Health insurance policies are an essential financial tool to shield your savings during health scares, and considering the increasing medical inflation, availing of a health insurance policy would be wise. However, you must choose a plan that ensures guaranteed claim settlement when you need it the most. In such cases, you need the best health insurance provider with a credible insurance track record, low complaint volume, incredible Claim Settlement Ratio, etc.
Now, considering you are in the market for a health insurance policy, we are sure you have heard of Boith Niva Bupa (previously known as Max Bupa) health insurance and Star health insurance. While they are well-known in the market, the question remains: which of the two will emerge as the superior provider, and will they uphold their industry reputation?
Let’s explore and find out!
| ASPECTS | Star Health Insurance | Niva Bupa Health Insurance |
|---|---|---|
| Claim Settlement Ratio | 82.01 | 90.66 |
| Incurred Claim Ratio | 82.17 | 57.42 |
| Volume of Complaints | 29.04 | 44.52 |
| Network Hospitals | 14,000 | 10,000 |
| Affordability of plans | Expensive | Affordable |
| Major Plans | Star Comprehensive Star Health Young Star |
Aspire ReAssure 2.0 |
Niva Bupa Health Insurance or Star Health Insurance: Which is Better?
Niva Bupa (previously known as Max Bupa) is a standalone health insurance provider founded in 2008. This company is a joint venture between Fettle Tone LLP and Bupa Singapore Holdings and currently holds great importance in the industry. Known for competitive and affordable policies with industry-first features, the company's comprehensive health insurance plans have faced a recent surge in operational complaints. This decline in performance is a cause for concern, impacting the insurer's potential growth.
Star Health Insurance is one of the country's oldest standalone private health insurance providers. Established in 2006, the company has had an intricate web of agents physically selling their plans. Subsequently, Star had a monopoly in the insurance industry for a long time. However, similar to Niva Bupa, the company has witnessed a decline in performance in recent years. Policyholders have encountered problems such as rejected claims, delisted network hospitals, sudden plan withdrawals, and unsatisfactory claim settlement experiences. Despite offering comprehensive and niche-specific policies, the insurer's poor operational performance is prompting policyholders to seek more reliable alternatives.
When you come across two insurers with similar drawbacks, our general recommendation would be to shop around a bit more and find a better insurance provider. However, since we are comparing these two insurers to locate the better, let’s look at the determining metrics and tally the numbers.
1. Claim Settlement Ratio (CSR)
One of the metrics to determine the credibility of a health insurer is the Claim Settlement Ratio (CSR). It is calculated by
(Total number of claims settled by an insurer in a year/Total number of claims raised to the insurer in the year) * 100
To compute the total number of claims settled in a year, outstanding claims of last year are added to the number and unsettled claims for the year are left out. Subsequently, you often find insurers with a CSR that is more than 100. That is not a good sign, considering it reflects delayed claims settlement. The ideal CSR would be above 90 and less than or equal to 100.
With this insight, let’s now take a look at how Niva Bupa and Star Health have performed over the last 3 years:
| CSR across the years | Star Health Insurance | Niva Bupa | Industry Average/year |
|---|---|---|---|
| 2020 - 2021 | 83.64 | 90.68 | 91.484 |
| 2021 - 2022 | 82.33 | 90.78 | 89.967 |
| 2022 - 2023 | 80.07 | 90.53 | 91.460 |
| Average of 3 years | 82.01 | 90.66 | 90.970 |
CONCLUSION: Niva Bupa wins this round by barely exceeding the threshold of 90. However, the insurer still needs to catch up to the industry average and considering its reputation, this is not a good show. On the other hand, Star is far below the threshold and has continued this performance from 2020 to 2023 by not crossing the 90+ threshold even once.
2. Incurred Claim Ratio (ICR)
When you file a claim to your insurer, a credible health insurance provider generally settles the claim in full (provided you haven’t exceeded your sum insured, crossed your room rent restrictions, and don’t have disease-wise sub-limits or copayments). However, in some cases (when the insurer isn’t an industry-best provider), the insurer will only partially settle your claim.
But, even before you approach an insurer, how do you recognise such insurers whose plans require you to pay out of your pocket?
The answer is Incurred Claim Ratio - a metric reflecting an insurer’s financial stability, claim settlement potential and long-term sustainability. This is calculated by -
(The amount of claim settled by an insurer in a year/ The total amount collected by the insurer via premiums in the year) * 100
The ideal range of ICR is 50 to 70 (or a bit higher), indicating a well-balanced insurer offering equal attention to its business profits and client claim settlement requirements.
In terms of ICR, how did Star Health Insurance and Niva Bupa perform over the previous 3 years? Let’s find out!
| ICR across the years | Star Health Insurance | Niva Bupa | Industry Average/year |
|---|---|---|---|
| 2020 - 2021 | 94.44 | 56.09 | 78.274 |
| 2021 - 2022 | 87.06 | 62.12 | 91.788 |
| 2022 - 2023 | 65 | 54.05 | 78.818 |
| Average of 3 years | 82.17 | 57.42 | 82.96 |
CONCLUSION: Star Health steals the win here. While it’s true that its numbers are higher than the ideal range of ICR, the numbers reflect that Star Health is more focused on meeting its client requirements than earning profits. This is a good sign for policyholders.
On the other hand, while Niva Bupa’s numbers lie in the ideal zone for ICR, they are barely in that range. This could be a sign that Niva Bupa is leaning towards counting on its profits rather than safeguarding its client’s interests.
3. Volume of Complaints
When choosing an insurer who helps you meet your financial requirements during a medical crisis, the last thing you want is a provider that delays or denies your claim settlement, pays part of your claim or doesn’t reply to your queries. The best way to avoid this would be to look into the providers' complaint volumes. The higher the complaint volume, the further you should be from the insurer!
(Spoiler Alert: Niva Bupa and Star Health take the cake in this metric with some of the highest complaint volumes in the industry!)
| Complaint Volume across the years | Star Health Insurance | Niva Bupa | Industry Average/year |
|---|---|---|---|
| 2020 - 2021 | 4.62 | 44.46 | 13.212 |
| 2021 - 2022 | 33.65 | 42.74 | 35.969 |
| 2022 - 2023 | 48.85 | 46.36 | 19.578 |
| Average of 3 years | 29.04 | 44.52 | 24.029 |
CONCLUSION: First of all, the numbers for BOTH insurers are much higher than we want. However, despite its slightly lower numbers, Star still takes the upper hand over Niva Bupa. The complaint volume for Star and Niva Bupa reflects the poor state of operational efficiency in both cases.
4. Network Hospitals
When you opt for a health insurance plan, one of your expectations is that you need not pay out of pocket in case of a medical emergency. Now, say you have an accident and have to be rushed to the nearest hospital, which turns out to be a non-network hospital. In such cases, the insurer will require you to pay the bill initially and they will only reimburse you after you are discharged and submit the relevant documents. But what if you don’t have the immediate funding? In that case, you must borrow and pay off the billed amount.
However, isn’t this the exact situation you wanted to avoid?
Under such circumstances, you need a partner hospital that ensures cashless treatments. You need an insurer with a vast network of partner hospitals to guarantee easy access to medical facilities. The more the number of network hospitals, the higher your chances of availing cashless treatments.
| Number of network hospitals | Star Health Insurance | Niva Bupa Health Insurance |
|---|---|---|
| 14,000 | 10,000 |
CONCLUSION: That Star Health Insurance will take the win in the metrics of network hospitals is no surprise. After all, this health insurance provider had long held the monopoly in the industry. Moreover, Star has agents selling its policies in the physical market, which has gained them an advantage by fetching a larger client pool. This, in turn ,also contributed to its increased ties with healthcare facilities. However, please do not mistake this for its operational or performance prowess.
5. Major Plans
Niva Bupa’s health insurance plans are widely known for their industry-first features and affordability. Not many insurers offer plans that are as comprehensive as this.
On the other hand, Star is known for its extensive plan list catering to policyholders with complicated medical track records. However, the plans are expensive and often contain multiple clauses and restrictions limiting the offered perks.
Considering these points, let’s look at some of the best health insurance plans offered by Star Health and Niva Bupa.
| Health Insurance Providers | Best Health Insurance Plans | Pros | Cons |
|---|---|---|---|
| Star Health Insurance | Star Comprehensive |
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| Star Health Young Star |
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| NIVA BUPA | Aspire |
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| ReAssure 2.0 Platinum |
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Star Health Insurance or Niva Bupa Health Insurance: What Should You Choose?
When selecting a health insurance plan, prioritise CREDIBILITY in your insurer. Regrettably, both Star Health and Niva Bupa have shown little improvement in metrics over the past 3 years. Hence, we are a bit hesitant when recommending plans from these insurers. If you're set on choosing between Niva Bupa and Star Health, base your decision on plan selection, premiums, features, and restrictions.