Health insurance plans have become popular over the last few years due to increased lifestyle ailments, the pandemic, and escalating medical inflation. As the demand for health insurance policies grew, so did the number of new health insurance providers. While a few new health insurers surfaced and came to the limelight, a few evergreen top-notch providers held their own. Established in 2001, Bajaj Allianz Health Insurance is one such provider with a strong client base due to its diverse insurance product portfolio and brand name. Health insurance policies from this insurer come with a host of riders that offer ample scope for customisation and niche policies that cater to niche categories of critically ill (for example, cancer patients in remission) policyholders.
Unfortunately, such plans are not without caveats—health insurance policies from Bajaj Allianz's stable are usually not as comprehensive as you would normally expect from top-notch plans. Moreover, these plans tend to be a tad bit more expensive than the ones from this brand's competitors.
Now, the question is - despite these couple of drawbacks, is it still worth availing of health insurance plans from this stable, and is Bajaj Allianz as credible as it is reputed to be? Let’s explore and find out!
| Pros | Cons |
|---|---|
| Excellent Claim Settlement Ratio | Expensive Health Insurance Plans |
| Good Incurred Claim Ratio | Non-Comprehensive Health Insurance Policies |
| Excellent Complaint Volume |
Metrics of Bajaj Allianz Health Insurance
Bajaj Allianz Health Insurance is a joint effort between Bajaj Finserv and the Allianz Group, launched in 2001. Given its familiarity with the brand's name, this company has become quite the household name across the health insurance industry. However, when purchasing a health insurance policy, you are looking at a long-term financial commitment that is meant to be your financial safety net during health scares. Your choice of health insurance provider and policy will play a pivotal role in ensuring the quality of healthcare services you have access to without straining your savings. Thus, only word-of-mouth isn’t enough when finalising an insurer. Rather, you should be taking a closer look at the provider's credibility, and the comprehensiveness of the health insurance plans it offers.
Let’s start by determining the health insurer's trustworthiness by considering a few metrics, namely Claim Settlement Ratio (CSR), Incurred Claim Ratio (ICR), and complaint volume. Please note that we have taken the data from the previous three years (2020 to 2023) to get a wholesome idea of Bajaj Allianz Health Insurance's consistency in overall performance proficiency.
Claim Settlement Ratio of Bajaj Allianz Health Insurance
A health insurer's Claim Settlement Ratio (CSR) is one of the primary metrics to determine its credibility. This is given by -
(Total number of claims settled by an insurer across a year/ Total number of claims raised to the insurer in the year) * 100
The ideal CSR range of a health insurance provider is more than 90 and less than 100. If you encounter an insurer with a CSR of less than 80 or more than 100, you need to rethink your decision. Such an insurer might either have a poor claim settlement track record or have an issue with delayed claim settlement. Neither of these two situations is desirable when dealing with a time-sensitive situation like a health insurance claim settlement.
(Please note: This CSR metric is crucial and not the only determining factor when choosing a health insurer. CSR will not reflect the time required to settle a claim or the future financial sustainability of the insurer. Hence, you must focus on a couple more metrics simultaneously.)
| Years | Bajaj Allianz Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 94.51 | 91.484 |
| 2021 - 2022 | 90.75 | 89.967 |
| 2022 - 2023 | 96.85 | 91.460 |
| Average (2020 - 2023) | 94.04 | 90.970 |
Insight: Bajaj Allianz Health Insurance’s CSR over the last 3 years is quite appreciable - the numbers stay above 90 and have almost reached the industry-best numbers. This is a great sign for its existing and potential policyholders since it reflects the brand's great claim settlement track record.
Incurred Claim Ratio of Bajaj Allianz Health Insurance
The second crucial metric used to determine a health insurer’s credibility is the Incurred Claim Ratio (ICR). This metric sheds some light on the provider’s claim settlement potential and future financial sustainability. The ICR of a brand is given by -
(The total amount of claims settled by the insurer in a year / The total amount collected by the insurer through premiums in that year) * 100
- If the ICR is below 50 - The Insurer is too focused on building its business profits and, hence, might reject some valid claims to shield its financial stability. Such insurers are best avoided.
- If the ICR is between 50 and 70 - Insurers with ICR in this range (or slightly higher, say in the 80s) is the sweet spot for you. Such insurers are balancing their profit-buildup and fulfilment of client claim settlement requirements to the T. If you come across such insurers, go for it (provided it also meets the other metrics requirement).
- If the ICR is above 100 - Avoid approaching insurers with an ICR of above 100 because while it's settling a large number of claims and may seem appealing to its potential policyholders, the brand might be nearing a major financial crunch because its finances may soon be running dry leading to an issue with its future sustainability.
| Years | Bajaj Allianz Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 77.31 | 78.27 |
| 2021 - 2022 | 90.64 | 91.79 |
| 2022 - 2023 | 74.27 | 78.82 |
| Average (2020 - 2023) | 80.74 | 82.96 |
Insight: While Bajaj Allianz’s ICR numbers may be a tad bit higher than what’s ideally recommended, the numbers are pretty good, considering that these slightly high numbers reflect that the brand is more focused on its client requirements of claim settlement.
Complaint Volume of Bajaj Allianz Health Insurance
When choosing a health insurance provider, one of the major concerns you have as a potential policyholder is the claim settlement experience of a brand’s existing policyholders. This is very well reflected in an insurer’s complaint volume (since most complaints root in claim settlement processes). The lower the complaint volume, the better the insurer.
| Years | Bajaj Allianz Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 1.72 | 13.212 |
| 2021 - 2022 | 2.27 | 35.969 |
| 2022 - 2023 | 2.91 | 19.578 |
| Average (2020 - 2023) | 2.30 | 24.029 |
Insight: Bajaj Allianz Health Insurance’s complaint volume is one of the best in the industry. Such low numbers indicate the insurer's overall operational efficiency and is a great sign for its existing and potential policyholders.
Top Health Insurance Plans Offered by Bajaj Allianz Health Insurance
- Bajaj Allianz Health-Guard Gold
This is one of the decent health insurance policies from the Bajaj Allianz stable. It covers most bases and is pretty economical. Apart from the basic features of no copayment (optional), no disease-wise sub-limits, pre and post-hospitalisation expense coverage, and daycare treatment coverage, the plan also offers maternity coverage.
Drawbacks: The policy has a nominal room rent restriction, a 6-year waiting period on its maternity coverage, no domiciliary coverage, a 3-year waiting period on its pre-existing medical conditions, a cap of ₹20,000 on its AYUSH coverage, a nominal restoration perk, and more.
2. Bajaj Allianz Health Care Supreme Vital
This is a great pick from Bajaj Allianz Health Insurance. The plan is comprehensive, considering it offers a host of value-worthy features—no copayment, no room rent restrictions, no disease-wise sub-limits, good restoration perks, pre- and post-hospitalisation coverage, maternity coverage, a moderate waiting period for pre-existing medical conditions, and more.
Drawbacks: The maternity coverage is for a maximum of ₹20,000 after a waiting period of 2 years, with no domiciliary coverage, and honestly, the plan is pretty expensive.
3. Bajaj Allianz Silver Health
If you are a potential policyholder aged 46 and above, this can be an option from the Bajaj Allianz Health Insurance stable. The plan has no room rent restrictions, and in most cases, it doesn’t require a copayment or a disease-wise sub-limit.
Drawbacks: While in some cases, the waiting period for some pre-existing medical conditions is only 1 year, there is a 50% co-payment. In some situations, there is a mandatory copayment of 20% if you are getting treated in a non-network hospital. There is no domiciliary coverage, no restoration benefits, pre- and post-hospitalisation coverage of up to 3% of the base sum insured, no AYUSH coverage, free health check-ups once in 4 years, and more.
Conclusion
Bajaj Allianz Health Insurance is an incredible provider if you consider the Claim Settlement Ratio, Incurred Claim ratio, and complaint volume metrics. However, if you look at the provider's insurance product portfolio, you might face some major hurdles - non-comprehensiveness, expensive premiums, restrictions, sub-limits, and exclusions. Under such circumstances, if you shift to another health insurance provider with affordable premiums and innovative features, you might be making a financially smart move.