As India’s first standalone health insurance provider, Star is widely popular and has a massive nationwide client base. Founded in 2006, the insurer once held a monopoly in the industry thanks to its diverse portfolio of health insurance plans that catered to clients with various health and financial requirements. This popularity and client base can also be attributed to the vast network of agents the brand has in the physical market. This network played a crucial role in increasing its number of policyholders.
However, Star Health’s overall operational efficiency has recently come under some scrutiny. The emergence of new players in the market, the popularity of digital purchase of health insurance policies, the insurer’s delisting of partner healthcare facilities, sudden withdrawal (and then relaunching) of cancer-specific health insurance plans, and increased cases of claim rejections - all played a crucial role in Star Health’s drop in performance as a credible provider. However, the insurer still has a good client base, thanks to the brand loyalty of some policyholders.
| Pros | Cons |
|---|---|
| Decent Claim Settlement Ratio | High Complaint Volume |
| Good Incurred Claim Ratio | Expensive policies with no special features |
| Health insurance plans for niche target audiences, like critical ailments (e.g., cancer) |
Metrics of Star Health Insurance
Star Health Insurance is a household name with an impressive network of 14,000+ partner hospitals. Unfortunately, this reputation and popularity can only be attributed to its agents and family members motivating the purchase of its policies.
Despite being the industry's oldest standalone health insurance provider, the company has failed to hold its own after the emergence of new health insurers in the market. While the insurer is only one of the few in the market to have health insurance policies for critically ill patients like Cancer patients in remission, its policyholders are now slowly drifting to credible insurers, reflecting a high probability of long-term sustenance.
This said, the opinions mentioned above are based on our interaction with the insurer and their clients who approached us for insurance advice. Hence, we will take into account a few metrics used to measure the credibility of insurance providers, draw an average of the last 3 years (to gauge the consistency of the insurer) and then tally them against the industry average.
Claim Settlement Ratio of Star Health Insurance
One of the primary metrics used to measure the credibility of an insurer is its Claim Settlement Ratio or CSR. CSR is the ratio between the total number of claims settled by an insurer in a year against the total number of claims raised to the insurer across the year, multiplied by 100. A credible insurer is one with a CSR of 90 and above but not below 80 or above 100.
| Years | Star Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 83.64 | 91.484 |
| 2021 - 2022 | 82.33 | 89.967 |
| 2022 - 2023 | 80.07 | 91.460 |
| Average (2020 - 2023) | 82.01 | 90.970 |
Insight: Star’s CSR is not only far below the industry average and ideal threshold of 90 but is also in the lower 80s, which is concerning for us. Additionally, this CSR has been deteriorating over the years and is one of the reasons why we are hesitant about recommending any health insurance plans from this stable.
Incurred Claim Ratio of Star Health Insurance
While the CSR of a health insurer offers you a primary insight into its credibility, it fails to reflect the company's financial stability and claim settlement potential. To gauge the future sustainability of the brand, you need its Incurred Claim Ratio or ICR. This is given by calculating the ratio between the total amount of claims settled against the total amount of premium collected by an insurer over the year and multiplying this ratio by 100.
| Years | Star Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 94.44 | 78.27 |
| 2021 - 2022 | 87.06 | 91.79 |
| 2022 - 2023 | 65 | 78.82 |
| Average (2020 - 2023) | 82.17 | 82.96 |
Insight: Star Health’s ICR is quite decent, considering that while the number is above our recommended threshold, Star is more focused on settling its client’s requirements - claim resolution instead of prioritising its business profits. This is a good sign for policyholders.
Complaint Volume of Star Health Insurance
When it comes to complaint volume, Star’s numbers reveal the extent of issues they have been having with their operational proficiency.
| Years | Star Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 4.62 | 13.212 |
| 2021 - 2022 | 33.65 | 35.969 |
| 2022 - 2023 | 48.85 | 19.578 |
| Average (2020 - 2023) | 29.04 | 24.029 |
Insight: Since complaints are primarily about claim settlement, the numbers are indicative of its claim settlement process. With Star’s recent issues across delisted network hospitals, cancelled policies rejected valid claims, and more, it is no surprise that the complaint volume has seen a shocking increase over the years. Unfortunately, if this trend continues, Star’s client pool will soon start drifting to other top-notch health insurance providers.
Top Health Insurance Plans Offered by Star Health Insurance
Star Comprehensive is a flagship health insurance product from this stable. The policy is, as the name goes, comprehensive and possibly still one of the best policies and, hence, one of its most popular plans. The plan requires no copayment until you turn 61, offers maternity coverage, dental coverage, and no room rent restrictions up to a single private room. The policy extends daycare and domiciliary coverage, pre and post-hospitalisation, a no-claim bonus (50% to 100%) and free annual health checkups. All in all, a good pick.
Drawbacks: The policy is slightly on the expensive side, with a pre-existing medical condition waiting period of 3 years. While there is a PED Buy Back rider to reduce this waiting period to 1 year, you can do nothing about its premiums! Moreover, the maternity, OPD, and AYUSH coverage all come with a relatively minimal capping.
One of the economic plans from Star Health, the Star Health Young Star policy, is a comprehensive and smart plan. Despite being specifically crafted for the youth pool of clients, the policy has the shortest waiting period (1 year) on its pre-existing conditions. There are no room rent restrictions up to a single private room, no copayment, no disease-wise sub-limits, free annual health check-ups, daycare coverage, and more.
In short, the plan is one of the best in its class if you are below 40 and have pre-existing medical conditions.
Drawbacks: The plan offers no domiciliary and AYUSH coverage.
Crafted specifically for women, the Star Women Care policy is one of a kind. With a short waiting period of 2 years for pre-existing medical conditions, an extensive range of coverage from ₹5 lakhs to ₹1 crore, Assisted reproduction coverage, maternity perk, Voluntary Sterilisation Expense coverage, Surrogacy Cover and Oocyte Donor Cover, Delivery Expenses, Newborn Cover, and Natal Care, apart from the primary offerings - this is a complete package.
Drawbacks: Unfortunately enough, the policy is not without an extensive list of restrictions, cappings, and limitations. Each of the offerings for women's care comes with sub-limits. There are also room rent restrictions based on your sum insured (up to ₹25 lakhs).
Conclusion
Star Health’s deteriorating overall operational efficiency overshadows its list of incredible feature-rich plans. Moreover, its policies are, at times, expensive and almost always have room rent restrictions, which is a significant hurdle. However, if you are loyal to the brand, you can still find a few relatively good policies. Otherwise, you can always shop for other insurers offering comprehensive plans at affordable rates and reasonable restrictions.