case you must see the Claim Settlement Ratio of an insurance company.
Incurred Claim Ratio (ICR):
The insurance company collects money from you in the form of Premiums and pays you in the form of Claims Settlements. Incurred Claim Ratio or ICR, you can find out how much premium the company has collected in a year and how much claim is spent on settlement.
For example, a total of Rs 100 crores came to a company as premium and out of that it paid Rs 95 crores on claim settlements. So that company’s Incurred Claim Ratio (ICR will be 95 percent.
The height of a company Incurred Claim Ratio shows that, the longer the company accepts new customers, the shorter the waiting period for pre-existing illnesses. And it is also generous in continuing the policy for people with pre-existing illnesses.
Network of Hospitals
Please see the list of hospitals associated with the company whose insurance plan you are looking for. A good company includes major hospitals in its network in all cities. Of these, there should also be good nursing homes, day-care centers and multi-specialty hospitals, etc.
The better the hospital network of the insurance company, the faster will be able to provide treatment facilities to more and more customers. Especially in its hospital network, you must see the list of hospitals in your city. Also keep in mind the hospitals with specialties of existing diseases to you or your family.
Waiting Period for pre-existing illnesses
While insuring, the diseases which occur before you can not be immediately insured on treatment. Even if you have started paying the insurance plan premium. Companies have some waiting period for this. Only after that waiting period has passed, you can claim the expense on the treatment of those diseases.
Some companies keep a waiting period of 2 years for pre-existing diseases and some companies also keep waiting period of up to 4 years. Obviously, the shorter the waiting period for a policy is for pre-existing illnesses, the less it will be for you. According to the experts, a waiting period of 2 years can be considered good.
How much Premiums to be paid
The premium the insurance company asks you to pay, in return for giving you insurance cover, is premium. You can also pay it outright and in installments. Obviously if you have to pay less premium in exchange for similar features then it is good.
But, more than the premium amount, you should also keep in mind the level and reach of the facilities of that company. If there is a problem in getting timely and appropriate treatment, or the record of Claim Settlements is not good, then do not fall for cheap premium.
If the insurance company has a good record on the above mentioned four things (Claim Settlement Ratio, Incurred Claim Ratio, Network Hospitals, waiting period) then only include it against the premium.
Major health insurance Companies
Please note: While choosing good health insurance companies, we have used certain standards. This list is just as a suggestion. In choosing an insurance policy, you are not obliged to consider it Standard. Depending on your needs and convenience, the policy of another company may also be better.
Based on the annual report published by IRDA on 9 January 2019 for data on health insurance companies, Claim Settlement Ratio (CSR) and Incred Claim Ratio (ICR). These figures show the performance of companies during FY 2017-18.
And also know that, Health Insurance comes under General Insurance. The life insurance company cannot do this. General insurance or stand alone health insurance companies are also different. However, many banks or insurance companies are also working in the field of general insurance by creating a separate company.
Star Health & Allied Insurance Company Limited
This is the first such company in India which started working only in the field of stand-alone health insurance. Its network is spread over 8000 hospitals in the country. Its plans are suitable for every category of customers.
Star Health and Allied Insurance Company is known for disease-specific health insurance products. For example, Diabetes Safe for diabetes patients and Star Netplus plan for HIV positive patients.
During the financial year 2017-18, the claim settlement ratio of the company has been 98.72% and Incred claim ratio is 60.51%.
The names of its most popular health insurance plans are-
- Star Family Health Optima
- Senior Citizen Red Carpet
Apollo Munich Health Insurance Company
It is also the leading Indian company offering stand-alone health insurance. Thanks to rapid claim authorization, easy insurance portability (it changed insurance company), it managed to make rapid inroads among high class people. Its network has spread to more than 4500 hospitals across the country.
During the fiscal year 2017-18, the claim ratio settlement of Apollo Munich Health Insurance Company has been 98.18% and Increded Claim Ratio has been 54.99%.
Some of its good health insurance plans are-
- Easy Health Gold, (Standard/Exclusive/Premium)
- Optima Restore Family,
- Dengue Care Plan
- Optima Super
Max Bupa Health Insurance Company
Established in 2010, the company has been able to reach every category rapidly due to its innovative health insurance products, easy service facilities and aggressive proliferation strategy. Its network has reached more than 3500 hospitals across the country.
The biggest feature of its health insurance plan is that the waiting period for pre-existing diseases is only 2 years. Whereas, the waiting period in health insurance plans of other major insurance companies is 3 to 4 years.
During the financial year 2017-18, the claim settlement ratio of the company has been 91.2% and the Increded claim ratio is 51.96%.
Its most popular health insurance plans are-
- Health Companion Health Insurance Plan
- Heartbeat health plan ( Gold, Silver and Platinum)
ICICI Lombard health Insurance company
ICICI Lombard is the largest private insurance company in the private sector in India. The company not only keeps incorporating new technologies in its services, but also helps the customers to choose the appropriate plan for them. It has increasingly connected private sector employees with its plans. It has more than 4500 hospitals in the country.
The Incred Claim Ratio of the company stood at 68.26% during FY 2017-18. It is the first such company in India which has got ISO 31000: 2018 certificate.
ICICI Lombard’s major insurance plans are-
- Health Advantage
- ICICI Lombard Complete Health Insurance
- ICICI Lombard Health Care Plus
National insurance company
It is the largest general insurance company in the government sector. Due to the high claim settlement ratio and the incurred claim ratio (ratio of payment to receipt) of about 98 percent, it is quite popular among people of all categories. It has a network of more than 6000 hospitals across the country.
The expenses of Ayurveda and Homeopathy in this. Also includes in its insurance plan. It also covers the cost of nursing care and doctor’s home visits.
During the financial year 2017-18, the claim settlement ratio of National Insurance Company has been 115.55% and Incarded Claim Ratio is 78.52%.
The major health insurance plans of the National Insurance Company include—
- National Parivar Mediclaim
- National Parivar Mediclaim Plus
- National Mediclaim Plus Policy
- Parivar Mediclaim Policy
- National Mediclaim Policy
Apart from these health insurance companies, there are many general insurance companies in India that provide health insurance plans. There are many stand alone health insurance companies (health insurance business only). Here are the names of some of the leading companies, their Incred Claim Ratio and the number of Network Hospitals.
- Name of the health insurance company Incred Claim ratio branches in FY 2017-2018
- Bajaj Allianz General Insurance Company 77.61% 5700+
- Bharti Aksa General Insurance Company 98.50% 4500+
- HDFC ERGO Health Insurance Company 52.58% 4800+
- IFFCO TOKIO General Insurance Company 90.69% 3000+
- Oriental General Insurance Company 113.86% 4300+
- Reliance General Insurance Company 106.54 4000+
- Religare Health Insurance Company 51.97% 4500+
- Royal Sundaram General Insurance Company 61.41% 3000+
- TATA AIG General Insurance Company 60.68% 3000+
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