Insurer
Product
No Claim Bonus
Score
Co-Pay
Disease Wise Capping
Total Premium
( including GST)
Ratings Methodology 
NOTE
- Only Products listed on an insurer’s website as on March 2022 have been considered.
- Sub limits on room rent:
- Rated “No” if any single room available in the hospital is allowed
- Rated “Yes” if there is a restriction such as getting the most basic single room in the hospital or AC rooms are not allowed.
- Waiting periods: We have looked at the waiting periods for pre-existing conditions and specific diseases, and taken the longest waiting period into consideration. In most cases this is the period for which pre-existing conditions are excluded but there are some products where specific ailments are excluded for longer than pre-existing conditions.
- No claim bonus and claw back:
- Rated “100 no claw back” if the highest No-Claim is 100% or above, with no claw back when a claim is made
- Rated “50 no claw back” if highest No-Claim is 50% or above, with no claw back when a claim is made
- Rated “100 with claw back” if highest No-Claim 100% plus or above, with a claw back when a claim is made
- Rated “50 with claw back” if highest No-Claim is 50% or above, with a claw back when a claim is made
- Policies with less than 50% No claim bonus do not get points
Mediclaim Ratings – Features
Comprehensive
All products in the market are rated. This covers 25 insurers and over 100 products. All the plans of each insurance company whether individual or family floater have been considered.
Transparent
The criteria and scores of individual products are published on the website. These can be independently verified. Only publicly available information is used for the ratings.
Balanced Criteria
Weightages are given to all relevant criteria – premium, product features and claims. The weight differs slightly for senior citizens.No one criterion can swing the scores.
Independent
The ratings are independent and not sponsored by insurers. These ratings, now in the sixth edition, provide a strong independent and comprehensive pespective to customers and insurers.
Rating Criteria
Premium
- Premium is an important but not the only criterion considered. It has an overall weight of 25% for age groups 60 and below. For higher ages we have reduced the weightage of premium to 20% because certain product features become relatively more important for seniors. The scoring for premium uses the quartile approach, with the highest marks to products in the top quartile.
Product features
- The overall score for product features is the sum of scores for individual features. The maximum weight is given to pre-existing disease exclusions and limits on room rent. Other features that have been scored are the maximum no-claim bonus, wellness cover and restore benefits. For each feature the minimum standards have been clearly specified. The total score is 40% for ages 60 and below. For seniors we have introduced co-pay into the rated features and increased the overall score to 45%.
Claims
- Claims information is available in the public disclosures and we have given this a high 35% weight. Most of this, 25%, is to claim settlement ratio, 5% to claims grievances & the remaining 5% to claims ageing . The settlement ratio is positive claims decisions taken over the total decisions taken. Grievances are expressed as claim complaints per 10,000 registered claims.
Frequently Asked Questions
The ratings include all health insurance products available in the market. Participation is not optional. A few products are excluded because they have not been launched nationally
All the products are divided into 3 categories – A, B and C. A is the highest rated. Products that score 65% or more are A rated, 45% or more are B rated and less than 45% are rated C. A rated products are always good to buy. B and C may be okay in some specific situations.
We have covered over 25 insurers and 117 products.
All important product features like pre-existing exclusion, sub-limits on room, no-claim bonus, wellness and restore benefits have been given weightage. Pre- existing exclusion and sub-limits on room have been given the highest weightage. Some features such as OPD, international care have been left out. This is because the tangible delivery of these features varies significantly by insurer and we have still not seen the level of claims incidence in these areas.
These weightages are based on our sense of what should matter to buyers of health insurance. These have been fine-tuned over the past six years based on our on-the-ground experience and feedback from insurers and customers.
Insuropedia
What is the meaning of Health Insurance?
Health insurance gives you coverage against hefty medical expenses that may arise due to sickness and accidental injury. In most of the cases, health insurance is offered to people in the age group of 5 to 80 years. In some cases, children under five years are covered if their parents are also covered.
Health insurance is a broad term which majorly covers...
Different types of Health Insurance plans to cover medical costs
There are multiple types of health insurance policies available to provide for the various health related expenses incurred by individuals. However, by buyer eligibility we can divide all plans into three broad classes:
Group Health Insurance Personal Health Family Floater Although, features and types of expenses covered are different in both the policies ...
What should you consider while buying health insurance for senior citizens?
People who are looking for health insurance for their senior citizen parents, or senior citizens who want to buy health insurance for themselves, should consider the following points which will help them to buy the right policy:
Age: Most of the health insurance companies offer policies for senior citizens, but they limit the entry age as 65...
Search Insuropedia - Enter Your Question.
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