If you seek a health insurance policy with industry-first features, affordability, and value-worthy add-ons, you've likely encountered two popular insurers: Niva Bupa Health Insurance and Care Health Insurance. With over a decade in the industry, both providers boast a vast pool of policyholders benefiting from their diverse, customised health insurance policies.

However, if asked, how would you choose from Niva Bupa Health Insurance vs. Care Health Insurance? Which would you choose when opting for a health insurance policy for yourself?

You should go with the insurer that provides the best claim settlement support, offers smooth and speedy resolutions, has the best Claim Settlement Ratio, and holds better numbers across multiple other metrics. After all, it’s the provider who ensures that the premiums you pay are worthy via smooth health insurance experiences!

Considering these metrics, who would take the win between Niva Bupa Health Insurance and Care Health Insurance? Let’s explore and find out!

ASPECTS Care Health Insurance Niva Bupa Health Insurance
Claim Settlement Ratio 90.75 90.66
Incurred Claim Ratio 58.01 57.42
Volume of Complaints 30.53 44.52
Network Hospitals 9,400 10,000
Affordability of plans Affordable Affordable
Major Plans Care Supreme
Care Advantage		 Aspire
ReAssure 2.0
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Care Health Insurance or Niva Bupa Health Insurance: Which is Better?

Founded in 2012, Care Health Insurance, a part of the Religare group, has rapidly become one of the most affordable health insurance providers. With a unique selling proposition of no loading charges, it's an ideal choice for individuals with pre-existing conditions, ensuring affordability by avoiding additional expenses. Care stands out as one of the few insurers offering health insurance plans to cancer patients in remission.

Founded in 2008, Niva Bupa, formerly Max Bupa, is a standalone health insurance provider. The brand gained popularity in the last decade with the rise of digital health insurance policy purchases. It offers economical and industry-first feature-loaded health insurance plans, appealing widely to potential policyholders.

While we've outlined the pros of both providers, it's crucial to note that both Niva Bupa Health Insurance and Care Health Insurance have experienced a rise in complaint volume over the last 3 years. This raises serious questions about the operational efficiency of both health insurers, a factor that cannot be ignored when recommending plans to clients

With both insurers having similar pros and cons as standalone health insurance providers, the comparison is close. To ensure consistent insight into their overall performance, we've analysed data from the previous 3 years (2020 to 2023). It's important to note that this period includes the pandemic year, potentially causing inconsistencies in the data for that specific year.

1. Claim Settlement Ratio (CSR)

When choosing a health insurance provider, one of the most commonly heard metrics is Claim Settlement Ratio, which is given by -

(Total number of claims settled in a year / Total number of claims received in the year) * 100

In this case, the total number of claims for a year =

Total number of claims filed for the year + Number of settled outstanding claims for the previous year - Number of outstanding claims for this year

We recommend you go with an insurance provider with a CSR of 90 or above. If you find an insurer with a CSR of above 100 or below 80, it’s best to avoid them, considering neither indicates a good provider. They suggest that the providers are either practising delayed claim settlement or lost credibility over poor experience with claim settlement and its process.

CSR across the years Care Health Insurance Niva Bupa Industry Average/year
2020 - 2021 95.2 90.68 91.484
2021 - 2022 87.03 90.78 89.967
2022 - 2023 90.03 90.53 91.460
Average of 3 years 90.75 90.66 90.970

CONCLUSION: This is a close call! With only a 0.09 score as a lead, Care Health Insurance takes the win over Niva Bupa. However, both insurers still have scores that are below the industry average. Considering the market reputation of these providers, we would have expected the CSRs to be a bit higher than the industry average.

2. Incurred Claim Ratio

When you approach an insurer for a health insurance policy, you seek a long-term relationship with your provider. Thus, the insurer must hold good business stability and financial potential to stay sustainable and be capable of meeting claim settlements in the future.

But how do you ensure this?

Simple - check the Incurred Claim Ratio and ensure your chosen insurer has an ICR ranging from 50 to 70. This range reflects how the insurer has a balanced focus on its business stability (read: profits) and its client requirements of claim settlement.

ICR across the years Care Health Insurance Niva Bupa Industry Average/year
2020 - 2021 55.15 56.09 78.274
2021 - 2022 65.07 62.12 91.788
2022 - 2023 53.82 54.05 78.818
Average of 3 years 58.01 57.42 82.96

CONCLUSION: Like CSR, for ICR too, this is a neck-to-neck finish. With only 0.59 as a lead, Care Health Insurance takes the edge over Niva Bupa. However, neither of the numbers is very encouraging since both are circling the lower threshold of 50. This indicates that Care and Niva Bupa are more focused on their business profits than their client’s claim requirements.

3. Volume of Complaints

While the volume of complaints reflects the operational efficiency of a health insurance provider, the numbers for neither Care nor Niva Bupa are encouraging. This indicates that both providers require a quick operational upgrade to ensure that clients are their priority in terms of queries, alterations in policies, claim settlement, etc.

Complaint Volume across the years Care Health Insurance Niva Bupa Industry Average/year
2020 - 2021 22.21 44.46 13.212
2021 - 2022 29.38 42.74 35.969
2022 - 2023 40 46.36 19.578
Average of 3 years 30.53 44.52 24.029

CONCLUSION: Care Health has a lower complaint volume than Niva Bupa and wins. However, the numbers for both these stables are alarming. Care’s relatively lower complaint volume became feasible because they started 2020 with an average number. However, as the numbers have continued to increase exponentially. When it comes to Niva Bupa, the numbers are simply a let-down. The insurer has had a consistently high complaint volume, reflecting its poor performance in operational functions.

Both health insurance providers have excellent policies, which can be considered worthy purchases. However, if these complaint volumes continue to stay the same or increase, no amount of well-crafted products can help them retain their client pool.

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4. Network Hospitals

Cashless perks are only possible with network hospitals. Hence, when seeking a credible health insurance provider, you must look into the number of partner hospitals the insurer has. The better the network of medical facilities, the better an insurer is for you, considering you won’t have to spend out of your pocket initially to be reimbursed later.

Number of network hospitals Care Health Insurance Niva Bupa Health Insurance
9400 10000+

CONCLUSION: Niva Bupa has the edge over Care Health with a 600+ lead over Care. The numbers are not surprising considering that Niva Bupa has a 4-year advantage over Care.

5. Major Plans

As stated before, both Care and Niva Bupa have a long list of health insurance plans that are comprehensive and economical. However, some policies are pristine in terms of their features, waiting periods, room rent restrictions, copayment, add-ons, and affordability. Here, take a look -

Health Insurance Providers Best Health Insurance Plans Details
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%)
NIVA BUPA Aspire Pros
  • M-iracle benefit for maternity, surrogacy, adoption, and reproductive assistance requirements
  • Future Ready feature to help policyholders cover the waiting period for future spouses
  • Affordable
  • Fast Forward feature to offer an accumulated sum insured at one go for multi-year payments (for 3-pay, you get access to the entire 3 years of coverage at one go, same with 2-pay)
Cons
  • The plan is relatively new in the market, so the clauses are under constant changes
  • Multiple restrictions across its features
ReAssure 2.0 Platinum Pros
  • Forever Restoration kicks in after the 1st claim is raised
  • Lock the clock feature ensuring that your premiums stay the same as per your entry age
Cons
  • 3-year waiting period on pre-existing medical conditions.

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Care Health Insurance or Niva Bupa Health Insurance: What Should You Choose?

Care Health Insurance and Niva Bupa Health Insurance’s flagship products have been worth recommending to our clients. The pocket-friendly attribute of the policies has added to the appeal.

In case you are on the lookout for industry-first features at affordable premiums,  Niva Bupa can prove to be a good option. However, in case their complaint volume is a worry for you, Care is definitely the better choice of the two.