Medical Inflation is rising at a rate of 15% to 20% per year, with the progression of medical treatments, the cost is increasing proportionally. In case of medical emergencies, patients lose their lives due to the lack of treatment and money. The Inflation rate crossed 11.2% in 2018 and is set to rise in the year 2020 as well. At this point, health insurance comes into play, as insurance with good health coverage can save lives. The government has introduced certain schemes which cover the insurance amount as per customer’s premium capacity, and most of the schemes are cheap with good medical coverage.
Insurance Regulatory & Development Authority of India (IRDA) has introduced a plethora of options, whereas the investor should follow certain factors to choose the best deal.
• Premium paid vs. Coverage paid:
The insurance premium is an investment an individual is making for an insurance policy. Premiums cover healthcare, home, vehicles, life, etc. It is a source of income for the insurance company, also representing as a liability, as the insurer must provide coverage against the premium paid. In the case of healthcare providers, a lot of insurers are out there with good coverage and low premiums.
• Incurred Claim Ratio:
The net claims paid by the company against the net premiums earned, i.e., the overall value of every claim a company paid to the customers divided by the total sum of premiums earned. The claiming process comes into play when medical expenses are subjected to the treatments made. If the policy secures the costs of treatments, the insurer is liable to pay for the expenses. A good insurer would always provide insurance with high incurred claim ratio,
• Death Claim Settlement Ratio:
Claim Settlement is one of the most important services a company can offer. For a better understanding of the Death Claim Settlement Ratio, we need to talk about life insurances. Suppose, if a life insurance company receives 100 death claims and settles 96 of them, the ratio would be 96%. The ratio can be calculated based on the benefit or claim amount to be paid.
According to Sl.No.5, LIC received 7,50,950 claims, out of which they solved 7,34,328, resulting in the ratio to be 97.79%. What happened to the rest of the claims made? The claims were rejected, pending, or written back.
• Co-Payment Clauses:
The investor agrees to pay a part of the expenses out of his pocket; the insurer covers the rest. Co-payment varies depending on the nature of the treatment.
Some of the private health care providers have low and simple co-payment procedures, which make it easy and flexible for the customer to understand and maintain.
• No Claim Bonus:
The reward offered by the insurer as a gift or bonus for not making any claim during a particular period. For some companies, the bonus provided is comparatively high concerning the period.
• Period for Pre-Existing Conditions:
If the patient has a condition during the six months before signing up for the health insurance, this factor comes into play. Reliable health care providers maintain a period between 9 months to 48 months, depending on the nature of the condition.
• The Network of Hospitals (Cashless Settlement):
Every health insurance company maintains a tie-up with several hospitals in the same network. Suppose a patient is in critical condition and needs immediate medical treatment. Due to the cashless settlement feature of that certain hospital, he can be admitted right away without any hassle. As for the expenses, the insurer would take care of that.
• The Reputation of the Insurer:
A healthcare provider that settles the most number of claims in less time is reliable and has a good performance ratio, which turns out to be helpful in the long run. Goodwill of the company is probably the most important factor among all of the factors mentioned above.
There are a lot of options available right now, and each one of them having an individual set of features. IRDAI has recently released the list of 24 top health care providers, and we’ve shortlisted the top 5 from the list.
1. United India Insurance Company Limited
Established in 1938, UIIC was nationalized in 1972. United India has the reputation of serving kingpin clients as ONGC Limited and Mumbai International Airport Limited. The central government partnered with UIIC and launched the Universal Health Insurance Program of Government of India & Vijaya Raji Janani Kalyan Yojana, which serves around 45 lakhs women in Madhya Pradesh, United India also sponsored for the Tsunami Jan Bima Yojana which includes four states and around 4.59 lakh families.
Covering a large area United India has introduced several schemes such as,
• Family Medicare: A single health insurance plan which covers the whole family.
• Platinum & Gold: These two plans are almost the same as they take care of the medical treatment incurred expenses.
• Senior Citizen: The plan speaks for itself.
The schemes have wide coverage with low premiums healing your pocket. It has an Incurred Claim Ratio of 110.51% with a grievance rate of 96.59% and has a tie-up with over 7000 cashless hospitals all around the world.
The health insurance sector has emerged out as the most important financial sector in recent days, and it requires reliability. As reliable as it gets, United India is serving over one crore policyholders and becoming one of the best health insurance in India.
2. National Insurance Company Limited
This insurance company, National Insurance is the oldest government health care provider established in 1906 and nationalized in1972. It is the only Indian insurance company that serves in Nepal. It started with 14,902 employees and 1998 offices all over the country. National Insurance covers a wide range of plans that include families, seniors, and individuals, and almost every plan cover inpatient hospitalization with daycare treatment.
There are certain factors one should be keeping in mind before choosing a plan,
• Be clear about the cover you need: maternity, pre-existing disease, cancer, diabetes, etc.
• Research and gather a concept about the differences in plans.
• Decide an optimum amount assured concerning medical inflation so that you don’t run out of coverage in between treatment.
• Eligibility factor of every member of the family.
• Keep an eye on the additional features to enhance the coverage by paying a minimal amount of premium.
National Insurance has a wide range of schemes, including National Mediclaim Policy, National Parivar Mediclaim Policy, National Critical Illness Policy, etc.
a) National Mediclaim Policy:
The reimbursement under every scheme varies from 1% to 50%, depending on the nature of the treatment. As an example, the insurer would pay 1% out of the total insured amount as the boarding and nursing charge and 2% for ICU. The total amount of reimbursement is 25%.
Expenses incurred on account of anaesthesia, OT charges, radiotherapy, and dialysis covers 50% of the total insured amount, the same goes for any organ transplant.
Eligibility is 18 to 65 years. Dependent children from 3 to 18 years can be covered under the same policy.
Total sum assured: Rs 50, 000 to 5 Lakhs.
Renewability: No limit.
Daycare procedures: 140+
Free usage: 15 days as a trial.
Any type of psychiatric disorder or accidental injury due to the usage of drug/alcohol has been excluded from the policy.
b) National Parivar Mediclaim Policy:
Total sum assured: 1 lakh to 10 lakhs in multiples of 1,00,000.
Family: Self, spouse, dependent children and dependent parents.
Period: 1 year (minimum) to 2 years (maximum).
c) National Critical Illness Policy:
Total sum assured: 1 lakh to 75 lakhs.
In the case of planned hospitalization, the policyholder or the insured has to inform the company(insurer) 72 hours before the hospitalization.
In the case of an emergency, the insured has to inform within 24 hours of hospitalization.
National Insurance is renowned for its goodwill, and it reflects through the incurred claim ratio of 98% with a grievance rate of 97.07% and has a tie-up with over 6000 hospitals.
3. IFFCO Tokio General Insurance Company Limited
Founded in 2000, Iffco was a joint initiative between Indian Farmers Fertilizer Cooperative, Tokio Marine, and Japan’s biggest insurer Nichido Fire Group. It is the only private health care insurance provider who has a fully owned subsidiary and is the leader of this health insurance market due to the boost of 10 years (2001 – 2011). IFFCO serves over 350 towns having 4200+ cashless hospitals all over in India, including Kolkata, with an incurred claim ratio of 102% with a grievance rate of 98.47%.
Some of the best plans Iffco offers from its wide range of schemes are discussed below:
a) IFFCO Tokio Family Health Protector:
IFFCO offers a wide range of policies for an individual, but covering the whole family under one policy that has a wide range of features is something that stands out for being the best health insurance in 2020.
Under this policy, pre-hospitalization charges for 45 days and post-hospitalization charges for 60 days are covered. Moreover, this policy covers any operation or Organ Transplant, and in case of critical illnesses, the insured has to pay 30% of the basic premium to avail double the insured amount. Critical illnesses that come under this policy are,
• Bone Marrow Transplant
• First Heart Attack Treatment
• Severe cancer Treatment
• Permanent paralysis of limbs
• Severe Coma treatment
Other than that, it covers 1% of the ambulance charges of the maximum insured amount of Rs 2500.
Total sum assured: 1,50,000 to 5,00,000
No-Claim Bonus: 5% to 50%
Eligibility: 18 to 65 years.
The family that comes under the policy: Spouse, dependent parent or children, brother, sister, brother-in-law, sister-in-law, nephew, and niece.
Any consequences due to a suicide attempt that harms the policyholder directly or indirectly have excluded from the coverage along with any injury or loss due to war, riot, or terrorism.
b) IFFCO Tokio Individual Health Protector Policy:
For each no-claim year, 5% of the basic sum at each renewal will add as a cumulative bonus, which can add up to a maximum of 50% of the basic sum.
This policy covers the incurred medical expenses of a single individual by covering his/her anaesthesia, operation, dialysis, or chemotherapy. Some of the critical illnesses covered by this policy are,
• Kidney Failure
• Open Heart Surgery
Total sum assured: 1,50,000 to 5,00,000
Discount: 5% annual increment
Policy Period: 1 year
Any gastric or duodenal ulcer treatment has excluded from the policy along with any injury or loss due to war, riot, or terrorism.
Plans other than the two mentioned above are,
• IFFCO Tokio Individual Accidental Insurance Policy
• IFFCO Tokio Critical Illness Policy
In the case of pre-planned hospitalization, the insured has to inform the insurer three days before the admission.
In the case of an emergency, the insured has to inform the insurer upon admission.
4. Bajaj Allianz General Insurance Company Limited
Bajaj Allianz is a joint venture between Bajaj Finserv Limited and Germany’s Allianz SE. The company was founded in 2001 and shares 26% of the stake with Allianz and keeps the rest. Bajaj has the reputation of solving Claim Settlement issues in an hour with a ratio of 77.61%. With over 6500 cashless hospitals all around the world, the incurred expense ratio of Bajaj is 85%, with a grievance rate of 99.78%, which justifies the reliability of the company. Bajaj has a wide range of schemes signifying its expertise, stability, and strength in the market.
Key Features of Bajaj Allianz General Insurance:
i. It covers a wide range of policies, including family health protection, critical health insurance, insurance for vector-borne diseases, and many more.
ii. Insurance can cover a maximum number of 6 members of the family, including two children.
iii. Pre-hospitalization charges for 60 days and post-hospitalization charges for 90 days are covered.
iv. No-claim bonus of 10% of every claim-free year is added to the basic sum.
v. The insurance covers doctor’s fees, operation theatre charges, and room rents.
vi. The insurance covers more than 36 critical illnesses, including heart and cancer.
vii. The premium is returned at the death of the policyholder.
viii. It covers the waiting period for a pre-existing disease of 4 years.
ix. It saves tax up to 1 lakh under the section of 80D.
Some of the best Bajaj Allianz plans are:
a) Bajaj Allianz Health Insurance Plan for Individuals:
i. 18 to 65 years (Adults)
ii. Three months to 30 years (Children)
Total Sum assured:
i. 1.5 lakh to 2 lakh (Silver Plan)
ii. 3 lakh to 50 lakh (Gold Plan)
Period: 1 year, two years, and three years.
i. Family discount: 10% for two members and 15% for three members.
ii. Employee discount: 20%
iii. Long term policy: 4% to 8%
This insurance covers a person but is flexible enough to cover parents, dependent siblings, parents-in-law, grandparents, and grandchildren.
b) Bajaj Allianz Health Insurance Plan for the family – Health-Guard
Eligibility: 18 to 65 years.
Pre-Hospitalization: 60 days
Post-Hospitalization: 90 days
No-claim bonus: 10% of every claim-free year.
The costs incurred on account of medical expenses will reimburse within 14 days after the submission of documents.
c) M-Care Health Insurance Policy:
Eligibility: 18 to 65 years.
Total sum assured: 10,000 to 65,000
This insurance cover any vector-borne diseases like malaria and dengue.
Bajaj provides one of the best private health care along with its insurances.
But, there are certain exclusions.
i. It covers no pre-existing disease meaning the insured would not get any coverage for the disease he/she was suffering from before signing up for the insurance.
ii. Bajaj does not cover any dental treatment.
iii. It pays no coverage for any cosmetic surgery due to an accident or hair transplant, lip surgery, etc.
iv. Any health issue because of the usage of alcohol or illegal drug.
v. Any Sex Transmitted Disease, including HIV.
5. Reliance General Insurance Company Limited
Reliance is one of the leading private health care insurance providers in India, founded in 2000 with 139 offices over 102 cities around including self offices, websites, corporate alliances, or brokers. Having lifelong renewability with over 4000 cashless hospitals, it has an incurred claim ratio of 94% with a grievance rate of 98.49% which is pretty top-notch. Reliance covers any pre-existing disease for 48 months of the insured.
Some of the health insurances Reliance offers are:
a) Reliance Healthgain Insurance Policy:
Reliance Healthgain is one of the best private health care products of Reliance; this policy comes with dual features: Policy A and Policy B.
Eligibility: 5 – 65 years.
Pre-hospitalization: 60 days.
Post-hospitalization: 60 days.
Health gain covers any organ transplant of the insured with a coverage of 50% of the total sum insured.
• Ambulance services cover an amount of 1,500.
• Policy period: 1 to 2 years.
• Medical tests planned: 45 years old or above.
• Total sum assured: 3, 6, and 9 lakhs.
• Ambulance services cover an amount of 3,000.
• Medical tests planned: 18 years or above.
• Total sum assured: 12, 15, and 18 lakhs.
No-claim bonus: Every claim-free years adds up to 33.33% of the basic sum insured.
Any issue related to maternity or fertility does not come under the roof of this policy.
b) Reliance Health Insurance on EMI Policy:
• EMI provides a discount of 15%
• The claim settlement is quick.
• No-claim bonus: Every claim-free years adds up to 33.33% of the basic sum insured.
• Any non-allopathic, diagnostics, or self-medication procedure does not come under this policy.
Policies other than the mentioned above two are,
• Cashless Health Insurance policy
• Senior Citizen health insurance policy
The process of paying incurred medical expenses begins when the insured or someone from his/her family claim for it. Documents required for the claiming process are,
• First doctor’s prescription.
• Hospital bills and receipts (original)
• Diagnostic reports, including ECG, X-Ray, etc.
• Discharge card from the hospital
• Copy of health card
Insurance policy is the kind of investment you can rely on as you would be buying protection for yourself and your family in the hour of help, be it any private health insurance or the public. In the case of choosing the best health insurance in 2020, a lot of statistics will talk, but there are certain factors a customer should keep in mind while choosing for the best. At first, comes the CSR or Claim Settlement Ratio, any good insurance company takes good care of their customers with a good CSR. Secondly, every insurance provider has different features and their respective benefits; the insured should thoroughly research according to his own requirements before investing in any policy. Thirdly, good network hospitals is a must before choosing the best insurance, you will not look out for a hospital 5 miles far from your residence during an emergency. Fourthly, easy buy and renewal through mobile applications as paperless deals are hassle-free.
Last but not least, a good insurance company would always provide the best customer service 24×7 as the relationship between customer to the insurer is very important, which reflects the goodwill of a company. The best health insurance depends on what you want. Thus, choose wisely.