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Insurer

Product

No Claim Bonus

Score

Co-Pay

Disease Wise Capping

Total Premium

( including GST)

Ratings Methodology

NOTE

Only Products listed on an insurer’s website as on March 2022 have been considered.

GST of 18% assumed.

Sub limits on room rent:
1. Rated “No” if any single room available in the hospital is allowed
2. Rated “Yes” if there is a restriction such as getting the most basic single room in the hospital or AC rooms are not allowed.

Waiting periods: We have looked at the waiting periods for pre-existing conditions and specific diseases, and taken the longest waiting period into consideration. In most cases this is the period for which pre-existing conditions are excluded but there are some products where specific ailments are excluded for longer than pre-existing conditions.

No claim bonus and claw back:
1. Rated “100 no claw back” if the highest No-Claim is 100% or above, with no claw back when a claim is made
2. Rated “50 no claw back” if highest No-Claim is 50% or above, with no claw back when a claim is made
3. Rated “100 with claw back” if highest No-Claim 100% plus or above, with a claw back when a claim is made
4. Rated “50 with claw back” if highest No-Claim is 50% or above, with a claw back when a claim is made
5. Policies with less than 50% No claim bonus do not get points

Mediclaim Ratings – Features

Comprehensive

All products in the market are rated. This covers 25 insurers and over 100 products. All the plans of each insurance company whether individual or family floater have been considered.

Transparent

The criteria and scores of individual products are published on the website. These can be independently verified. Only publicly available information is used for the ratings.

Balanced Criteria

Weightages are given to all relevant criteria – premium, product features and claims. The weight differs slightly for senior citizens.No one criterion can swing the scores.

Independent

The ratings are independent and not sponsored by insurers. These ratings, now in the sixth edition, provide a strong independent and comprehensive pespective to customers and insurers.

Rating Criteria

Premium

Premium is an important but not the only criterion considered. It has an overall weight of 25% for age groups 60 and below. For higher ages we have reduced the weightage of premium to 20% because certain product features become relatively more important for seniors. The scoring for premium uses the quartile approach, with the highest marks to products in the top quartile.

Product features

The overall score for product features is the sum of scores for individual features. The maximum weight is given to pre-existing disease exclusions and limits on room rent. Other features that have been scored are the maximum no-claim bonus, wellness cover and restore benefits. For each feature the minimum standards have been clearly specified. The total score is 40% for ages 60 and below. For seniors we have introduced co-pay into the rated features and increased the overall score to 45%.

Claims

Claims information is available in the public disclosures and we have given this a high 35% weight. Most of this, 25%, is to claim settlement ratio, 5% to claims grievances & the remaining 5% to claims ageing . The settlement ratio is positive claims decisions taken over the total decisions taken. Grievances are expressed as claim complaints per 10,000 registered claims.

Frequently Asked Questions

The ratings include all health insurance products available in the market. Participation is not optional. A few products are excluded because they have not been launched nationally

All the products are divided into 3 categories – A, B and C. A is the highest rated. Products that score 65% or more are A rated, 45% or more are B rated and less than 45% are rated C. A rated products are always good to buy. B and C may be okay in some specific situations.

We have covered over 25 insurers and 117 products.

All important product features like pre-existing exclusion, sub-limits on room, no-claim bonus, wellness and restore benefits have been given weightage. Pre- existing exclusion and sub-limits on room have been given the highest weightage. Some features such as OPD, international care have been left out. This is because the tangible delivery of these features varies significantly by insurer and we have still not seen the level of claims incidence in these areas.

These weightages are based on our sense of what should matter to buyers of health insurance. These have been fine-tuned over the past six years based on our on-the-ground experience and feedback from insurers and customers.

All the information has been sourced from public data. In the case of premiums from the website, product features from the policy wordings and claims from the public disclosures. This information has then been cross-checked with the insurers.

We have considered four ages for rating – 30, 45, 60 and 75 years. The sum assured ranges from Rupees 5 Lacs, 10 Lacs, 20 Lacs and 50 Lacs. These combinations provide a comprehensive view of customer needs.

For age 30, we have considered a family of three, including one child. For age 45, we have considered a family of 4. Ages 60 and above are individual insurances.

We have not considered maternity because our youngest age is 30 years. Public information suggests that a small proportion of women have children after 30. Since most products have a waiting period for maternity claims this means that even if a person buys an insurance at age 30 they will be eligible for a maternity claim after a few years. So, this benefit was not relevant for our selected segments.

Anybody over the age of 65 is considered a senior. The reason for this is that as per insurance laws all products must allow a maximum age of entry of 65 years. Many insurers do not issue insurances above that age which means that specific products have to be identified for people over 65. The ratings identify these products and rate them.

The main difference is that the weightage for premium is reduced slightly from 25 to 20%. And the weightage for product features has been increased by 5%. Within product features we have scored features such as co-pay and disease waiting periods that are not included in people under 65. Our rationale was that getting products that actually pay out claims with minimum restrictions is relatively more important for seniors. We have also dropped the weightage on no-claim bonus because seniors are likely to hold the insurance for fewer years and are a little less affected by long term inflation.

Most products restrict entry age to 65 years. So, we have considered only those products which are available for first time purchase at the age of 75. The additional challenge that seniors face in buying insurance is that they often have chronic ailments and insurers either reject the proposal or load the premiums in such cases.

Yes. Although the options are limited. Insurers are adept at factoring in well managed chronic diseases. Seniors can also buy specific diseases plans or top-up plans that are issued more easily.

For some insurers the premium varies by area of residence. In such cases we have taken Delhi as the location for premium calculations. Delhi is typically, but not always, the most expensive zone.

We have not considered Raheja QBE’s products, Bharti Axa's Individual health plan, Reliance Health Insurance, Raheja & Kotak products. Raheja QBE’s products have not been considered because they are not available nationally yet and there is no claims history. For Bharti Axa, Kotak, Magma & Reliance Health Insurance, we have not considered individual health insurance because the premiums were not available on the website nor provided by the company or the claims were less than 10,000.

No, we have not deducted online discounts or other specific discounts from premium. The exception we made was to consider discounts given to “go-green” which is to not use paper copies of the insurance policy or renewal notices.

We have taken four most commonly used sum insureds: Rs 5 Lac, 10 Lac, 20 Lac and 50 Lac. But some insurers do not provide these exact amounts. For example, Reliance Health Gain, has available sum assured of Rs 6 Lac, 9 Lac and 18 Lac, so we have considered them in our ratings for Rs 5 Lac, 9 Lac and Rs 20 Lac. Similarly, for Cigna TTK, a sum assured of Rupees 5.5 lakhs has been considered in the Rupees 5 lakhs category. Generally we try to find the closest match provided the differences are not large.

Some Insurers vary their premium rates by gender. In such cases we have considered the premiums for males. There is no gender bias in this - our rationale is that premiums are set by the age of the oldest person in the family, most often a male.Premium assumes TPA charges. Where there is an option to buy the insurance without a TPA we have considered the option with TPAs.

Insuropedia

What is the meaning of Health Insurance?

Health insurance gives you coverage against hefty medical expenses that may arise due to sickness and accidental injury. In most of the cases, health insurance is offered to people in the age group of 5 to 80 years. In some cases, children under five years are covered if their parents are also covered.

Health insurance is a broad term which majorly covers...

Different types of Health Insurance plans to cover medical costs

There are multiple types of health insurance policies available to provide for the various health related expenses incurred by individuals. However, by buyer eligibility we can divide all plans into three broad classes:

Group Health Insurance Personal Health Family Floater Although, features and types of expenses covered are different in both the policies ...

What should you consider while buying health insurance for senior citizens?

People who are looking for health insurance for their senior citizen parents, or senior citizens who want to buy health insurance for themselves, should consider the following points which will help them to buy the right policy:

Age: Most of the health insurance companies offer policies for senior citizens, but they limit the entry age as 65...

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