In the insurance section, the term top rated reflects a combination of multiple factors that show how an insurance policy functions in real claim situations. Some of the crucial indications include:
Below each of them is briefly discussed.
1. Solvency and Claim Settlement Ratio
The solvency and claim settlement ratios indicate the health insurance plan’s reliability in making the settlement of claims. Here’s how both of them work:
Solvency Ratio
The solvency ratio indicates the insurer’s financial health and the ability to meet future obligations. The Insurance Regulatory and Development Authority of India (IRDAI) has mandated that each insurer should have a minimum solvency ratio of 1.5 (150%). This numerical value indicates that the insurer has adequate assets to cover the potential claims.
Claim Settlement Ratio (CSR)
The claim settlement ratio is published annually by the IRDAI. This ratio indicates the number of claims approved by the insurer against the number of claims received. A consistent CSR of more than 95% shows efficient claims processing. In addition, the Incurred Claim Ratio (ICR) shows the claims paid against the premiums collected.
2. Plan Inclusions
The scope of the coverage determines a policy’s usefulness in any case you face a medical emergency. A top-rated health insurance often gives policyholders the following facilities:
- In-patient hospitalisation: The in-patient hospitalisation covers the amount charged for room rent, ICU charges, nursing care, and surgeon fees if the admission exceeds 24 hours.
- Pre and post-hospitalisation: A health insurance plan may be positioned as stronger if the plan has about 30 to 60 days of pre-hospitalisation service. Similarly, such plans also have about 60 to 90 days post-hospitalisation coverage.
- Day Care Procedures: Treatments like chemotherapy, dialysis, and minor surgeries may not require overnight hospital admission. In such healthcare needs, a day care service covers the necessary medical costs. For instance, insurers like HDFC ERGO give health insurance policyholders up to 60 days of admission and up to 180 days after discharge coverage.
3. Sub-Limits and Cost-Sharing
There are a few limits associated with medical insurance policies that indicate the maximum amount that will be paid for certain healthcare facilities. To identify this in a better way, you should evaluate the following aspects:
- Room Rent Sub Limits: Some medical insurance policies may have a cap for room rents at a percentage of the sum insured.
- Disease Wise Sub Limited: In a few policies, the insurer may set a maximum payout limit regardless of the sum insured.
- Co-Payment Clauses: The Co-Payment clause refers to the percentage of the claim amount you’ll have to pay at the time of making claims. This amount is known as the deductible.
Comparing these aspects can significantly help you with selecting the top-rated health insurance.
4. Network Hospitals and Cashless Access
The practical value of a top-rated health insurer is shown in its ability to give you cover through convenient cashless hospitalisation networks. Here’s how this system works:
- Hospitals Network Size: Each medical insurer has a network of hospitals in which they provide you with coverage. The wider the network of hospitals, the more chances you’ll get insured treatment in your neighbourhood hospitals.
- Cashless Processing: With a cashless facility, the insurer directly pays the amount of medical coverage to the hospital minus your deductibles. It is a highly useful feature as you don’t have to arrange a high upfront cost for the treatment.
Final Thoughts
A top-rated health insurance gives you adequate coverage along with a manageable sub-limit for hospitalisation costs. By reviewing an insurer’s CSR, plan inclusions, sub-limits, and network of hospitals, you’ll be able to compare health insurance policies better and choose the right plan for yourself as well as for your family. Compare quotes, choose the right option, and get insured today.
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