As medical inflation rises and lifestyle ailments become prevalent, health insurance policies gain popularity as a financial product. Crafted to provide funding during health crises, these plans prevent depleting savings for hospital expenses. While a health insurance plan eliminates the need to use savings for medical bills, it requires payment of premiums to stay active.
Now, considering the finances you invest in this, you expect a policy that will settle your claims in full and ease the settlement process. However, claims don’t depend on the policy; they are primarily about the health insurance provider. A credible health insurer is a must when it comes to ensuring supreme claim settlement experiences.
Under such circumstances, you can’t merely choose a health insurer based on what an agent or your family recommends. What you need is a solid comparison of diverse metrics before you finalise a provider. Regarding such requirements, we are pitting two of the most well-known health insurers against each other (for a quick comparison): Care Health Insurance and Star Health Insurance.
Let’s find out which of these two will be a better health insurance provider, shall we?
| ASPECTS | Care Health Insurance | Star Health Insurance |
|---|---|---|
| Claim Settlement Ratio | 90.75 | 82.01 |
| Incurred Claim Ratio | 58.01 | 82.17 |
| Volume of Complaints | 30.53 | 29.04 |
| Network Hospitals | 9,400 | 14,000 |
| Affordability of plans | Affordable | Expensive |
| Major Plans |
Care Supreme Care Advantage |
Star Comprehensive Star Health Young Star |
Care Health Insurance or Star Health Insurance: Which is Better?
Founded in 2012, Care, a part of the Religare Group, has evolved into a prominent standalone health insurance company. Renowned for its unique "NO LOADING CHARGES" perk, Care's health insurance policies stand out as some of the most affordable in the industry. Notably, the insurer provides specialised plans for policyholders with a history of critical ailments, and due to the absence of loading charges, these plans are more economical than other options in the market.
Coming to Star Health, the insurer is one of the industry's oldest standalone private health insurance providers. Established in 2006, the insurer held a monopoly over the industry for a long time. However, as online purchases of health insurance plans grew, Star started losing dominance. Additionally, the company’s recent drop in reputation due to deteriorating operational performances and sudden withdrawals of plans haven’t helped the insurer much regarding its credibility.
This contrast between Care Health Insurance and Star Health Insurance is brought to you by our first-hand experiences and those shared by our clients. However, similar insights can be drawn when you look at the metrics used to determine the credibility of an insurer. Such metrics will be more revealing, considering both are standalone insurers with an extensive client pool.
(Please note that we have used the metrics for 2020-2023 for a consistent understanding of the insurer’s performance. Also, considering the pandemic in 2020, you can expect a slight inconsistency for 2020 - 21 since higher claims were filed during this phase.)
1. Claim Settlement Ratio (CSR)
The most widely trusted metric to gauge the credibility of a health insurance provider is Claim Settlement Ratio. This is calculated by tallying the total number of claims settled in a year against the total number of claims filed for an insurer, multiplied by 100.
Generally, an insurer with a 90+ CSR is ideal; conversely, a provider with less than 80 CSR is best avoided. At times, some insurers also have a CSR of 100+. This becomes possible in cases where the outstanding claims of the last year have been settled this year. Considering this inconsistency in the time required to settle claims, an insurer with 100+ CSR is a no-go.
Here is how the CSRs look for Care Health Insurance and Star Health Insurance for the last 3 years.
| CSR across the years | Care Health Insurance | Star Health Insurance | Industry Average/year |
|---|---|---|---|
| 2020 - 2021 | 95.2 | 83.64 | 91.484 |
| 2021 - 2022 | 87.03 | 82.33 | 89.967 |
| 2022 - 2023 | 90.03 | 80.07 | 91.460 |
| Average of 3 years | 90.75 | 82.01 | 90.970 |
CONCLUSION: Care is clearly the winner in terms of CSR. Moreover, Star is dangerously close to the 80-mark threshold. Considering the insurer has decades of experience in the field, such numbers are not encouraging.
However, this metric alone can’t be relied on to reveal the proficiency of an insurer because it fails to reflect the time required to settle a claim and the amount of claim settled against the amount of claim filed. Hence, there are some other metrics that we will be looking into for better insight into Care Health Insurance vs Star Health Insurance.
2. Incurred Claim Ratio (ICR)
The Incurred Claim Ratio of an insurer is given by calculating the total amount of claims settled in a year against the total premium collected for the year by the insurer, multiplied by 100.
This ratio indicates the insurer’s potential to settle claims, its financial stability, and the company’s sustainability in the long run.
- ICR = 50 to 70 (or slightly higher): This is the ideal range for ICRs. It indicates that an insurer is equally focused on ensuring business stability and client requirements. So, while the company manages to turn a profit, it’s not being stingy when it comes to settling claims.
- ICR < 50: Insurers with an ICR less than 50 are only interested in ensuring business stability for their company. Consequently, policyholders with this insurer might be looking at rejected claims or partial payouts.
- ICR > 100: Such insurers pay more claims than their earned premiums over a year. While this might be a temporary success for policyholders, in the long run, such insurers might develop a financial crunch and have a sustainability issue.
Keeping these points in mind, take a look at how Care and Star health insurance providers have performed from 2020 to 2023 -
| ICR across the years | Care Health Insurance | Star Health Insurance | Industry Average/year |
|---|---|---|---|
| 2020 - 2021 | 55.15 | 94.44 | 78.274 |
| 2021 - 2022 | 65.07 | 87.06 | 91.788 |
| 2022 - 2023 | 53.82 | 65 | 78.818 |
| Average of 3 years | 58.01 | 82.17 | 82.96 |
CONCLUSION: The ICR of Care Health Insurance lies in the ideal range. However, we would have preferred a tad higher ICR (maybe in the 70s or early 80s), like Star. This would have indicated that the insurer is more responsive towards its clients’ requirements than its own business.
3. Volume of Complaints
So, we talked about CSR and ICR. However, neither of them talks about the operational efficiency of the insurer. How do you know if the insurer resolves claims swiftly? If/Whether they are reachable when you have queries?
The answer is simple - take a look at their complaint volume! Your predecessors (regarding policyholders) will reveal if this insurer is worth approaching. And here’s what Star and Care’s complaint volume has looked like over the last 3 years -
| Complaint Volume across the years | Care Health Insurance | Star Health Insurance | Industry Average/year |
|---|---|---|---|
| 2020 - 2021 | 22.21 | 4.62 | 13.212 |
| 2021 - 2022 | 29.38 | 33.65 | 35.969 |
| 2022 - 2023 | 40 | 48.85 | 19.578 |
| Average of 3 years | 30.53 | 29.04 | 24.029 |
CONCLUSION: Care and Star have a close call with the complaint volume metrics. While it’s true that Star beats Care by a minimal margin, this is a concerning sign for us that neither of these insurers is doing so well! With above-average numbers, these health insurance providers need an operational proficiency check reflecting their clients' prioritisation.
4. Network Hospitals
When choosing a health insurance provider, you should always factor in the number of network hospitals an insurer has. This would indicate that you can access more partner hospitals in and around your residence for emergency and scheduled treatments or medical requirements.
Being admitted to a network hospital means you can avail of the cashless perk from your health insurance provider and payoff the invoiced amount without digging into your pockets. Otherwise, you might have to shell out the amount yourself and then wait to be reimbursed: this temporarily defies the purpose of having an active health insurance policy in place to safeguard your savings during times of medical scare.
Here is a quick look at the total number of network hospitals for Star Health Insurance and Care Health Insurance:
| Number of network hospitals | Care Health Insurance | Star Health Insurance |
|---|---|---|
| 9,400 | 14,000 |
CONCLUSION: Star Health has the edge over Care Health Insurance regarding the number of network hospitals each insurer has. However, this does not come as a surprise considering Star’s
- 6 years of advantage over Care Health (Star started in 2006 and Care in 20912),
- An extensive network of agents selling their plans physically and
- A vast pool of policyholders encouraging ties with more medical facilities as compared to that for Care.
5. Major Plans
Care Health Insurance may have entered the industry 6 years later than Star, but its insurance product portfolio is no less extensive. Care’s health insurance policies are comprehensive, affordable, niche-specific, and have multiple add-ons that facilitate their customisation.
On the other hand, Star’s years of experience are well reflected in its product portfolio, wherein you can find policies catering to almost every ailment possible. However, the policies are a bit expensive (as compared to Care’s) and sometimes lack certain basic comprehensiveness.
Both insurers are among the few in the industry that offer policies to cancer patients in remission (Care Freedom and Star Cancer Care).
That said, in the case of both insurers, some plans can be considered flagship products. Here is a look at some of these policies!
| Health Insurance Providers | Best Health Insurance Plans | Pros | Cons |
|---|---|---|---|
| Care Health Insurance | Care Supreme |
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| Care Advantage |
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| Star Health Insurance | Star Comprehensive |
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| Star Health Young Star |
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Care Health Insurance vs Star Health Insurance: What Should You Choose?
Care Health Insurance outperforms Star Health in offering affordable plans, comprehensive policies, and coverage for pre-existing conditions. Star's recent actions, such as delisting network hospitals and withdrawing major plans, raise concerns for policyholders. Choosing Care ensures a more reliable provider, but consulting industry experts before finalising a policy is recommended, as not all plans offer equal benefits.