Mediclaim Ratings
Family Floater Plan
Sum Insured:
Rs10 lakh
Family Floater Plan
Sum Insured:
Rs20 lakh
Family Floater Plan
Sum Insured:
Rs50 lakh
Individual Plan
Sum Insured:
Rs10 lakh
Individual Plan
Sum Insured:
Rs20 lakh
Individual Plan
Sum Insured:
Rs50 lakh
Eldest person age 30 yrs(2A+1C)
Eldest person age 45 yrs(2A+2C)
Eldest person age 30 yrs(2A+1C)
Eldest person age 45 yrs(2A+2C)
Eldest person age 30 yrs(2A+1C)
Eldest person age 45 yrs(2A+2C)
Age 30 yrs
Age 45 yrs
Age 60 yrs
Age 75 yrs
Age 30 yrs
Age 45 yrs
Age 60 yrs
Age 75 yrs
Age 30 yrs
Age 45 yrs
Age 60 yrs
Age 75 yrs
S.No. | Insurer | Product |
Overall
Rating |
Overall
Score |
Premium
(INR) |
* To know how these ratings are calculated,
click here
To find out how these policies were rated on individual parameters,
click here
Updated: 31 July 2017
-
2A+1C means 2 adults + 1 child 2A+2C means 2 adults + 2 children
- GST of 18% included in premiums.
- If any single room is allowed, then policy is considered “no limit” and get full points. But if the policy will pay only a non-AC most basic single room, this is a ‘sub limit’ and the policy gets no points for this parameter.
- No-claim Bonus. If no-claim bonuses do not increase sum assured but reduce premium, no points are given.
- OPD. An OPD cover gets a “yes” if in at least one year during a 5-year period, an OPD cost of Rs10,000 or more can be availed. We have not differentiated by the type of OPD allowed such as dental, ophthalmic or ayush. Only inbuilt OPD covers have been covered. Optional covers have not been rated
- Wellness benefits. Rated “yes” if there is a monetary benefit for the insured to maintain good health. Health check-ups or discounts on purchases are not considered as wellness programmes.
- Where rates differ by gender we consider rates for men.
- QBE Raheja’s products have not been considered because they are not available on the website and are being marketed in select regions.
- Premium ratings are based on the averages of current and future premiums. For an entry age of individual insurance is 30, then average premiums for ages 30, 45 and 60 of the same policy are considered. If entry age is 45, then average for 45 and 60 is considered. We do this to factor in the impact of future premium increases. For age 60 and 75 years, exact premiums have been rated and not the averages.
- Claims Claims settlement = claims settled/(claims settled + claims closed + claim repudiated). Where there is a difference between public disclosures and company provided information, we have taken public disclosures. In the case of Star Health, we have corrected the Q4 public disclosure because there was an obvious error. The opening of Q4 was not tying in with the closing of Q3 so it was corrected. For United India and National India, public disclosures for only the first three quarters was available, 1 April to 31 December 2016. For Aditya Birla, two quarters’ data was available, which is what we used. For Iffco Tokio we have used the claims information sent by the insurer for three quarters from 1 April 2016 to 31 December 2016 because the public disclosure appears to be wrong—it shows no claim rejections of closures during the entire year. Future Generali includes claims repudiated and claims closed in claims settled. We have made an adjustment in claims settled to make their reporting consistent with other insurers. For Royal Sundaram, we have used claims data (Individual health + Group Health claims) provided by the insurer because the public disclosures were inconsistent. This has not improved their product ratings. For Bajaj Allianz, Oriental and New India, we have taken corrected public disclosure numbers from the company because the disclosures on the website were inconsistent. These new numbers have not improved these insurers’ ratings. Star Health and Cigna TTK have disclosed claim complaints per 10,000 policies. These ratios have been recast to make the denominator total claims rather than total policies.
- Selection of sum assured where exact matches not available. We used a higher sum assured in the Rs10 lakh category because at a relatively low sum assured of Rs10 lakh, we want to be conservative and ensure that buyers have a minimum of Rs10 lakh available. For higher sum assureds, we have selected the closest match.
- For Max Bupa Hearbeat, products are considered without co-pay to be comparable to other products. For Family First Gold in the family floater categories of Rs10, 20 and 50 lakhs, we have considered a combination of Rs1 lakh sum assured per person and a floater of Rs10, 20 and 50 lakhs, respectively. Family First Silver and Platinum and other family first variants have not been rated because Family First Gold is a good representative of the Family First benefit structure.
- Date of birth for each category has been considered as 1 May.
- HDFC Ergo Suraksha Gold has not been considered because it has maternity benefits that are not scored. The Silver versions without maternity benefits have been scored.
- For National’s Parivar Mediclaim Plus, we have rated the restore feature as “No” because restore is narrowly defined and available only in case of road accidents.
- In Cholamandalam MS we have not rated Privilege Healthline because the additional benefit of maternity over the Enrich version does not get any weightage. Similarly we have not rated Freedom Healthline because it is similar to Value and Enrich in terms of features and overall scores.
- Where pricing of products varies by zone, we have considered Delhi as the location. This is typically, but not always, the most expensive zone.
- In determining the premiums, specific channel discounts such as for online, have not been considered.
- The premiums we have selected assume TPA services.
- The criteria scores may not total to a 100 because of rounding off the decimals.