This research offers an in-depth analysis of health insurance options in India, focusing on base cover and super top-up policies. It evaluates plans based on coverage, cost, claim ratios, and other key features.

---

1. Key Filters for a Good Health Policy:

• No Co-Pay: Avoid policies that require you to share a portion of the hospital bill.
• No Room Rent Limit: Look for single private AC room coverage or no cap.
• No Sublimits: Policies should not restrict coverage for specific surgeries.
• Reset Benefit: Ability to restore the sum insured for future claims in the same year.
• Claims Paid Ratio > 85%: Higher claim settlement ratios indicate reliability.
• Hospital Network: Ensure a strong network of empaneled hospitals near your location.

---

2. Summary of Findings by Insurer:

ICICI Lombard

• Base Policy:
• Sublimit for surgeries in 5L cover but not for 7L+ cover.
• Limited pre/post-hospitalization (30/60 days).
• Super Top-Up:
• Excellent with no major drawbacks.
• Claims Paid Ratio: 88% (average).
• Premium: Slightly high.

---

Max Bupa (ReAssure + Recharge)

• Base and Super Top-Up Policies:
• Cheaper than competitors but suspiciously so.
• Incurred Claim Ratio: 53% (low).
• Possible partial claims approval to inflate claims paid ratio (91%).
• Complaints: High complaints per 10,000 claims.

---

Star Health (Comprehensive + Super Surplus)

• Features:
• OPD and dental coverage included.
• Single private AC room cap.
• Claims Paid Ratio: 81% (low).
• Complaints: High complaint frequency.
• Cost: Higher than competitors.

---

HDFC Ergo (Optima Restore + Medisure Super Top-Up)

• Base Policy:
• Excellent features but slightly expensive.
• Super Top-Up:
• Max cover capped at 20L.
• Claims Paid Ratio: 97% (excellent).
• Hospital Network: Extensive.

---

Manipal Cigna (ProHealth + Super Top-Up)

• Base Policy:
• Good features at an affordable price.
• Super Top-Up:
• Max cover limited to 30L.
• Incurred Claim Ratio: 61% (low).
• Complaints: Moderately high.

---

Religare (Care Health + Enhance)

• Features:
• Affordable and comprehensive base policy.
• Super top-up max cover at 30L.
• Claims Paid Ratio: 94%.
• Incurred Claim Ratio: 59% (low).

---

New India (Premier Mediclaim + Top-Up)

• Base Policy:
• Room rent cap in 5L plan; 15L plan has no issues but is very costly.
• Super Top-Up:
• Not available. Top-up max cover limited to 22L.
• Hospital Network: Limited.

---

Royal Sundaram (Lifeline Supreme)

• Features:
• Excellent base policy at the lowest premium.
• Claims Paid Ratio: 95%.
• Super Top-Up: Couldn’t find details online.

---

Go Digit (Health + Super Top-Up)

• Base Policy:
• Affordable but includes a 4-year waiting period for pre-existing diseases.
• Super Top-Up:
• Max cover of 20L, relatively expensive.
• Claims Paid Ratio: 83%.
• Incurred Claim Ratio: 51% (low).

---

3. Shortlist:

Based on claims ratio, coverage, and cost, the top contenders are:
- HDFC Ergo (Excellent claim ratio, limited super top-up cover).
- ICICI Lombard (Good overall but average claim ratio).

---

4. Next Steps Before Finalizing:

• Review Claim Settlement Experience:
• Seek feedback on real-world claim processes for the shortlisted insurers.
• Future Scalability:
• Ensure the policy allows upgrading coverage as needs grow.
• Regional Network:
• Confirm hospital network quality in your area.

---

5. Conclusion:

• HDFC Ergo stands out for its excellent claim settlement ratio, despite a lower super top-up cap.
• ICICI Lombard is reliable but lags in certain aspects like pre/post-hospitalization limits.
• Policies should be chosen based on individual needs, insurer reputation, and long-term viability.

---

Next: Read 2500+ consumer guides to shopping, electronics, appliances, home services, cars, money and more.

❤ If you liked all this, consider supporting us by checking out SkillThing DOING Manuals