Founded in 2016, Aditya Birla General Insurance Company is a joint venture between Aditya Birla Group and MMI Holdings of South Africa. The insurer offers a broad portfolio of financial products that extend across life insurance, health insurance, multiply wellness, motor insurance, travel insurance, mutual funds, stocks and securities, real estate investments, pension funds, and more.
The brand has also gained trust as a health insurance provider over its affordable plans, credible metrics, and the customisation potential of its health insurance policies. However, despite being a general insurance company, the insurer’s high number of complaints is a matter of concern.
| Pros | Cons |
|---|---|
| Good Claim Settlement Ratio | High Complaint Volume |
| Great Incurred Claim Ratio | |
| Affordable health insurance plans |
Metrics of Aditya Birla Health Insurance
Aditya Birla Health Insurance is a comparatively new insurer in the market with not much of an insurance track record. However, the provider has been doing well so far in crafting customised plans for policyholders with pre-existing medical conditions and senior citizens. While some of the offered policies are comprehensive and can be considered solid picks, what remains to be gauged is the credibility of this insurance provider.
We have considered a few metrics to determine the credibility of an insurer. In these cases, we have taken the track record of the last 3 years and drawn an average to get an idea about the insurer's consistency.
Claim Settlement Ratio of Aditya Birla Health Insurance
The Claim Settlement Ratio (CSR) is a primary metric for assessing an insurer's credibility. It is derived by dividing the total number of claims settled by the insurer in a year by the total number of claims raised to the insurer in that year, then multiplying by 100. When calculating the annual total of settled claims, outstanding claims from the previous year are aggregated with those resolved in the current year, while unresolved claims are excluded.
- If the CSR falls below 80, avoiding engaging with this insurer is advisable. A CSR below this threshold indicates insufficient claim settlement practices, posing a heightened risk of valid claims being denied to potential policyholders.
- In the range of 90 to 100, a CSR is considered ideal. Selecting an insurer within this range ensures a sound choice.
- If the CSR exceeds 100, it raises concerns despite appearing to surpass perfection. This indicates delayed claim settlements, as outstanding claims from the previous year are factored into the calculation. For health insurance policyholders, delayed claim settlements are undesirable.
| Years | Aditya Birla Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 89.3 | 91.484 |
| 2021 - 2022 | 93.72 | 89.967 |
| 2022 - 2023 | 95.95 | 91.460 | Average (2020 - 2023) | 92.99 | 90.970 |
Insight: The CSR of Aditya Birla is one of the best in the industry. Its numbers beat the industry average, which is an encouraging sign for potential stakeholders.
Incurred Claim Ratio of Aditya Birla Health Insurance
While the Claim Settlement Ratio (CSR) provides an overview of the number of claims settled by an insurer throughout a year, gaining deeper insights is essential. Understanding the long-term sustainability of your chosen insurer is crucial. The Incurred Claim Ratio (ICR) of an insurer, calculated by dividing the total amount of claims settled by the insurer in a year by the total amount collected through premiums in that year and multiplying by 100, helps illuminate the overall amount settled via claims.
- If the ICR falls below 50, it suggests that the insurer may prioritise its business interests over ensuring the complete settlement of claims. This raises concerns for policyholders, who may encounter the rejection of valid claims or partial settlements.
- The ICR is ideal for health insurance providers in the range of 50 to 70. Insurers within this range, possibly slightly higher, demonstrate a balanced approach, emphasising settling claims from policyholders and maintaining business stability.
- If the ICR exceeds 100, insurers pay more claims than the premiums collected. While this might initially seem beneficial for policyholders, it could lead to financial challenges and sustainability issues for the insurer's brand in the long term, signalling potential concerns ahead.
| Years | Aditya Birla Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 49.99 | 78.27 |
| 2021 - 2022 | 69.56 | 91.79 |
| 2022 - 2023 | 64.68 | 78.82 | Average (2020 - 2023) | 61.41 | 82.96 |
Insight: Aditya Birla’s ICR doesn’t just fall within the ideal range; the numbers reveal the brand's ideal balance over prioritising client requirements (via claim settlement) and business stability. The numbers have been consistently good, which is an excellent sign for policyholders.
Complaint Volume of Aditya Birla Health Insurance
Examining its complaint numbers is crucial to assess the credibility of a health insurance provider. Higher complaint numbers indicate a poorer performance for the insurer. Most complaints typically concern claim settlement issues, so avoiding insurers with a high volume of complaints is advisable.
| Years | Aditya Birla Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 35 | 13.212 |
| 2021 - 2022 | 26 | 35.969 |
| 2022 - 2023 | 18 | 19.578 | Average (2020 - 2023) | 26.33 | 24.029 |
Insight: The Complaint numbers for Aditya Birla are higher than what we prefer. However, the brand’s complaint numbers have been improving consistently, which suggests that it has been working on its overall operational efficiency. Such numbers are promising and may get even better over the coming years.
Top Health Insurance Plans Offered by Aditya Birla Health Insurance
Activ Care Premier can be a good option if you are 55+ with pre-existing medical complications. The policy offers a reduced waiting period of only 2 years for policyholders with pre-existing medical conditions. The Activ Care Premier plan from Aditya Birla also provides free annual health check-ups, domiciliary coverage, daycare treatment coverage, and more.
There are a few caveats since this is a health insurance plan crafted for senior citizens. However, such hurdles in senior citizen health insurance policies are common across the industry.
Drawbacks: The plan includes room rent restrictions, disease-wise sub-limits, co-payments, nominal pre and post-hospitalisation coverage of only 30 and 60 days, and more.
Aditya Birla Activ Fit is explicitly crafted for young adults, considering the discounts offered during insurance renewals if you are healthy (as diagnosed in their Health Assessment Program). This is a decent pick with 2 variants - Plus (individual, multi-individual and family floater) and Preferred (family floater), extending exhaustive sum insured ranging from ₹1 lakh to ₹1 crore.
The policy offers maternity coverage perks, multiple premium discounts if you stay healthy during renewals, and add-ons like - Super No-Claim Bonus, OPD coverage, Reduction in maternity waiting period, Travel Protect Cover, Premiums Waiver Cover, EMI Protection Cover, and Consumables Coverage.
Unfortunately, the policy has a few restrictions, cappings, and exclusions.
Drawbacks: The waiting period for pre-existing ailments is 4 years, and that for maternity is 3 years. There is a capping on the maternity coverage based on the chosen sum insured and room rent restrictions if the sum insured is less than ₹5 lakhs.
This is an economic plan extending basic coverage and free health check-ups. Unfortunately, the Aditya Birla Activ Health Platinum Essential is not a comprehensive policy considering the list of restrictions, exclusions, and terms and conditions it demands.
Drawbacks: The policy comes with a copayment, a 4-year waiting period for those with pre-existing medical conditions, disease-wise sub-limits, and more.
Conclusion
Aditya Birla Health Insurance is a decent pick when it comes to comprehensive and affordable policies. While the company is relatively new, and we don’t have much of an insurance track record to rely on, the brand is gaining credibility in the market with its overall operational efficiency. Overall, Aditya Birla is an excellent option if you are comfortable with a new insurance provider.