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Health Insurance Scoring and Ranking
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100+ Plans & 20+ Companies
Evaluated by our team till dateBest 5 Featured List
As per individual and family sizeScoring Parameters
Product features, Price, Claims experienceAll you need to know about Health Insurance
TABLE OF CONTENT
FAQ
What is Health Insurance?
Health insurance is an essential safeguard against unexpected medical expenses. Whether you need a comprehensive plan for yourself or a family floater policy, it’s important to find the right coverage that fits your needs.
Health insurance is a contractual agreement between the policyholder (the insured) and the insurance company (the insurer), where the policyholder pays a specified amount, known as the premium. In return, the insurer covers medical expenses such as hospital stays, surgeries, doctor consultations, diagnostic tests, day-care treatments, pre- and post-hospitalization expenses and more. If the insured faces a medical emergency covered by the plan, the insurance company reimburses the eligible expenses.
It serves as a safety net that prevents significant financial strain in case of serious health issues. For families, having adequate health insurance ensures that all members are covered under a single policy, providing peace of mind.
For more information read : Health Insurance- Shield for your medical emergencies
Types of Health Insurance Plans
When it comes to health insurance, there are several options to choose from. Understanding the different types will help you make an informed decision:
Individual Health Insurance Plans
These plans provide coverage for a single person. Ideal for those who do not have a family or whose family is covered under a different plan.
Family Floater Plans
This is a single policy that covers the entire family. The sum insured is shared among family members, and it is a cost-effective option for families of all sizes.
Employer-Sponsored Health Insurance
Many companies offer health insurance as part of their benefits package, usually for the employee and sometimes for their family. However, coverage may be limited, and additional private insurance is often recommended.
Government Health Insurance Schemes
Some governments provide health insurance options to citizens at subsidised rates or free of cost.
How to Find the Best Health Insurance Plan?
Choosing the right health insurance plan can feel overwhelming with so many options available. To help you find the best health insurance plan for you and your family, here are 10 Must look features you should consider before selecting the best health insurance plan:
1. Coverage and Pricing
Determine the Coverage Amount
Identifying the right coverage amount is crucial. While there is no definitive formula, the following factors can guide your decision:
Individual vs. Family Floater: Individual health insurance provides coverage exclusively for you on an individual basis, while a family floater plan covers all family members under a single policy on a floater basis.
Pre-Medical Conditions: Factor in any family history of pre-existing medical conditions.
Starting Early: If you’re young, begin with a minimum individual cover of ₹5 lakhs and increase it over time through super top-ups or by upgrading your policy as your life stage evolves.
Evaluate Pricing
Once the coverage amount is determined, compare premiums for policies offering similar benefits. While a lower premium may seem appealing, prioritize value for money by assessing the coverage and features provided.
2. Room Rent
Room rent is a critical component as it impacts incidental expenses such as doctor consultations and nursing charges. Opt for a policy with no room rent limits or sub-limits to avoid out-of-pocket costs.
3. Waiting Period & Pre-Existing Diseases
Understand the waiting periods in the policy:
Initial Waiting Period: Typically 30 days from the policy’s start date
Specified Diseases: Usually a waiting period of 2 years for conditions listed in the policy.
Pre-Existing Conditions: A 3-year waiting period is common for pre-existing medical conditions.
Select a policy with shorter waiting periods for pre-existing conditions for better coverage.
For first-time buyers with PEDs, it’s crucial to research plans, understand waiting periods, customize coverage with relevant riders, and provide accurate disclosures.
Insurers may issue policies directly, request medical evaluations, or propose counteroffers with conditions like copayments or exclusions. Ready to dive deeper? Explore our comprehensive guide on Understanding and Managing Pre-Existing Diseases in Health Insurance.
4. Co-Payment
Co-payment requires the policyholder to pay a percentage of the claim amount (e.g., 10% or 20%) alongside the insurer. While opting for co-payment reduces the premium, it increases your out-of-pocket expense during claims. It’s generally better to choose a policy with no mandatory co-payment.
5. No Claim Bonus (NCB)
No Claim Bonus (NCB) or Cumulative Bonus rewards policyholders with a percentage increase in the sum insured or a premium discount for each claim-free year. Policies offering higher bonuses (e.g., 100% or 150% of the sum insured over time) provide added financial security.
6. Recharge of Sum Insured (SI)
This feature restores the sum insured when it is exhausted during a policy period. Variations include:
Default recharge once per year.
Recharge after the first claim exhausts the sum insured.
Unlimited restoration for related or unrelated illnesses.
Evaluate these options to maximize benefits during emergencies.
7. Health & Wellness Benefits
Comprehensive health insurance plans often include:
Annual Health Check-ups: Keep track of your health.
Rewards for Healthy Behavior: Earn points for fitness activities like step counts or gym visits. Points can be redeemed for discounts, medical services, or premium reductions.
Outpatient Benefits: Coverage for chronic diseases and OPD treatments.
Choose a policy that supports your overall well-being with robust health and wellness features.
8. Network Hospitals
Health insurance claims can be either cashless or reimbursement-based. To ensure a smooth cashless claim experience, it is essential to choose a policy with a comprehensive network of hospitals in your vicinity. Opt for a health insurance policy where the network hospitals are not only easily accessible but also renowned for their quality care.
Below is a consolidated list of network hospitals associated with each insurer to help you make an informed decision.
Network Hospitals of General & Health Insurance Companies
| Insurer Name | Network Hospitals |
|---|---|
| Aditya Birla Health Insurance | 11,000+ |
| Bajaj Allianz General Insurance | 18,400+ |
| Care Health Insurance | 24,800+ |
| Cholamandalam MS General Insurance | 12,000+ |
| Future Generali | 8,000+ |
| HDFC ERGO General Insurance | 16,000+ |
| ICICI Lombard General Insurance | 10,800+ |
| IFFCO Tokio General Insurance | 7,000+ |
| Zurich Kotak General Insurance | 11,200+ |
| Liberty General Insurance | 6,000+ |
| Magma HDI General Insurance | 9,100+ |
| Manipal Cigna Health Insurance | 8,500+ |
| National Insurance | 6,000+ |
| Navi General Insurance | 12,000+ |
| The New India Assurance | 2,055+ |
| Niva Bupa Health Insurance | 10,000+ |
| Raheja QBE General Insurance | 5,000+ |
| Reliance General Insurance | 10,000+ |
| SBI General Insurance | 16,625+ |
| Star Health and Allied Insurance | 14,000+ |
| Tata AIG General Insurance | 11,000+ |
| The Oriental Insurance | 4,300+ |
| United India Insurance | 14,000+ |
| Universal Sompo General Insurance | 8,500+ |
Disclaimer: As of December 2024 and has been sourced from the respective insurers' official websites.
To learn about How to locate nearby network hospitals and essential preparations for network hospital emergencies in India, read the full blog.
9. Claim Settlement Ratio (CSR)
The Claim Settlement Ratio (CSR) indicates the insurer’s reliability in settling claims. A higher CSR reflects better claim processing efficiency. When evaluating CSR, it’s essential to consider both the ratio based on the number of claims processed and the ratio reflecting the actual claims paid.
The below CSR ratios are calculated using the formula:
Claim Settlement Ratio = (Total Claims Settled / Net Claims Processed) × 100
Understanding Net Claims Processed
The calculation of Net Claims Processed involves:
- Claims Outstanding at the Beginning of the Year: XXX
- Add: Claims Received During the Year: XXX
- Total Claims to be Processed: XXX
- Less: Claims Outstanding at the End of the Year: XXX
- Net Claims Processed: XXX
Click here to Understand Claim Ratios in Health Insurance
Claim Settlement Ratio of General & Health Insurance Company
| Insurer Name | CSR- Number 2023-2024 | CSR (Absolute Amount) 2023-2024 |
|---|---|---|
| Aditya Birla Health Insurance | 95.64% | 76.48% |
| Bajaj Allianz General Insurance | 93.22% | 92.56% |
| Care Health Insurance | 92.81% | 86.95% |
| Cholamandalam MS General Insurance | 82.90% | 78.50% |
| Future Generali | 92.37% | 71.99% |
| HDFC ERGO General Insurance | 94.42% | 84.82% |
| ICICI Lombard General Insurance | 86.86% | 68.49% |
| IFFCO Tokio General Insurance | 93.47% | 86.58% |
| Zurich Kotak General Insurance | 90.73% | 88.81% |
| Liberty General Insurance | 87.07% | 87.62% |
| Magma HDI General Insurance | 86.48% | 68.61% |
| Manipal Cigna Health Insurance | 88.64% | 56.81% |
| National Insurance | 88.89% | 96.48% |
| Niva Bupa Health Insurance | 92.02% | 73.34% |
| Raheja QBE General Insurance | 79.00% | 71.62% |
| Reliance General Insurance | 80.45% | 87.08% |
| SBI General Insurance | 95.11% | 97.93% |
| Star Health and Allied Insurance | 86.61% | 67.79% |
| Tata AIG General Insurance | 86.73% | 83.95% |
| The New India Assurance | 98.44% | 108.76% |
| The Oriental Insurance | 94.21% | 129.19% |
| United India Insurance | 90.07% | 79.98% |
| Universal Sompo General Insurance | 90.42% | 70.95% |
Disclaimer: The above data is sourced as on 31st Mar 2023-24 and has been sourced from the respective insurers' websites , public disclosures, IRDA Annual report 23-24 and other publicly available information.
10. Incurred Claim Ratio
The Incurred Claim Ratio (ICR) measures the percentage of premiums used to pay claims. A very high ICR may indicate financial instability, while a moderate ICR reflects a balance between claim payments and financial health. It represents the total value of claims incurred by the insurer against the premium collected during a specific period. The formula for ICR is:
Incurred Claim Ratio = (Net Claims Incurred / Net Premium Earned) * 100
Incurred Claim Ratio of General & Health Insurance Company
| Insurer Name | CSR- Number 2023-2024 |
|---|---|
| Aditya Birla Health Insurance | 68.31% |
| Bajaj Allianz General Insurance | 84.96% |
| Care Health Insurance | 57.69% |
| Cholamandalam MS General Insurance | 66.67% |
| Future Generali | 92.37% |
| HDFC ERGO General Insurance | 80.98% |
| ICICI Lombard General Insurance | 78.85% |
| IFFCO Tokio General Insurance | 107.46% |
| Zurich Kotak General Insurance | 59.06% |
| Liberty General Insurance | 79.92% |
| Magma HDI General Insurance | 87.46% |
| Manipal Cigna Health Insurance | 63.78% |
| National Insurance | 90.83% |
| Navi General Insurance | 59.40% |
| Niva Bupa Health Insurance | 105.87% |
| Raheja QBE General Insurance | 59.02% |
| Reliance General Insurance | 106.27% |
| SBI General Insurance | 89.42% |
| Star Health and Allied Insurance | 87.86% |
| Tata AIG General Insurance | 66.47% |
| The New India Assurance | 77.94% |
| The Oriental Insurance | 101.96% |
| United India Insurance | 109.23% |
| Universal Sompo General Insurance | 105.76% |
Disclaimer: As per IRDA report 2023-24
Understanding the Health Insurance Claims Process
Health insurance plays a vital role during medical emergencies, ensuring financial security for you and your family. Understanding the claims process is key to making the most of your health insurance policy. When you or a family member requires medical treatment covered by your policy, initiating a claim is the first step. Health insurance claims in India typically follow two methods: cashless claims and reimbursement claims.
Cashless Claims Process
The cashless claims process allows you to receive medical treatment at network hospitals without any upfront payment. Here’s how it works:
- For planned hospitalisation, inform your insurer in advance and obtain a pre-authorization letter.
- Visit the Third-Party Administrator (TPA) helpdesk at the network hospital.
- Share your health e-card and ID proof at the TPA desk and fill out the necessary forms, such as the pre-authorization form.
- Once approved, the insurer directly settles the bills with the hospital, making the process hassle-free.
Reimbursement Claims Process
In contrast, the reimbursement claims process requires you to pay the medical bills upfront and then seek reimbursement from your insurer. This method applies to:
- Treatments received at non-network hospitals.
- Pre- and post-hospitalisation expenses.
To file a reimbursement claim:
- Collect and submit all relevant documents, including bills, prescriptions, and discharge summaries, to your insurer.
- Follow the insurer’s guidelines for claim submission to ensure a smooth process.
Filing a health insurance claim can sometimes feel overwhelming, but following a few key strategies can help you streamline the process and minimize potential issues. To know the tips on Navigating the Claims Process and Tips for a Smooth Experience with Health Insurance in India, read the blog.
Understanding the dynamics of Individual Vs Family Floater Health Insurance
Health insurance is a critical component of financial planning, and choosing between Individual Health Insurance and Family Floater Health Insurance can make all the difference for your family’s well-being.
Individual Health Insurance provides separate coverage for each family member, offering personalized benefits tailored to individual needs. Ideal for those with pre-existing health conditions, this plan ensures comprehensive care without compromising flexibility. However, premiums may be higher since they are calculated separately for each member.
In contrast, Family Floater Health Insurance combines the coverage for all members under a single policy with a shared sum insured. This cost-effective option is perfect for young, healthy families, as the premium is based on the eldest member's age. However, the shared coverage might be depleted if one member uses a significant portion, impacting the rest of the family.
Key Highlights:
- Coverage Flexibility: Individual plans offer separate covers, while family floaters provide a shared pool.
- Premiums: Family floater premiums are generally lower but are determined by the eldest member's age.
- No Claim Bonus (NCB): In individual plans, claims affect only the claimant’s NCB, whereas in floaters, it impacts the entire policy.
Explore The dynamics of Individual Vs Family Floater Health Insurance to make an informed decision about securing your family’s health with the right plan.
What Does Portability in Health Insurance mean?
Health insurance portability lets you transfer your existing policy to a new insurer without losing accrued benefits like reduced waiting periods for pre-existing conditions. Whether you’re seeking better coverage, improved services, or competitive premiums, portability ensures you can upgrade your policy without starting over.
Switching is easy when planned right—start the process 45 days before renewal to avoid gaps in coverage. Ensure your new insurer honors waiting periods, cumulative bonuses, and offers a robust hospital network.
For more information read this blog : Portability in Health Insurance: Empowering Policyholders with Choice and Flexibility
What are the Tax Benefits for Buying Health Insurance?
Health insurance not only protects you and your family from financial strain during medical emergencies but also offers significant tax benefits. Under Section 80D of the Income Tax Act, you can claim deductions of up to ₹25,000 for premiums paid for yourself, your spouse, and dependent children. Additionally, insuring senior citizen parents allows for an extra deduction of up to ₹50,000, maximizing your tax savings.
Tax Season : Aligning Insurance Choices with Holistic Financial Wellbeing read the full blog to explore how health insurance combines financial security with tax-saving opportunities.
How to Make the Most of Your Health Insurance
To maximise the benefits of your health insurance policy:
Understand Your Policy
Be aware of the coverage, exclusions, and claim procedures.
Use Network Hospitals
Opt for treatment at hospitals within the insurer’s network for cashless transactions.
Stay Healthy
Many insurers offer wellness programs and discounts for maintaining a healthy lifestyle.
Frequently asked questions
Key Factors for Choosing a Health Insurance Policy:
- Product Features: Consider room rent limits, no-claim bonuses, and rewards for healthy behavior.
- Price: Ensure the premium is affordable and offers value for money based on your budget.
- Claims Experience: Evaluate claim settlement ratios, network hospitals, and claim handling efficiency for reliability.
Individual plans cover a single person, while family floater plans cover all family members under one policy.
Yes, health insurance covers PEDs after serving a waiting period specified by the insurer, typically ranging from 2 to 3 years. A pre-existing disease includes any condition, ailment, or injury you were aware of or treated for within a specified period (usually 3 years) before purchasing the policy.
Yes, many family floater plans allow you to include your parents, but it’s generally not advisable. Family floater policies typically cover 2 adults and up to 2 children, and adding elderly parents can significantly increase the premium due to their higher health risks. Instead, it’s better to opt for a separate health insurance plan for parents, as this ensures adequate coverage tailored to their specific medical needs without impacting the overall family floater coverage.
OPD (Outpatient Department) in health insurance covers medical expenses for treatments, consultations, and diagnostic tests that do not require hospitalization. OPD is generally available as an add-on benefits
Policies with OPD coverage often have higher premiums, and the benefits may not justify the additional cost due to restrictive sub-limits and caps.
Super top-up health insurance provides additional coverage for cumulative medical expenses exceeding a specified threshold during a policy year, offering cost-effective protection beyond your base policy.
Disclaimer
1 Finance Private Limited operates independently. The information presented herein is intended solely for educational and informational purposes and should not be construed as financial advice. Before making any financial decisions, it's essential to undertake your own thorough research and analysis. If you're uncertain about any financial matters, we strongly recommend seeking guidance from a qualified financial advisor.