Mediclaim Ratings
Livemint
epaper
×
Home Companies Money Industry Technology Politics Opinion LoungeMultimediaAI Science Education Sports ConsumerSpecials
×

Mediclaim Ratings

*
Family Floater Plan
Sum Insured: Rs5 lakh
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: Rs5 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)
S.No. Insurer Product Overall
Rating 		Overall
Score 		Premium
(INR)

 Knowledge Partner
* To know how these ratings are calculated, click here
To find out how these policies were rated on individual parameters, click here
Updated: 21 August 2018
    2A+1C means 2 adults + 1 child  2A+2C means 2 adults + 2 children

  1. GST of 18% assumed.
  2.  Co-pay related assumptions:
    3. a. Rated "Yes" if
    i.there is a co-pay on multiple claims. So, if a co-pay kicks in on the second claim then this is rated as Yes.
    ii.co-pay is charged on non-network hospitals or reimbursement claims.
    iii.there is a co-pay for higher zone or higher room category.
    iv. there is co-pay if treatment is taken in a different zone.
    b. Rated "No" if
    i.co-pay is optional.
    ii. there is a co-pay on ayurvedic or OPD but not on hospitalisation.
    iii.co-pay kicks in at an age higher (post 60) than entry age.
    c. c. Optional discounts, for example to use network hospitals or opt for co-pay have not been given weightage.
    d. where co-pay and without co-pay options are available, we have taken without co-pay product variants.
  3.  Room rent related assumptions
    4. a. Rated "No limit" if
    i.any single room available in the hospital is allowed.
    b. Rated "With limits" if
    ii.If there is a restriction on getting the most basic single room in the hospital.
    ii.AC rooms are not allowed.
  4.  No-claim Bonus
    5. a.If no-claim bonuses do not increase sum assured but reduce premium we have not considered this because the purpose of a no-claim bonus is to increase sum assured in line with inflation.
  5.  Wellness benefits
    6. a.These have been rated "Yes" if there is a monetary benefit for the insured to maintain good health. The monetary benefit may be lower premium or redeemable points.
    b.Health check-ups or discounts on purchases are not considered as wellness programmes. Partly, this is because health check-ups are standard features now and the health check-ups offered tend to be basic. Discounts on OPDs and diagnostics are also easily available without the insurance.
  6.  We have not considered certain product features for the following reasons:
    7. a.OPD, International treatment: The tangible benefits vary significantly across products in amount and claim process. Also, we do not have public information on how often and to what extent these are used.
    b.Built-in critical illness, personal accident benefit: These benefits are typically bundled with considerable restrictions on sum assured and number of diseases.. Also where these plans are optional we have not included them in the ratings.
    c.Maternity: Our youngest age is 30. Those buying insurance at 30 will be eligible for maternity benefits only a few years later. Public data suggests that child births in India after the age of 30 are limited. This is why we have not given any weightage to maternity. For younger age groups, in the 20s, this is a relevant benefit.
  7. Where rates differ by gender we have considered rates for males.
  8. For the age category 75 years, we have rated only those insurances that can be bought at 75 years. Policies that need to be bought before 65 years but continue until 75 are not considered.
  9. Raheja QBE's products have not been considered because they are not available nationally yet and there is no claims history.
  10. For Bharti AXA, we have not considered individual health insurance because the premiums were not available on the website nor provided by the company.
  11. For New India, the plan Asha Kiran has been considered only at age 30 because it is a family floater available only at that age for a family with one girl child.
  12. Premium ratings have been done based on the averages of current and future premiums. So, if entry age for individual insurance is 30 then average premiums for ages 30, 45 and 60 are considered. If entry age is 45 then average for 45 and 60 is considered. This factors in future premium increases. In the case of family floaters only ages 30 and 45 are considered for this averaging because when parents turn 60 the children are likely to have their independent insurances and are unlikely to be covered under the family floater.
  13. Claims
    14. a.Claims settlement = claims settled/(claims settled + claims closed + claim repudiated)
    b.Where there is a difference between public disclosures and company provided information we have taken public disclosures
    c.Star Health and Cigna TTK have disclosed claim complaints per 10,000 policies. This is inconsistent with the way claims complaints are reported by other insurers – on a base of claims rather than policies. So, we have recast these ratios to make the denominator total claims rather than total policies
    d.For Magma HDI we have assumed a claim settlement of 85% and claims grievances of 36 per 10,000 claims. This is the average for all the insurers. The actual number of claims for Magma is very small, just 10 claims in FY2018. Data submitted by the insurer with information for April to June quarter indicate a claim settlement rate of 100%. This is not representative given the small base.
    e.For National Insurance and Bharti AXA, we have used quarter 3 information for claims from the public disclosures because quarter 4 disclosures were not available at the time of collating the data.
    f.For New India and Oriental, claims grievance rates were not published and have been estimated from the quarter 4 disclosures.
  14. Selection of sum assured where exact matches not available
    15. a.Reliance Health Gain. For the Rs10 lakh category sum assured of Rs9 lakh has been considered; for the Rs20 lakh category a sum assured of Rs18 lakh; a sum assured of Rs6 lakh has been considered for the Rs5 lakh category. Exact matches are not available
    b.Max BUPA Go Active has not been rated in the Rs20 lakh category because they have sum assureds of Rs15 or 25 lakhs. There is no close match to Rs20 lakh
    c.IFFCO Tokio. In the category of Rs 20 lakhs family floater we have used a sum assured of Rs 16 lakhs because Rs 20 lakhs is not available. IFFCO also has a Rs25 lakhs sum assured.
    d.For Cigna TTK, a sum assured of Rs5.5 lakh has been considered in the Rs5 lakh category.
  15. For Max BUPA, Family First Gold in the family floater categories of Rs5, 10, 20 and 50 lakh we have considered a combination of Rs1 lakh sum assured per person and a floater of Rs3, 10, 20 and 50 lakh, respectively.
  16. Date of birth for each category has been considered April 1st
  17. 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. For all others we have given 'yes' to restore feature if the sum insured is reinstated and can be subsequently used on account of same or different ailment.
  18. Where pricing of products varies by zone we have considered Delhi as the location. This is typically, but not always, the most expensive zone.
  19. In determining the premiums, specific channel discounts such as for online, have not been considered. We have factored in discounts given to "go-green" to not use paper copies.
  20. The premiums we have selected assume TPA services.
  21. Optional benefits have not been considered.