Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Elevate is sold by ICICI Lombard and Health Guard Gold 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. Elevate is quite comprehensive. It offers considerable protection and it doesn't impose as many restrictions. However, Health Guard Gold is specifically designed for Maternity. 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 Elevate. The product comes from ICICI Lombard's stable:
ICICI Lombard Health Insurance company is a joint venture between India's ICICI Bank and Canada's Fairfax Holdings. They are one of the leading insurance companies with over 270 branches spread across India.
However, with a claim settlement ratio of 87% and a measly network of 11,000+ hospitals, their performance needs significant improvement.
Health Guard Gold 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.
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ICICI Lombard Elevate vs Bajaj General Health Guard Gold
Compare Insurances Insurance Parameters Recommended Not Recommended |  ICICI Lombard Elevate |  Bajaj General Health Guard Gold |
|---|---|---|
| Network hospitals | 11000 | 12600 |
| Claim settlement ratio (avg. of last 3 years) | 87% | 96% |
| Co-payment | No | No |
| Room rent | Single Private room | Any Room |
| Disease sub-limit | No | Yes |
| Pre existing diseases waiting | 3 years | 3 years |
| Pre/Post hospitalization | 90/180 days | 60/90 days |
| No claim bonus | 20% per year (up to 100%) | 10% per year (up to 100%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (unlimited no. of times for any illness) | 100% restoration (once for different illness after complete exhaustion of sum insured) |
| Health check-up | Once every 3 years | |
| Maternity | Available (up to ₹25,000 after 6 years) | |
| Out Patient Department | ||
| Day care |
Insurer Comparison
ICICI Lombard settles 87% of the claims it receives, while Bajaj General settles 96%. Ditto looks for a claim settlement ratio of 90% and above. Bajaj General clears that comfortably, while ICICI Lombard sits just short of it, which is worth weighing alongside the rest of the comparison.
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
ICICI Lombard pays out ₹79 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, ICICI Lombard received 15 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.
ICICI Lombard has 11,000 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
ICICI Lombard has been operating since 2001 (25 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, Elevate doesn’t impose a co-payment clause. And neither does Health Guard Gold.
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, Elevate only lets you stay in a single private room but you can pick any room you want with Health Guard Gold.
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, Elevate doesn’t impose a disease wise sub-limit whereas Health Guard Gold imposes disease-wise 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. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, Elevate imposes a 3 year waiting period on pre-existing diseases and Health Guard Gold will similarly tell you to wait 3 years before making a claim related to your pre-existing diseases
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, Elevate covers expenses incurred 90 days before hospitalization and expenses incurred 180 days post-hospitalization. Meanwhile, Health Guard Gold covers expenses incurred 60 days before hospitalization and expenses incurred 90 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, Elevate offers a no-claim bonus of 20% whereas Health Guard Gold offers a no-claim bonus of 10%. 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, Elevate offers domiciliary cover whereas Health Guard Gold 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, Elevate covers Ayush procedures and Health Guard Gold 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, Elevate doesn’t offer protection for maternity-related hospitalizations whereas Health Guard Gold offers maternity cover.
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 Elevate extends coverage for outpatient consultations, nor does Health Guard Gold.
Final Conclusion
If you're specifically looking to buy a policy for Maternity, Health Guard Gold makes a lot of sense. But considering ICICI Lombard has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that Bajaj General has to offer, if the policy is made available to you.
Other ICICI Lombard Elevate Comparisons
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