From the air we breathe to the food we eat, everything is intentionally or unintentionally subjected to adulteration. Due to this, the disease rate in India is rising drastically. Naturally, more and more people are visiting hospitals frequently. And, with the rise in the cost of quality healthcare, it only takes a few treatments to wipe-off an average person’s lifetime savings. This is where a health insurance policy comes into effect. Health insurance is a type of insurance that helps the policyholder cover their medical expenses and surgical costs. In fact, in order to reduce a policyholder’s hassle, some insurance providers offer cashless treatment at their network-listed hospitals.
What is Incurred Claim Ratio?
Incurred Claim Ratio (ICR) is an indicator of a company’s ability settle claims. Every year, the incurred claim ratios of prominent health insurers are published by the Insurance Regulatory and Development Authority of India. The formula for calculating Incurred claim ratio is simple. It is equal to the net amount paid as claims divided by the net premium collected by the company in a financial year.
Ideally, one should go for an insurance company with ICR close to the average ICR of all the providers in an FY.
With an increase in the demand for health insurance, the insurance industry has an overabundance of insurance providers and policies. The question arises- which one should you buy? There are a lot of reputable players in the market. A few of them are Religare health insurance policy, Star health insurance, HDFC Ergo Health insurance, and Aditya Birla Health Insurance.
What Do Health Insurance Plans Include & Do Not Include?
According to your requirements, you can customize your health insurance policy. You can club it with add-ons as well. There are various types of health insurance like Individual health care policy, Family health plan, Senior citizen health plan, surgical plans, critical disease plans, cancer care plans, maternity policies etc. To protect yourself as well as your family, you can go for a family floater plan. A few features of such a plan are as follows.
- Cashless Treatment
- Cover for Pre and post hospitalization fee
- Reimbursement for Ambulance fees.
- Expenses of Routine medical check-ups are covered
- In-patient hospital expenses
- Charges for treatment due to a pre-existing illness
- Charges for treatment availed at home.
Now let us see a list of services Not Covered By the Health Insurance Companies in India
- No coverage is given during the waiting period which is usually first 30 of policy commencement. For pre-existing diseases, the waiting period can be of 2-4 years
- Coverage of critical illnesses is subjected to a waiting period of 2-3 years.
- Injuries caused by war or terrorism or suicide attempts.
- Cosmetic surgeries.
- Treatment by an under-qualified medic or doctors.
While looking for health insurance, people often search for the best family health insurance policies. In reality, there is no “best health insurance policy”. Instead, the search should be for a policy that meets your insurance needs. If understanding insurance puts you in a quandary, you should go for a third-party, professional opinion. This is why buying policy online is much better than running from pillar to post.
However, keeping in mind the needs of an average Indian, we have compiled a list of top health insurance policies.
1. Religare Care :
Incurred Claim Ratio (2016-17): 51%
- Min Entry age: Children- 3 months; Adults- 18
- Max Entry age: N.A. (No max entry age); Lifelong renewability
- Minimum and the maximum sum assured: 3 lakhs to 60 lakhs
- Max. Number of members covered: 6
- Waiting period for pre-existing medical conditions: 4 years
- Waiting period for policy-specified diseases: 2 years
Every No-claim year will lead to a 50% waiver of the premium which can go up to 150%. This policy covers room rent in case of hospitalisation, pre-hospitalisation expenses and post-hospitalisation expenses in case of a surgery, ambulance expenses and also provides a daily cash benefit. It also offers cover for pre-hospitalisation charges of up to 30 days and post-hospitalisation up to 60 days. It also offers an organ donor cover of Rs.1 lakh-2 lakhs. There is no limit on ICU-stay charges. This policy offers private room facility in case of hospitalisation and one free medical check-up every year. Add-ons like Air ambulance cover, personal accident cover etc., can also be added.
2. Apollo Munich Optima Restore Family:
Incurred Claim Ratio (2016-17): 55%
- Minimum entry age: 5 years for children and 18 years for adults
- Maximum entry age: 65 years; Lifetime renewability
- Minimum amount assured: 3 lakhs
- Maximum amount assured: 50 lakhs.
- Max. Number of members covered: 6
- Waiting period for pre-existing medical conditions: 3 years.
Auto-reinstatement of the sum assured if the basic sum assured gets exhausted. But, this restoration can take place only once in a policy period. For every no-claim year, your basic sum assured will be increased by 50%. This policy will cover the complete expense in case of a life-threatening disease and comes with the feature of daily cash benefit as well.
3. Star Family Health Optima
Incurred Claim Ratio (2016-17): 61%
- Minimum entry age: 16 days; Adults- 18
- Maximum entry age: 65 years; Lifelong renewability
- Minimum and the maximum sum assured: 2 to 15 lakhs
- Max. Number of members covered: 5
- Waiting period for pre-existing medical conditions: 4 years
- Waiting period for policy-specified diseases: 2 years
The expense cover expands to ambulance expenses, hospital charges, in-house treatments etc. Also, if the sum assured is exhausted, it will be automatically restored. 3 auto-restorations can be availed in one policy period. This insurance provider has tie-ups with more than 6000 hospital networks. Hence, the payouts are quicker. They have an option of maintaining records online as well.
4. Max BUPA Health Companion:
Incurred Claim Ratio (2016-17): 52%
- Min Entry age: 3 years; Adults- 18
- Max Entry age: N.A. (No max entry age); Lifelong renewability
- Minimum and the maximum sum assured: 3 lakhs to 1 crore.
- Max. Number of members covered: 6 (4 adults+2 children)
- Waiting period for pre-existing medical conditions: 4 years
- Waiting period for policy-specified diseases: 2-3 years
Auto-refill of the sum assured is available in case the basic sum assured is exhausted. With a premium that does not burn a hole in your wallet, this policy offers higher daily cash benefit. Also, as NCB, for 5 consecutive no-claim years, the basic sum assured will be increased by 100%.
5. HDFC Health Suraksha:
Incurred Claim Ratio (2016-17): 41%
- Min Entry age: 3 years; Adults- 18
- Max Entry age: N.A. (No max entry age); Lifelong renewability
- Minimum and the maximum sum assured: 3 lakhs to 7.5 lakhs
- Max. Number of members covered: 4
- Waiting period for pre-existing medical conditions: 4 years
Pre and post hospitalisation expenses, ambulance expense, daycare or in-house treatment expenses are covered by this plan. Every non-claimable year will accumulate a 5% premium discount.
6. Bajaj Allianz Family Floater health Guard:
Incurred Claim Ratio (2016-17): 73.59%
- Min Entry age: Children- 3 months; Adults- 18
- Max Entry age: Children-25years; Adults- 65 years
- Minimum and the maximum sum assured: 2 lakhs to 10 lakhs
- Lifelong renewal Option
- Max. Number of members covered: 6
- Waiting period for pre-existing medical conditions: 28 months
- Pre-hospitalization coverage- 60days
- Post-hospitalization coverage- 90 days
With simple eligibility criteria, Bajaj Allianz Family Floater Health Guard offers a maximum coverage of 10 lakh. The policy offers a cumulative bonus of 5% for each claim free year up to a maximum of 50%. Moreover, the plan also provides tax benefit under section 80D of the Income Tax Act. 15 days grace period is offered in case the policy is not renewed timely. As this is a family health plan, it provides coverage to the entire family under a single plan.
7. Oriental Insurance Happy Family Floater Policy:
Incurred Claim Ratio (2016-17): 114%
- Min Entry age: Children-3 months; Adults- 18
- Max Entry age: N.A. Children-25 years ; Adult- 55 years
- Minimum and the maximum sum assured: 1 lakhs to 10 lakh
- Max. Number of members covered: 8 (6 adults+2 children)
- Waiting period for pre-existing medical conditions: 28 months
Oriental Health Insurance Family Floater plan is available in two variants- gold and silver. The policy provides coverage to the insured and his/her immediate family members. The insured can avail tax benefits under section 80D of Income Tax Act. The plan also provides no claim bonus of 5% for every claim free year up to maximum of 20%.
8. SBI LifeSmart Health Insurance:
Incurred Claim Ratio (2016-17): 54.41%
- Min Entry age: Children-3 months; Adults- 18
- Max Entry age: N.A. Children-22 years ; Adult- 65 years
- Minimum and the maximum sum assured: 1 lakhs to 5 lakhs
- Max. Number of members covered: 6
- Waiting period for pre-existing medical conditions: 28 months
This is a comprehensive health plan with fixed benefits. Irrespective of the claims made, the premium of the policy remains constant and is required to be paid for the entire tenure of 5 years. The plan provides daily cash benefit upon hospitalization, daily ICU benefit, day care treatment, lump-sum surgical benefit post hospitalization coverage.
A healthcare policy is a protective cover that will shield your savings in case of a health emergency and will let you recuperate in peace. To find the best health insurance policy in India that suits you and your family, you must compare different policies according to your family’s needs.
