SBI Arogya Premier vs Bajaj General Health Ensure Family Plan
Last updated on:
VS
Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Arogya Premier is sold by SBI and Health Ensure Family Plan is sold by Bajaj General. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products have massive differences in their core structure. Arogya Premier is specifically designed for Maternity. However, Health Ensure Family Plan is quite basic. It offers little protection and it's a generic policy that anybody could pick off the shelf. So in many ways, you're comparing apples and oranges here.
And finally, any comparison is ultimately futile without considering the use case. Who are you buying this policy for? You, your family, your parents?
That's something you'll need to answer before using this guide. So with that introduction out of the way, we can get to comparing the actual policies themselves.
Let's start with Arogya Premier. The product comes from SBI's stable:
SBI General Insurance Company Limited is a joint venture between the State Bank of India and Insurance Australia Group (IAG). The firm, which was founded in 2008, offers insurance products in the areas of auto, travel, home, and health.
However considering they are a part of India’s largest government-owned banking firm, you can expect a bit of dilly-dallying during the claims process. And their claim settlement ratio of 96% isn’t something to boast of either.
Health Ensure Family Plan meanwhile comes from Bajaj General's stable:
Bajaj General Insurance Limited (formerly known as Bajaj Allianz) is one of India's leading private general insurance companies, operating since 2001.
And while they may not be the biggest insurer out there, they do have a claim settlement ratio of 96%, with a network of more than 12,600 hospitals.
Talk to an expert
today and
find
the right
insurance for you.
SBI Arogya Premier vs Bajaj General Health Ensure Family Plan
Compare Insurances Insurance Parameters Recommended Not Recommended | SBI Arogya Premier | Bajaj General Health Ensure Family Plan |
|---|---|---|
| Network hospitals | 18000 | 12600 |
| Claim settlement ratio (avg. of last 3 years) | 96% | 96% |
| Co-payment | No | No |
| Room rent | Any Room | Any Room (up to 1% of sum insured) |
| Disease sub-limit | Yes | Yes |
| Pre existing diseases waiting | 3 years | 2 years |
| Pre/Post hospitalization | 60/90 days | 30/60 days |
| No claim bonus | 10% per year (up to 50%) | 5% per year (up to 25%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for any illness) | |
| Health check-up | Once every 4 years | Once every 3 years |
| Maternity | Available (Available upto defined limits) | |
| Out Patient Department | ||
| Day care |
Insurer Comparison
SBI settles 96% of the claims it receives, while Bajaj General settles 96%. Both clear the 90% mark Ditto looks for, so neither insurer is a concern on this metric. Do keep in mind that the claim settlement ratio counts claims, not the money paid out, so it is only one part of the picture.
What is the Claim Settlement Ratio (CSR)?
The Claim Settlement Ratio tells you what percentage of health insurance claims an insurer settled during a given year, out of the total claims it received. A CSR of 93% means the insurer paid out 93 claims for every 100 filed. Ditto uses a 3-year average to smooth out year-on-year fluctuations, and recommends insurers at 90% or above — anything below 85% is a red flag.
Incurred Claims Ratio
SBI pays out ₹81 in claims for every ₹100 it collects as premium. Bajaj General pays out ₹82. Both sit inside the 55%-85% band Ditto considers healthy — high enough to show claims are actually being paid, low enough to be sustainable.
What is the Incurred Claims Ratio (ICR)?
The Incurred Claims Ratio tells you how much of every rupee collected as premium was paid back to customers as claims. An ICR of 70% means the insurer paid out ₹70 in claims for every ₹100 of premium collected. Unlike CSR, a very high ICR is not necessarily good — it can point to an unsustainable payout rate and future premium hikes, while a very low ICR can indicate an insurer that is overly restrictive in settling claims. Ditto looks for an ICR between 55% and 85%.
For every 10,000 claims processed, SBI received 14 complaints and Bajaj General received 4. Fewer complaints usually mean smoother claim processing and better servicing, so Bajaj General has the edge on this metric. Ditto looks for under 20 complaints per 10,000 claims from general insurers, and under 40 from standalone health insurers, since their claims are more complex.
What is the complaint volume?
Complaint volume shows how many customers formally complained per 10,000 claims processed. Fewer complaints generally mean smoother claim processing and better customer support. General insurers and Standalone Health Insurers (SAHIs) are judged against different baselines because SAHIs handle only health claims, which are more complex — Ditto looks for below 20 complaints for general insurers and below 40 for standalone health insurers.
SBI has 18,000 network hospitals and Bajaj General has 12,600. Both are past the 10,000-hospital mark Ditto recommends. A bigger network makes it easier to find cashless treatment near you, but it counts for little if your preferred hospitals are not on the list — so check that before you decide.
What are network hospitals?
Network hospitals are the hospitals an insurer has tied up with, where it settles bills directly so you get cashless treatment instead of paying out of pocket and claiming reimbursement later. The larger the network, the easier it is to find cashless treatment near you. Ditto recommends a network of 10,000+ hospitals, but a large network matters little if your preferred hospitals are not on it — always check.
Track Record
SBI has been operating since 2009 (17 years) and Bajaj General since 2001 (25 years). Both have the 10+ years of history Ditto looks for, which means there is enough data to judge how they behave at scale rather than just early on.
Why does the insurer’s track record matter?
India’s insurance sector was privatised in 2000, so most private players have been operating for 20-25 years. A company with just 3-4 years of data gives you very little to judge it on — numbers can look excellent early on and deteriorate sharply as the insurer scales. Ditto considers 10+ years ideal, and under 5 years a reason to proceed with caution.
Feature Comparison
With a co-payment clause, the insurer will mandate that you pay a part of the bill. So if the bill adds up to Rs. 2,00,000 and the co-payment is set at 20% then you could be asked to pay Rs. 40,000 from the bill. In this case, however, Arogya Premier doesn’t impose a co-payment clause. And neither does Health Ensure Family Plan.
If the policy does impose room rent restrictions then the insurer may only let you stay in a room of a certain specification or impose a cap on the total room rent. If you were to breach either criterion then the insurance company may ask you to pay a portion of all the expenses you incurred while staying in the room. In this case, however, you can pick any room you want with Arogya Premier but Health Ensure Family Plan only lets you stay in a room whose rent doesn’t exceed 1% of the total sum insured.
Some policies will tell you that they will cover all medical expenses up until the sum insured, but then impose caps on the total costs you can incur while dealing with a very specific list of diseases. We call these caps “Disease Wise Sub Limits.” In this case, Arogya Premier imposes disease-wise sub-limits on modern treatments whereas Health Ensure Family Plan imposes sub-limits on null
If you’re suffering from a lifestyle condition or if you’ve had surgery in the past, or if you’re dealing with an acute or chronic illness at the time of buying the policy, then the insurer may classify this as a pre-existing disease. And they may tell you that they will only cover these illnesses after some time. In this case, Arogya Premier imposes a waiting period of 3 years on pre-existing diseases while Health Ensure Family Plan extends a waiting period of 2 years on existing conditions.
Most people aren’t hospitalized right off the bat. Instead, they’ll have to go through a whole series of diagnostic tests before hospitalization and take medication post-discharge. These costs are outlined as pre-hospitalization expenses and post-hospitalization expenses respectively. In this case, Arogya Premier covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, Health Ensure Family Plan covers expenses incurred 30 days before hospitalization and expenses incurred 60 after hospitalization, although there may be different sub-limits
Some policies will tell you that they will incentivize you for not making a claim in any given year. And they offer such incentives by offering extra cover on top of the existing sum insured. This extra cover is categorized as a no-claim bonus. In this case, however, Arogya Premier offers a no-claim bonus of 10% whereas Health Ensure Family Plan offers a no-claim bonus of 5%. And the no-claim bonus may be capped at different levels too.
Imagine you are forced to treat yourself at home because you don’t find a hospital bed, or you have a chronic condition that prevents you from visiting one, then, insurers may choose to cover your treatment even if you’re hospitalized at home. And such costs are collectively categorized as domiciliary treatment costs. In this case, however, Arogya Premier offers domiciliary cover whereas Health Ensure Family Plan doesn’t offer domiciliary protection.
Most policies only cover treatments administered in a registered medical facility. However, on some occasions, you may want to pursue alternative treatments including homoeopathy, Ayurveda, Unani and Siddha. These treatments are collectively categorized as Ayush treatments. And in this case, Arogya Premier covers Ayush procedures and Health Ensure Family Plan also extends coverage for Ayush treatments.
If you’re hospitalized during childbirth, then you may have to incur significant costs during delivery of your newborn, child care and other related matters during the course of the hospitalization. These costs are collectively termed maternity costs. And in this case, however, Arogya Premier offers maternity cover whereas Health Ensure Family Plan doesn’t offer protection for maternity-related hospitalizations.
Doctor visits and regular consultations aren’t usually covered by health insurance policies. They are categorized as Outpatient consultations (or OPD treatments) and patients have to bear the cost on their own. In this case, however, neither Arogya Premier extends coverage for outpatient consultations, nor does Health Ensure Family Plan.
Final Conclusion
Since this isn't a fair comparison, to begin with, we will only tell you this much. If you want something that's affordable, you could go for Health Ensure Family Plan. However, if you are specifically looking to buy a policy for Maternity, then it's a no brainer, Arogya Premier is your go-to option.
Other SBI Arogya Premier Comparisons
Other Bajaj General Health Ensure Family Plan Comparisons
Talk to an expert
today and
find
the right
insurance for you.