Health insurance policies are crafted to safeguard your finances when you face a health scare. However, this was the primary function of the basic plans. They are tailored to meet specific financial and medical needs. Multiple providers have embraced this trend, offering similar policies with innovative, industry-first features.

However, when choosing a plan, the first decision you must make is about deciding upon a health insurance provider. Currently, two of the most popular names in the industry are - Care Health Insurance and HDFC Ergo Health Insurance. These insurers have been in the market for about a decade and have gained a vast client pool.

While both insurers have a long list of pros they can boast of, the question is - which of these two should you opt for? After all, both insurers have a strong base of credibility! Well, let’s find out!

ASPECTS HDFC Ergo Health Insurance Care Health Insurance
Claim Settlement Ratio 97.50 90.75
Incurred Claim Ratio 85.27 58.01
Volume of Complaints 6.80 30.53
Network Hospitals 9300+ 9,400
Affordability of plans Slightly expensive Affordable
Major Plans Optima Super Secure
myHealth Suraksha Gold		 Care Supreme
Care Advantage
Heads Up: It takes an average person up to 5 hours to read & analyze a policy, and 10 hours or more to compare different plans and make a decision.
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HDFC Ergo Health Insurance or Care Health Insurance: Which is Better?

Established in 2002, HDFC Ergo is one of the country's largest private insurance companies with a robust track record across various insurance products. In health insurance, HDFC Ergo stands out as a solid provider, offering comprehensive policies, superior features, valuable riders, and a diverse product range. The only drawback is that its plans are relatively expensive compared to others in its class.

Care Health Insurance was founded in 2012 - a decade after HDFC came into play. Despite this delayed entry, Care has already built a solid foundation with its policyholders over - affordable plans, comprehensive policies, industry-first add-ons, no loading charges, an extensive list of products, and more. The insurer is a good pick; however, its recent record of increasing complaint volume has become a severe concern when recommending plans from this stable.

Let’s take a look at how Care and HDFC Ergo perform when it comes to the determining metrics used to compare health insurance providers -

1. Claim Settlement Ratio (CSR)

Claim Settlement Ratio is computed by drawing a percentage from the ratio between the total number of claims settled over a year by an insurer and the total number of claims filed to an insurer for the year.

The total number of claims filed to an insurer is given by

(Claims raised in a year + remaining claims from the last year) - the total number of claims left outstanding in the year.

  • If the CSR is below 80: The insurer is not credible with no consistency across claim settlement assurances.
  • If the CSR is above 100: The beyond perfect score is indicative that the insurer has settled outstanding claims from the last year. So, you are looking at an insurer practising delayed claim settlements. Such insurers are best avoided.
  • If the CSR is above 90 and below 100: This is the ideal range for health insurance providers.
CSR across the years HDFC Ergo Care Health Insurance Industry Average/year
2020 - 2021 97 95.2 91.484
2021 - 2022 100 87.03 89.967
2022 - 2023 95.49 90.03 91.460
Average of 3 years 97.50 90.75 90.970

CONCLUSION: HDFC Ergo takes the win over Care Health Insurance with an industry-high CSR number. The brand continues to impress with its consistency in numbers over the years, irrespective of the havoc caused by the pandemic.

2. Incurred Claim Ratio (ICR)

Incurred Claim Ratio is given by -

(Total amount of claims settled in a year by an insurer / Total amount of premiums collected by the insurer in the year) * 100

ICR indicates the claim settlement potential of an insurer, its financial stability, and long-term sustainability. The numbers reveal if a health insurance provider is too focused on

  • Business profits and thereby ignoring paying off client claim requests (ICR drops below 50 in this case), or
  • Paying significant claims for its clients and hence edging towards a possible financial crunch (ICR is above 100)

The ideal ICR range is between 50 and 70 (or slightly higher), where the insurer strikes the perfect balance between client prioritisation and business profits.

ICR across the years HDFC Ergo Care Health Insurance Industry Average/year
2020 - 2021 79.3 55.15 78.274
2021 - 2022 97.47 65.07 91.788
2022 - 2023 79.04 53.82 78.818
Average of 3 years 85.27 58.01 82.96

CONCLUSION: Care Health Insurance’s numbers may lie within the ideal range (50 and 70); however, the numbers are close to the lower limit of 50. This indicates that Care is leaning towards ensuring its business profits.

On the other hand, HDFC Ergo gets the upper hand over Care despite falling outside the ideal range since it indicates that the insurer is more focused on catering towards their clients’ requirements.

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3. Volume of Complaints

Suppose you want to know how well your health insurer is about claim settlement efficiency, handling queries, and any other actions regarding your policy. In that case, you must look into the complaint volume of the providers.

(Spoiler alert: In the case of Care Health Insurance vs HDFC Ergo Health Insurance, the metrics of complaint volume will become the deciding factor.)

Complaint Volume across the years HDFC Ergo Care Health Insurance Industry Average/year
2020 - 2021 6.21 22.21 13.212
2021 - 2022 7.95 29.38 35.969
2022 - 2023 6.23 40 19.578
Average of 3 years 6.80 30.53 24.029

CONCLUSION: HDFC Ergo boasts one of the lowest complaint volumes in the industry and hence has an easy edge over Care Health Insurance. While HDFC Ergo’s complaint volume is encouraging for potential policyholders, that of Care is just concerning. Such increasing complaint volume from a popular insurer is a significant hurdle. However, since Care’s product portfolio is feature-rich, we hope they work on their operation efficiency.

4. Network Hospitals

When you seek a health insurance policy, a crucial perk you expect is cashless treatments for scheduled and emergency medical treatments. Thus, the number of network hospitals a health insurer holds becomes a determining metric when choosing a provider for your policy.

Number of network hospitals HDFC Ergo Health Insurance Care Health Insurance
9300+ 9400

CONCLUSION: In this case, HDFC Ergo and Care Health Insurance go head-to-head with the network hospital metrics. Despite HDFC Ergo health insurance having a 10-year lead over Care, Care Health Insurance steals the win.

5. Major Plans

HDFC Ergo Health Insurance and Care Health Insurance have an impressive lineup of comprehensive, feature-rich products, mostly with minimal clauses and restrictions. While several health insurance products from these providers are genuinely appealing, here is our pick for the best!

Health Insurance Providers Best Health Insurance Plans Details
HDFC Ergo Optima Super Secure Pros
  • Secure Benefit that ensures 3 times the cover amount right from the time the policy commences.
  • The healthy loyalty benefits (50% to 100%) that boost your cover amount during each renewal.
  • The plan is comprehensive.
Cons
  • To opt for the Secure benefit, a 3-pay is a must.
  • Slightly more expensive as compared to regular plans.
myHealth Suraksha Gold Pros
  • A comprehensive plan with not many restrictions/clauses.
  • Affordable.
  • Extensive coverage.
Cons
  • 3-year waiting period on pre-existing medical conditions.
Care Health Insurance Care Supreme Pros
  • Affordable premiums.
  • Extensive coverage.
  • No copayment, room rent restrictions, or disease-wise sub-limits.
Cons
  • Multiple add-ons.
  • 4-year waiting period on pre-existing conditions (that can be cut down to 30 days with an Instant Cover add-on in the case of some illnesses).
Care Advantage Pros
  • Extensive coverage.
  • Affordable premiums.
  • No room rent restrictions or disease-wise sub-limit.
Cons
  • 4 years waiting period for pre-existing ailments.
  • Nominal NO-Claim Bonus (10% to a maximum of 50%).

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HDFC Ergo Health Insurance or Care Health Insurance: What Should You Choose?

If you have shopped around for a comprehensive health insurance policy, chances are you have been caught between some of the best plans from these two insurers.

They are possibly two of the best providers in the industry with some of the best health insurance plans.

Both insurers have comprehensive policies and are developing some unique and value-worthy policies. However, Care’s recent increase in complaint volume is a matter of concern that gives HDFC Ergo an edge over Care despite its slightly pricey policies.