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Mediclaim Ratings

Family Floater Plan
Sum Insured: 20 lakh , 2A+2C
Family Floater Plan
Sum Insured: 10 lakh , 2A+2C
Individual Plan
Sum Insured: 5 lakh
Individual Plan
Sum Insured: 10 lakh
Individual Plan
Sum Insured: 20 lakh
Eldest person age 35 yrs
Eldest person age 45 yrs
Eldest person age 65 yrs
S.No. Insurer Product Overall

Updated: 28th Jul, 2016
  1. For general and health insurers, claims and grievances are from public disclosures. In very few cases, such as Royal Sundaram and Iffco Tokio, we accepted modifications because the published data was obviously wrong. For New India Insurance and Oriental Insurance we have estimated grievance ratios from their disclosures. Claims data is for the nine months, April 2015 to December 2015
  2. Health products offered by life insurers have been excluded because the new health insurance guidelines require these products to be withdrawn from the market.
  3. Religare Health Insurance Co Ltd has launched a new version of their health insurance plan called Care today. For the purpose of the ratings, we have used the older version of Care and are in the process of updating and rating the new version.
  4. Claims settled is claims settled/claims decisions taken, i.e., claims settled/(claims settled + claims rejected + claims closed)
  5. Service tax is 15%.
  6. Products as on 1 June 2016
  7. Entry level plans are considered. Top-ups and riders that require additional premium are excluded. All products available online and through the call centre have been included.
  8. If insurers have out-patient (OPD) and non-OPD plans, we have selected the non-OPD version.
  9. If premiums vary by location we have selected NCR as reference.
  10. Information is sourced from public sources except in a few cases such as Tata AIG Medi Senior and Iffco Tokio insurances.
  11. If the only disease capping is on cataract, then we have considered the product to have no capping in the ratings. Co-pay is considred "yes" only if it is payable in all claims. Premium discounts have not been considered as no-claim bonus; only sum assured increases meet that bar.
  12. SBI General charges a 10% co-pay for non-network hospitals. We have factored no co-pay at the network hospitals into the rating.
  13. For Cigna TTK we have used prices for Rs 4.5 lakh and Rs 15 lakh sum assured for the Rs 5 lakh and Rs 20 lakh categories since these are the closest match. For Max Bupa Family First - Silver sum assured of Rs 10 lakh, we have assumed individual cover of Rs 1 lakh and a floater of Rs 10 lakh; for a sum assured of Rs 20 lakh in Heartbeat-Family First Gold Plan, we have assumed individual cover of Rs 1 lakh and a floater of Rs 20 lakh; for a sum assured of Rs 20 lakh in Heartbeat-Family First Silver Plan, we have assumed individual cover of Rs 2 lakh and a floater of Rs 15 lakh for ages 35 and 45; for New India Assurance Floater Mediclaim we have used sum assured rates of Rs 8 lakh for the Rs 10 lakh band since Rs 8 lakh is the closest fit; for Reliance General Health Gain sum assured of Rs 6, 9 and 18 lakh is used for the Rs 5, 10 and 20 lakh sum assured categories.
  14. Maternity cover is offered by these insurers. The waiting periods are: SBI Arogya Premier–9 months; Bajaj Health Care Supreme, Max Bupa Heartbeat, National Mediclaim Plus, Future Generali Health Total Vital–2 years; Apollo Easy Health Exclusive sum assured Rs 20 lakh, Star Health Comprehensive, Universal Sompo–3 years; Apollo Easy Health Exclusive Rs 5-10 lakh sum assured, Cigna TTK Pro Health Plus and Pro Health Preferred, HDFC Ergo Health Suraksha–Regain Gold, L&T Medisure Prime and Classic–4 years; Cholamandalam–5 years.
  15. Cigna TTK Prohealth Plus and Preferred offer overseas accident insurance cover.
  16. OPD costs are covered by the insurers mentioned here. Apollo Easy Health Premium: for dental treatment up to 1% of sum assured subject to a cap of Rs5,000-7,500 depending on the sum assured. Cholamandalam: dental costs up to 1% of sum assured capped at Rs 5,000. Universal Sompo: up to 1% of sum assured capped at R2,500-7,500 depending on product. Tata AIG: only for accidental dental and post-bite vaccination up to Rs5,000. Star Comprehensive and Family Health Optima: for dental and ophthalmic needs. Star Senior Citizen Red Carpet: up to R1,000. Cigna TTK: up to R500-2,000 a year; Bajaj Allianz Health Care Supreme: R2,500-15,000; Future Generali Health Total Supreme: R3,000-10,000.