See, maximum health insurance companies want all the things, and all the terms and conditions do not come in front of you. And that has its advantages. And all those things, step-by-step in this article we have simplified it in a very nice way so that in the future, no Indian will make any mistake in buying the wrong insurance policy. So, in this overall video, we will focus on 5 things that you have to see in detail. And out of these 5, three things are there, which is very personalized. This means that your requirement depends on that. But before going into those things, let me tell you about two ratios that will help you avoid the wrong health insurance. So, out of these two.
The first one is the Incurred claim ratio.
What is the meaning of this Incurred claim ratio?
It means that during that financial year, how much rupees premium did the company collect and against that how much rupee claim have they cleared? So, generally, ideally, this ratio should not be too much, Just as you can see, Realiance's ratio was 196% in 2021-22. This means they have collected 100 rupees premium, and they have paid 196 rupees for their claim. So like this, the company will go for a loss. So if the company itself goes to a loss, giving the upcoming claims will be difficult. This thing also we have to keep in mind. So Incurred claim ratio should ideally be between 50 and 90% and if it is above 90%, the company can go for a loss. And if it is below 50%, then it can mean that the company is unable to pass the claim that easily. Let me tell you that, see any ratio, don't see it for one year. Most of the companies show their one-year ratio and attract you. You should not get trapped in this. Here if we look at these four years, if we talk about Reliance, Reliance is very inconsistent. Sometimes it is very low, and sometimes it is very high. So in these situations, you can refer those companies that are somewhat consistent. So in this, none of them are that consistent. Over here, Niva Bupa and Reliance Health are extra inconsistent. Others are somewhat consistent. Now here if we talk about Star Health we can see that it is somewhat consistent. See, the matter is not only about Incurred Claim Ratio. For this, we have to understand how many claims the company repudiates, which I will tell you later. But to understand this,
We have to talk about the Claim Settlement Ratio.
Over here, we have shown you some of the company's Claim Settlement Ratio. We have also talked about the Claim Settlement Ratio before. It tells us that, out of 100, how many claims has the company cleared. So generally what happens is that many companies show the last year or, the first three months, or six months and try to attract you. If you see here, in the first three months of this financial year, all these companies's Claim Settlement Ratio has gone above 99%. Does this mean that all these companies settle their claims very nicely? Absolutely Not. Look at their situation in the year of Covid. Here we get to know their reality. So during the Covid, not even one company could settle their claim properly. And this is the reality. So if we take the average of these four years, Clear Health Insurance, Manipal Cigna, and Niva Bupa have settled their claims a little better than other insurance companies But again, this does not clear the whole thing. For that,
You also have to see how many claims are getting repudated
See this is the data for the financial year 2022 of the Ken where it is shown how many claims are repudiated. You can see that Manipal Cigna has got about 3,45,000 claims. Out of which 3,10,000 have been cleared. 35,000 has been rejected. If you see rejection as a percentage-wise, then two companies have a high rejection rate. One is Clear Health Insurance and another is Star Health Insurance. So we can see that Care has been performing well in the first two ratios, but over here we might get to see another reality. So all this reality can be known through these three things. Let me tell you that Star Health Insurance has a 33% market share. Meaning it is a very big player. But a lot of allegations have come up from their side they have not settled their claims. Through the data, we can see that other insurance companies are becoming low. All these things, you will get to know from the ratio. But is this sufficient? No. Now let's come to the main issue. A lot of people have an understanding of how much rupees I have taken cover? I have taken one crore cover then it is good. Now my problems are solved. No. Many people are not even able to understand health insurance. If you want to understand health insurance, then you have to first understand your requirements. And I will explain all these things in a very simple language. So Sub Limit, pre-hospitalization, post-hospitalization, room renting, understand all these in a simple way, and what will be your requirement, you understand in detail. So I would like you to save this article so that the data presented in this article will help you from time to time while getting health insurance. And the things which I am going to simplify, and the things which we are going to explain in detail will help you a lot to keep the cost low and get the best health insurance, particularly getting for you. Now you tell me,
What is the biggest health insurance claim problem in India?
Some patients' surgery happens, then their family member goes to claim, and then they get to know that even if the surgery is 10,00,000 the company will give only 1,00,000. Then people think what is the use of getting health insurance? Now all these things get covered in Sub Limit. Now that you have understood the terms and conditions of Sub Limit, this means that you have understood 40% of the health insurance. This is a Sub-limit of health insurance companies, in which they have added a note stating that if you have robotic surgery, we won't give more than 1,00,000. Then even if 50,00,000 goes for surgery, or even more, even if your insurance coverage is 50,00,000 or 1,00,00,000 we will give a maximum of only 1,00,000. Now all these these things where you have to check all these things. As soon as you put your basic details in the policy bazaar, as per your requirements, you will get some health insurance. After that click on 'view all features'. After that, once you scroll to the bottom, here, you will get the policy documents where, which and all you have to read are Policy Wordings you have to read where each term has been defined. Each and everything the company defines here. Like different types of surgery, and subelements related to diseases. What are your daycare treatments? How in many hospitals it happens, where you have to be hospitalized 24 hours, then only you can go and claim, or else it won't be possible. So where will you get to know all these details? You will get to know this in wordings. So all these things you will get to read it here. Along with this, you have to read the prospectus and brochure. Now the important thing is whatever you have not understood, When Policy Bazaar calls you or you call them, you can get this clarification, and get answers to all the things, so that you don't have any confusion. Now see, you have a care supreme direct plan where it is written no sublimit This means that whatever surgery happens, there won't be any sub limit, 1,00,000 or 2,00,000. So this is very important to see, and many people don't see this. They directly see the premium or coverage and they immediately buy it, and there only they face the problem. So the first thing is over here, which is sublimit, which you should check at all costs.
The second thing is that is the cashless hospitals. Here you get the option of a cashless hospital. Click on that. Enter your city name in that and all your city hospitals' names will come where the company will do cashless payments directly. See, now I'm giving a lot of importance to this one because there are a lot of benefits to a cashless hospital.
Like a company has a condition that if you're from our network hospital, and if you get an ambulance, then that expenses we will take care. Imagine your house is very far from the hospital, so, in this, all the expenses will be covered in the ambulance. But if the ambulance is not from our network hospital, then we can give only 3,000 rupees. So instead of all these problems occurring, it is better that you choose a network hospital And also see which has a better network hospital. Which health insurance company they have tied up with? So seeing this also is equally important, no need to take too much burden. You can just put in your PIN code or city name and get to know about these things easily.
And one advantage of cashless is that you don't have to arrange for cash first, the company itself will do.
The third thing you have to see is Room rent. See, you can go with such a health insurance company where there is no limit on the room rent. Because a lot of problems happen because of that, or if there is no limit on room rent then you will get hospitalized, a specialist is called who will just come to see you. That is not a full part of the treatment, he will come just to check up. The company says, that there is a limit on room rent, we will give only so much. And we won't cover this checkup. So all these things can also be done. Nowadays, a lot of companies are not keeping limits on room rent, that also you can see by clicking on view all features. And you can see that, many companies don't have any condition on the room rent. No room rent limit.
And you have to see 3-4 small things, let me quickly tell you those things also.
First is no claims bonus. Meaning, that any year you don't have to claim the bonus, what the company does is it has two options. Either it pays your premium or gives additional coverage. So many companies think about their profit, they don't reduce the premium, they will increase your coverage. How much they are increasing, also can be seen. It is not that important. But make sure you pay attention, along with that,
you see the restoration benefit. If at all any year you use a particular claim, then how much amount you get restored. Like these many health insurance companies are there, where, they give a good amount of restoration or unlimited restoration. Meaning once you claim a particular amount, it gets restored.
And then you can see the waiting period, for normal disease, growing disease, and pre-existing disease. Because only after the waiting period we can claim the thing against it. Not before that. And after that, the chance of riders come.
So here you can see that four riders are there in front of me, instant cover. Meaning, if you have any diseases, like diabetes, hypertension, etc, and you want instant coverage, you don't want to wait, you have to pay an additional amount. This depends if you have that thing already, and according to that you can see,
For annual health checkups, they're asking for a separate amount of 450. My suggestion is that don't take that. Because most of health insurance companies provide this for you for free.
Then comes a reduction in pre-existing diseases: So if you want to reduce the time period of that you have to pay separately for that. That depends on if you have any disease and you have chances of being hospitalized The chances of expenses going up will be high in the future. So according to you, you can decide that.
Along with that, you get option of super top up and top up. I will suggest you go with super top-up, rather than simple top-up. Here you can see that In top-up and super top up there is an insurance of 10,00,000 and you can claim 5,00,000 in both places. After that imagine that the insurance company gives you a claim of 3,00,000. And in the second claim, you do it for 6,00,000 wherein top up you will have deductible. But in super top-up, during the second claim, there won't be any deductibles. So you will get the full amount over here. So this is the main difference between top-up and super top-up. So many times super top-up gives you separate coverage of 80-90 lakhs after you pay 1000 rupees per year. So this can be a good deal, depending from situation to situation. So in the conclusion of the video, I would like to say that, In India medical expenses have gone by 14% which is more than in other Asia countries. So health insurance should be there. Along with that, you get benefits also.
You can get a tax benefit of about 25,000 for your spouse or children. If you take your parents, then from that also you can get up to 25000, or in some cases, you get more than that for the tax reduction. And all these small things that we looked upon, you can see in the filter section of the policy bazaar. Like how much you want to get covered, you can fill it there, and can select the no-room rent type, and select the policy benefits, you won't like pre-hospitalization, for a few diseases where you have to be hospitalized, and after that surgery, also you have to be hospitalized, so you can pay attention to the pre-hospitalized and post-hospitalized. So like these, you can pay attention to these main things, Doctor consultation, and pharmacy, if we want we can click that also. And how much you want the waiting period, you can add all the filters. After pressing enter, you can get relevant health insurance. But it is not necessary to what they show you have to select that only. I showed you the three ratios in the beginning, meaning incurred claim ratio, claim settlement ratio, and how many claims have been repudiated, you have to check all these. After that, because some company is fluffing all your conditions, it does not mean you go and take insurance from that company. Check these three things and then only after these requirements only and find your best insurance.
When you are seeing your personalized things, your main focus should be on, Sub-limit, Post post-hospitalization, pre-hospitalization no room rent, and which and all disease, and network hospitals. You can focus on these a little more. Now out of all these things I've told you this company keeps itself a secret so that more people don't get to know about it. And when people get to about the conditions during claiming, then you cannot do anything. And these companies have these advantages.
So just see all these things, understand them, and take the correct health insurance. And you can get all these things in Policy Bazaar. And lastly, I would say that to check these things and don't compromise on your requirements. And then you can easily find a good insurance company.
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