scorecardresearchNavigating the maze: 5 tips to choose the right health insurer

Navigating the maze: 5 tips to choose the right health insurer

Updated: 04 Apr 2023, 02:21 PM IST

Choosing the right health insurer can be a daunting task, but it is important to look at the company metrics such as the claims settlement ratio, customer complaints, online customer ratings, the benefits offered, and any discounts available before making a decision.

Health insurance companies can now launch health products without the IRDAI's nod

Health insurance companies can now launch health products without the IRDAI's nod

Post the Covid-19 pandemic, many people have realised having an adequate health insurance plan is really important. However, if you were to do your own research, you might be overwhelmed by the sheer amount of information that is available online and otherwise.

While you may somehow succeed in deciding how much sum insured you should go for, the crucial step of choosing the right insurance company can be a daunting task. There are 24 general insurers and five standalone health insurers in India. With so many insurers operating in India, it can be challenging to determine which provider is the best fit for your unique needs.

While the plan you choose would be based on your individual requirement, you can look at a few company metrics to decide the customer service and claims experience of the company. Here are five things you can look at to decide a suitable health insurer for you:

Claims settlement ratio

The claims settlement ratio is one of the most important metrics to check before picking a health insurance company. This ratio represents the percentage of claims that are settled by the insurer. A high claims settlement ratio indicates that the insurer is reliable and settles claims efficiently. This ratio is calculated by dividing the total number of claims settled by the total number of claims received by the insurer in a financial year. A ratio of 95% or higher is considered good, and you can get a sense of the claim settlement history by looking at this metric. A low claims settlement ratio could indicate that the insurer may have a history of rejecting claims, which could be a red flag.

Consumer complaints

Another important factor to consider when choosing a health insurer is the record of consumer complaints it receives. One can find the details of policy complaints and claim complaints the company received in the current year per 10,000 claims it registered during the year.

These details can typically be found in the “NL-45 (Grievance Disposal) Form” under the Public Disclosures section of the insurance company’s website. These records provide insight into the experiences of other policyholders with the insurer. A low number can be an indication of the insurer settling all genuine or valid claims on time.

Online customer ratings

Customer ratings on social media platforms such as Facebook and Google can also be another way of getting an insight into the experiences of policyholders with the insurer. The ratings and the reviews written by actual customers can help you gauge the track record of the insurer in providing quality customer services.

Most customers unabashedly provide their honest experience on social media and one can browse through them to get a sense of the service levels of the insurer—right from the policy buying process to claims settlement to grievance redressal. The proactiveness of the company in addressing and solving such grievances in real time can also be judged online.

Premium charged versus benefits offered

The premium charged by the insurer is a crucial factor for most people looking to buy health insurance. However, it is difficult to make the decision of buying a plan solely on the basis of the premium charged as a basic plan could be cheap but lack the basic features a health plan should have. So, compare the premium being charged with respect to seven crucial benefits being offered. These include:

  1. No limit on the choice of room & ICU (No room rent capping)
  2. Sum-insured backup or reinstatement benefit (one-time or unlimited with no exhaustion clause)
  3. The percentage of cumulative bonus offered (recommended up to 100% Cumulative Bonus)
  4. Zero co-payment
  5. Consumable cover
  6. Pre- and post-hospitalization benefit (of at least 60/90 days)
  7. Coverage of organ donor expenses.

The premium being charged should ideally be priced competitively against these seven core benefits being embedded in the plan. That would make the health plan more value for money rather than hunting for a plan with the cheapest premium.

Discounts offered

If the health plan you want to opt for is slightly expensive, there are ways to try and reduce the premium rather than compromising on the coverage or sum insured being opted. Many insurers today offer different types of discounts and one can opt for them based on their individual need and scenario.

For example, if you don’t have any pre-existing disease (PED), you can opt for a higher PED waiting period cover. This can reduce the premium by 4-5%. Opting for a small fixed deductible that you can afford to pay can also bring down your premium.

Insurers also offer up to 5-10% discount for non-smokers, people with better credit score history (750 and above), loyalty discounts (for being a former customer) and city discounts (if you reside in Zone 2), among others. So, check with your insurer on the different discounts it offers before buying a plan.

If you already have a health insurance plan and you feel your insurer isn’t meeting these needs, you can also port your policy to another plan or insurer. Selecting the right health insurer is one of the most critical decisions that one has to make when one plans to buy a health insurance plan.

Choose an insurer whom you feel you can trust better based on some of these parameters and have a better sense of their customer service levels. Making an informed decision will make sure you end up picking an insurer who you feel will service your claim seamlessly in time of need.

Vivek Chaturvedi is Chief Marketing Officer and Head of Direct Sales at Digit Insurance.


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First Published: 04 Apr 2023, 02:21 PM IST