TATA AIG Health Insurance is a collaborative effort by the TATA Group and American International Group, founded in 2001. With over a decade of insurance history, this standalone insurer has already gained a solid base of policyholders, thanks to the brand name and the diversity of its health insurance products.
While TATA AIG health insurance plans offer unique features such as built-in maternity and international coverage, they tend to be relatively expensive and lack distinctive features. However, the insurer performs well across various metrics, including Claim Settlement Ratio, Incurred Claim Ratio, and complaint volume, cementing its credibility.
| Pros | Cons |
|---|---|
| Decent Claim Settlement Ratio | Expensive plans with not many stand-out features |
| Good Incurred Claim Ratio | |
| Great complaint volume |
Metrics of TATA AIG Health Insurance
With a network of 10,000+ partner hospitals and multiple insurance products across travel, home, motor, health and more, TATA AIG health insurance is one of the most popular insurers. However, the brand has a significant drawback regarding health insurance, considering its expensive premiums. This is likely a result of the in-built offerings of international coverage and maternity perks. The problem is that while these features can be a choice for some, we generally don’t recommend them. Maternity coverage tends to come with a long waiting period, a sub-limit and multiple exclusions. International coverage, too, has similar drawbacks. Thus, purchasing such plans with high premiums (due to the presence of these features) makes them a questionable choice.
On the other hand, TATA AIG has some niche health insurance plans that are competitive and may prove to be value-worthy if you can ignore a couple of caveats (like room rent restrictions, copayments, disease-wise sub-limits or high premiums).
However, before evaluating health insurance plans from this stable, we first need to determine TATA AIG’s credibility. Do its metrics reiterate its market reputation as a dependable health insurance provider? Let’s find out by considering a few metrics and tallying them against the industry average.
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Claim Settlement Ratio of TATA AIG Health Insurance
The Claim Settlement Ratio of a health insurer or CSR is given by -
(Total number of claims settled in a year by a health insurer / Total number of claims raised to the insurer over the year|) * 100
CSR is one of the metrics that helps determine the credibility of an insurer by providing insight into how many claims are being settled by the provider. A health insurance provider with a CSR of 90% and above is a top-notch insurer, but steer clear of any provider with a CSR of below 80% and above 100%.
| Years | TATA AIG Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 87.7 | 91.484 |
| 2021 - 2022 | 90.85 | 89.967 |
| 2022 - 2023 | 88.65 | 91.460 |
| Average (2020 - 2023) | 89.07 | 90.970 |
Insight: TATA AIG health insurance fails to cross the threshold of 90% across the years (except in 2021 - 2022) and hence falls below the industry average too. Considering its market reputation and extensive insurance track record, this isn’t a good sign for the policyholders.
Incurred Claim Ratio of TATA AIG Health Insurance
The Incurred Claim Ratio or ICR of a health insurance provider is calculated by -
(Total amount of claims settled for a year / Total amount of premiums collected for the year by the insurer) * 100
ICR helps you gauge the long-term sustainability of the provider. Since health insurance indicates a long-term financial commitment, you need a provider with claim settlement potential for the long run.
The ideal range of ICR is between 50 and 70 since it reflects that the provider is paying equal attention to its business stability and meeting client requirements over efficient claim settlement. However, an ICR in the 80s is also good to go since it indicates that the insurer prioritises client expectations of claim resolutions.
On the other hand, an insurer with an ICR of below 50 suggests that it is focused on maximising its business profits, which might lead to partial claim settlements or complete rejections of valid claims. Again, a health insurance provider with an ICR of 100 or above suggests the company is paying off significant claims, which might lead to a financial crunch. While the temporary claim settlement situation might seem encouraging and appealing, the insurer might face a long-term problem.
| Years | TATA AIG Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 67.27 | 78.27 |
| 2021 - 2022 | 86.53 | 91.79 |
| 2022 - 2023 | 78.33 | 78.82 |
| Average (2020 - 2023) | 77.38 | 82.96 |
Insight: While TATA AIG Health Insurance has an ICR above 70 (the ideal range), this is a good sign for policyholders. The numbers merely suggest that the insurer focuses more on settling claims than on its business profits.
Complaint Volume of TATA AIG Health Insurance
One of the primary issues that health insurance policyholders face is dealing with delays or rejections in claim settlement. Imagine approaching a partner hospital for a scheduled treatment, hoping for cashless coverage, and then facing issues from the insurer that lead to delayed payment. Naturally, you will be forced to pay off the hospital bill from your pocket, despite having health insurance coverage and then wait for a reimbursement. This creates redundant pressure on your savings and defies the purpose of availing of a health insurance policy. Such issues are followed by complaints from the policyholders and are reflected in the complaint volume of the brand.
Thus, before approaching an insurer for a health insurance policy, check its complaint volume. The lower the numbers, the better since it indicates a hassle-free claim settlement process.
| Years | TATA AIG Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 8.15 | 13.212 |
| 2021 - 2022 | 10.22 | 35.969 |
| 2022 - 2023 | 10.08 | 19.578 |
| Average (2020 - 2023) | 9.48 | 24.029 |
Insight: TATA AIG’S complaint volumes are among the lowest in the industry and have consistently remained so, thanks to its improving operational efficiency. This is a positive sign for potential policyholders deciding whether to buy a health insurance plan from TATA AIG.
(Please note that we have taken the data of the last 3 years, 2020 - 2023, for each metric and drawn an average to better understand the consistency of the insurer’s performance.)
Top Health Insurance Plans Offered by TATA AIG Health Insurance
- Medicare Premier
Medicare Premier is one of the market's most comprehensive health insurance policies. Apart from coverage for the traditional features-
- 2 years waiting period for pre-existing medical conditions
- Domiciliary and daycare coverage
- Restoration perk
- No-claim bonus
- Free health check-up
- AYUSH coverage
- No room rent restrictions
- No disease-wise sub-limits
- the policy also offers international perks, dental treatments, outpatient consultations, etc.
Drawbacks: The presence of features like OPD coverage (up to ₹5000 annually), maternity perk (up to ₹50,000 with a 4-year waiting period), and international and dental coverage makes this policy pretty expensive, and yet the premium features come with cappings that restrict policyholders from tapping into their full potential.
2. Medicare Protect
Medicare Protect policy from the stable of TATA AIG is relatively comprehensive and covers most bases at affordable prices. The policy is a decent pick since it extends features like - no copayment, no disease-wise sub-limit, AYUSH coverage, domiciliary and daycare coverage, and restoration perks. However, a few restrictions in the plan make comparing other health insurance plans a good idea before finalising this one.
Drawbacks: There is a room rent restriction in the plan. The policyholder pays 10% of the admissible claim amount if the chosen room category exceeds shared accommodation. Since the room rent charges affect the hospital bill, the individual will pay a pro-rata share of the hospital invoice.
Moreover, the pre and post-hospitalisation coverage extends only for 30 and 60 days, respectively. The waiting period for pre-existing medical conditions is 4 years. And the free health check-ups can be availed only once every 3 years.
3. Medicare Senior
Medicare Senior is a plan crafted for senior citizens. Now, we expect a few restrictions in the health insurance policies for those above 60 (to spread out the risk between the insurer and the insured since senior citizens usually bring in pre-existing medical conditions and higher chances of payouts over frequent hospitalisation). However, in the case of Medicare Senior, the number of cappings, terms and conditions, and restrictions are far higher and almost defy the purpose of being a niche plan for senior citizens. The only silver lining in the policy is - domiciliary coverage.
Drawbacks: Expect copayments if you opt for a few select procedures (this includes joint replacement, angioplasty, and more). No no-claim bonuses, free health check-ups, AYUSH coverage, or restoration perks exist. Daycare treatments are only covered for 85% of the bill. Pre- and post-hospitalisation are only for 30 and 60 days, respectively. There are room rent restrictions, disease-wise sub-limits, and mandatory copayments.
Honestly, if you are 60+ and looking for a health insurance policy, we suggest you shop around a bit more!
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Conclusion
TATA AIG Health Insurance is a good pick as a provider. Its credibility is well-established over its exceptional metrics data. However, when picking health insurance plans from this insurer, you look at expensive policies with no special features. So, unless you are loyal to the brand and confident about your purchase from this insurer, we suggest you look around for top-notch providers in the market and some of their best health insurance plans.
