Here are 6 things you need to keep in mind:

1. Never procrastinate when it comes to policy renewal. If you forget to renew it by the last date of your policy, remember to at least finish the renewal before the “grace period” expires. Note that the “grace period” is only for renewals, and you are not covered on these days. A medical emergency during this period can be devastating.
2. Whether or not you have made any claims in the last year, you have invested in the policy, month after month. If you decide not to renew it, you lose out on benefits like no-claim bonus and coverage on health checkups. Some insurance companies may even increase the sum insured to you on renewal, without increasing your premium.
3. Almost every policy has an initial waiting period of 30 days from the date of registration before it begins to cover your medical expenses. If you forget to renew your policy, you will be forced to re-register as a new policy and will need to wait another 30 days before the coverage kicks in.
4. For treatment of pre-existing diseases and (in special cases) maternity, there is usually a waiting period of one or two years. If you miss out on renewing your policy on time, you also lose the one year you have waited and will need to begin your waiting period from Day 1 once again.
5. Before the validity of your policy expires, consider other policies that may be available with the same insurance company or a different one. As per the  Health Insurance Portability provision made by the Insurance Regulatory and Development Authority of India (IRDA), you can transfer from one policy to another without losing out on no-claim bonus, waiting period and the like. However, this can only be done if you apply for the transfer well before expiry as there may be some processing time required.
6. The policy you opted for one year ago may seem obsolete now as your family may have changed (if there has been a birth or death), or if you feel that your medical needs are now different. This may leave you with a tendency to allow the policy to expire. Instead, we suggest that you use the last month of your policy period as an opportunity to revise your coverage, increase your sum insured or make any other changes you may need in terms of the policy in a timely manner without losing out on continued coverage.

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You may have noticed, while searching for a policy, that different policies quote different premium amounts. Sometimes, the same insurance company may quote a different premium amount for you and someone else who is opting for the same policy. So, what really determines your premium?

At the base of it all, most policy premiums are calculated keeping in mind the marketing/administrative expense, how much the insurance company wants to use for savings and how much it will reinvest, the medical underwriting which takes into account various types of risks (to prevent loss for the company), and so on.

In addition to these, the following factors also affect your insurance policy premium:

• Type & extent of risk coverage

There are, often, a wide range of options provided by insurance companies when it comes to the type of policy one can opt for. There are policies that cover only treatment costs, and there are ones that cover room rent as well. Therefore, depending on the extent of coverage offered by the policy you choose, the premium will also vary.

• Policy-related payments

While it is obvious that the total sum insured will directly affect the insurance premium you pay, there are also a few other payments known a deductibles that can affect your premium. If, for example, you are willing to opt for a higher co-pay, then your insurance premium might be lesser.

• Your personal information

Your age

Your age is considered to be one of the factors affecting your health and, therefore, it is also one of the factors affecting your health insurance premium. The older you get, the more susceptible you are to ailments like diabetes or blood pressure, and your treatment costs would be reasonably higher due to these underlying ailments.

Insurance companies have set “bands” based on different age groups (for example persons from age 26 – 35 years belong to one band and those between 36 – 40 years belong to the next). It is said that the premiums from one band to another can vary between 30-60%.

Your medical history

Your medical history and your personal habits that can affect your health (drinking, smoking etc.) affect the amount you pay as premium for your health insurance.  Even your family’s medical history will be taken into account, as you are at higher risk of acquiring certain diseases if a family member has it already.

Your BMI

The body mass index (BMI) speaks volumes about your current health status. This calculation involving your weight, age and height determines if you carry a healthy weight or if you are underweight/overweight. Those found to be overweight may be at a higher risk of certain diseases (including heart problems). Some insurance companies may even require you to go in for a health checkup before signing you up for a policy.

Community Rating

Where you live can have an impact on your health and, therefore, on your health insurance premium. For example, if there is a factory emitting toxic elements into the air/water in your neighbourhood, you may be prone to a certain sickness due to these factors. Insurance companies, therefore, provide ratings to different localities and this can affect the premium you pay.

Family size (for group policies)

If your policy is for an individual, the policy payments are calculated accordingly and if you opt for a policy that will cover your family, then the number of individuals the policy covers will affect the calculation of the premium.

• Market Competition

When two or more insurance company agents are trying to get a large policyholder (like a company which wants to provide health insurance to employees) to sign up with, the competition may cause slight variations in the premium amount they quote. As the policyholder is likely to choose a policy with a company offering the lowest premium for the same benefits, this is likely to happen.

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There are 3 major factors that affect the fate of a claim. They are:

• The medical necessity of the treatment
• The correctness of the details filled in the claim
• The inclusion/exclusion of certain healthcare procedures as part of the policy

Here are a few steps to consider if you are ever faced with a health insurance claim rejection.

1. Question yourself

Everybody makes mistakes and, in this case, it could have been the insurance company or it could have been you. Before you go about taking any kind of action in response to the claim rejection, ask yourself these questions to find out if there has been a mistake at your end.

With regard to your eligibility in the purview of the policy:

• Did you have a pre-existing disease that you did not disclose to the insurance company while purchasing the policy?
• Was there a waiting period for pre-existing diseases that you may or may not have notified to the insurance company about? Was your recent hospitalisation connected to this pre-existing disease?
• Was your claim for a cosmetic surgery or some other non-curative treatment? If it was a dental treatment, is it something covered by your policy?
• Was the hospitalisation only for diagnostic purposes and not for actual treatment?
• Did you inflict injury on yourself – such as a suicide attempt or a condition caused by your drinking or smoking habit?
• Was the treatment you availed related to any other permanent exclusions mentioned in the policy document? These could be congenital or genetic diseases, injury during war, etc.

With regard to your claim:

• Did you submit the adequate documents as required?
• Did you make the claim in a timely manner? Most claims need to be made within a certain number of days/weeks after the hospitalisation.
• Did you make your claim during a waiting period?
• Has the date of your insurance cover expired or has the sum insured been exhausted?
• Did your claim exceed the permitted sub-limit applicable for the particular treatment?

Once you ask yourself the above questions, you will know (more or less) if the claim was rejected because of an error at your end. However, if you are convinced that you have done everything right, then you can proceed to investigate further.

2. Read the adjudication report

The insurance company is required to state a valid reason for the rejection of your claim. In the case of a cashless claim, this report is sent to the hospital and in case of a reimbursement claim, it will be sent directly to you.

Reading through this report may give you answers and help you take the next steps.

• Sometimes, there may have been an error in the way the form was filled. If it is something that can be rectified (such as a spelling error or a customer number error), you can inform the TPA with a request to reopen the case and/or reapply once again.
• If your claim was rejected due to insufficient proof/documentation, then you can reapply after checking and collecting the required documents. You may need to make a few trips to the hospital for these, if you don’t have them already. Sometimes, you may have simply forgotten to attest a document, and this could have caused the rejection. In case of this and the previous scenario, remember to reapply before the window period for submission expires.
• If the reason for rejection was that the treatment you availed didn’t seem necessary to the insurance company, go back to your doctor and collect a letter explaining why the treatment was necessary at that point. To strengthen your argument, you may also meet another doctor (who did not treat you for this) and get him/her to vouch for the validity of the treatment as well.

3. Contact the TPA/insurance company

It is highly probable that a claim was rejected due to an error from the insurance company’s side. If you have a valid argument and adequate proof, then you can get in touch with the TPA or insurance company and request them to reconsider your claim. Here’s how you can do it:

• Write a formal letter/email with a clear title and a clear, understandable statement that validates your claim.
• Attach appropriate documents (along with letters from doctors) with their medical opinion on why the treatment was necessary.
• Await a response from the insurance company. However, if you do not receive a timely response, you may escalate the issue with a higher authority of the insurance company.

If your reasons seem valid, chances are that your claim will be accepted (either fully or partially) at this point. Ensure that you maintain a copy of every communication that has transpired between you and the TPA or insurance company regarding this case.

According to an article by Forbes, it is perfectly acceptable to re-apply the claim and/or appeal for the claim as many times as you want. Sometimes, if you give up too soon, you may lose out on what you rightfully deserve – especially if the insurance company is not genuine and is rejecting your claim simply to make a profit.

4. Seek a lawyer’s help

If none of the above work out and you are still fully convinced of the validity of your claim, make an appeal opposing the insurance company’s decision with the help of a lawyer. Remember that this is the last straw, and that you may be wasting your time, money and energy if your appeal is made against a valid rejection by the insurance company.

While making an appeal, make sure you have a copy of all the relevant documents with you – starting from hospital bills to all the communications (including emails) made regarding the claim between you and the TPA/insurance company. If your appeal has been found valid, you will be rightly rewarded by the approval of your claim.

The post What to do if your health insurance claim is rejected appeared first on Attune Technologies Pvt Ltd.

The process begins with receiving the claim, either directly from the policyholder or from the healthcare provider (in case of health insurance).

Once the process of adjudication is complete, the insurance company make the payment and/or sends a letter to the claimant, describing the company’s decision to accept or reject the claim, along with validating reasons for doing so. nd how the amount to be paid was determined. This is known as the remittance advice or, more popularly, Explanation of Benefits (EoB).

The letter also includes, for an accepted claim, detailed information about how each service included in the claim was settled and how much is being paid for them.

Problems Faced in Claims Adjudication

The claims adjudication process is riddled with challenges because:

• Claims are submitted through a variety of mediums – electronic and manual
• A dedicated workforce is required to manually verify each claim and filter and investigate suspicious claims through a long and cumbersome process
• Manual rule-driven mechanisms are time consuming and pose threats like loss of customer base due to delays or perceived harassment over submitted claims
• Erroneous rejection of genuine claims or delayed settlement of claims can cause customer dissatisfaction
• Several billions of rupees are lost due to fraudulent claims each year, missed out by inefficient adjudication process

The Attune-ABI Solution

Attune ABI has developed a software, HealthClaim Hub, which can automate most of the claims adjudication process using techniques of artificial intelligence including machine learning, text mining, and deep learning.

The major functionalities of the HealthClaim Hub are:

• Conversion of claim data from existing PDF formats (patient details, diagnosis details, diagnosis tests, treatment details and bill summary) into structured formats (mines reports, notes)
• Points out to anomalous elements within claims (bills for diagnosis tests, procedures, medicines or actual prescribed diagnosis/treatment path for the patient)
• Flagging of suspicious claims at individual and hospital levels with a high degree of sensitivity so that insurance companies can give manual attention only to flagged claims
• Payment determination is made easy through HealthClaim Hub as the system uses big data analysis to estimate the average and reasonable amount usually charged for specific services

The automation of the claims adjudication using HealthClaim Hub makes the entire process of claims adjudication easy, effective and efficient. More claims can be processed in less time and the time, money and manpower invested in adjudication can be reasonably brought down. The improved turnaround time in responding to and settling of claims leads to improved goodwill among customers and other stakeholders. In other words, HealthClaim Hub smoothens the claims process for the healthcare provider, the policyholder/patient as well as the insurance company involved.

The post Claims Adjudication Made Easy appeared first on Attune Technologies Pvt Ltd.

When it comes to health insurance, age is an important factor. Insurance companies offer health insurance at a cheaper premium for younger people as they tend to have fewer medical problems and lesser chances of making a claim. As you get older, not only will you need to but also pay higher premiums, you will also need to undergo a medical test and prove that you are fit in order to be accepted into a health insurance plan. If a ‘pre-existing disease’ is identified during the test, your application may be rejected or you may be forced to go through a ‘waiting period’ before getting coverage.

If you get enrolled in a plan while you are still young and healthy, you will continue to pay the same premiums as you age and will be covered for any diseases that are diagnosed while already covered.

Treatment Costs are Skyrocketing

If you are hesitating to part with your money to pay for health insurance premiums, consider this – healthcare costs are increasing by the day and will continue to rise!

The Global Medical Trends Report shows a 12.5% inflation in medical treatment costs, particularly in India during the year 2017. While it is true that we see breakthrough after breakthrough in the medical research, science and technology industries, these new and improved treatment methods are also highly expensive and inaccessible by the middle class. Without a health insurance policy, paying for such treatments would be unimaginable and put you at the risk of availing debt with cut-throat interest rates.

An Emergency Occurs When You Least Expect It

In the prime of our lives, we tend to think of health insurance as an unnecessary or even a foolish act.

Think about it – stress, itself, can lead to multiple health complications, adding to the woe of pollution, the contamination of water, the toxicity of chemical-pumped vegetables and meat, to name a few. Even if you do manage to eat and live healthy, diseases like cancer can come when least expected. Not to scare you, but accidents are called accidents simply because of how unexpectedly they occur.

Your Employer’s Health Insurance is Not Enough

A lot of people tend to dismiss the idea of investing in a health insurance under the premise that their employer has already covered them under a group insurance policy. However, such policy covers are highly limited and may not be applicable for your specific treatment need. And by the time you find out, it may be too late to look for an alternative source to pay for the treatment. Sometimes, there may be an overall limit for the group, and if someone else in the same group policy has availed a part of it, it may not be sufficient for you.

Moreover, if you lose or leave your job, you will lose your insurance cover as well. The worst possible time to be uninsured is the time when you are between jobs!

Why Deny the Tax Benefits?

Everybody loves a little savings on income tax, so why not set aside a portion of what you might otherwise have to pay as taxes for investing in your own health?

As per Section 80D of the Indian Income Tax Act, a person with a health insurance policy can save up to Rs. 25,000 (or Rs. 30,000 for senior citizens) annually depending on the premiums paid towards health insurance. Additionally, there is also an additional Rs. 5,000 you can save for expenses incurred for health check-ups for yourself as well as your dependent family members. It is almost like getting paid to stay healthy, so why not?

The post 5 Reasons Why You Need Health Insurance Now! appeared first on Attune Technologies Pvt Ltd.

1. Claim: A claim is a payment request made by the network healthcare provider to the health insurance company for services it has rendered to the policyholder in case of a cashless claim. However, in case the policyholder has paid for the healthcare services he/she has received, then a claim will be for reimbursement and submitted to the health insurance company directly by the policyholder. To know more about the types of claims, click here.
2. Case Management: Healthcare providers employ a team to handle the health insurance process. This team/health insurance desk coordinates with the policyholder prior to treatment, during treatment and post treatment to ensure that appropriate services are made available and also with the health insurance company for pre-authorisation, claim submissions, etc.
3. Date of Service: The date(s) of service refer to the date on which the policyholder availed the healthcare services for which the claim has been made.
4. Submission Date: Submission date refers to the actual date on which the claim was submitted to the insurance company.
5. Principal Diagnosis: The principal diagnosis refers to the main reason why the policyholder visited the healthcare provider in the first place and the diagnosis that lead to the treatment (for which a claim has been made).
6. Evidence of Insurability: Before treatment (during the pre-authorisation stage) or later, the health insurance company or the healthcare provider might require documentation from the policyholder as proof of his/her eligibility for the insurance.
7. Supplemental Reports: Supplemental reports refer to additional information/proof requested by the health insurance company from the healthcare provider to explain why a certain treatment was provided to the policyholder.
8. Adjudication: Adjudication is an administrative process followed by the insurance company to check the details of the claim received and to verify its authenticity and need. The insurance company also determines, through this process, whether the requested claim amount is to be fully paid, partially paid or rejected.
9. Anomalous Elements: During the adjudication process, the insurance company may find anomalies within bills for diagnosis tests, procedures, medicines or actual prescribed diagnosis/treatment path for the patient. This will affect the outcome of the claim.
10. Claim Status: Claim Status refers to the status of the claim at any given point in the process – paid, not paid, in-progress or waiting for action, etc.
11. Withhold: This refers to the amount withheld by the insurance company, in comparison to the amount requested in the claim.
12. Denied Claim: For some reason or the other, after the adjudication process, an insurance company may decide to reject the claim. This is known as  denied claim.
13. Explanation of Benefits (EOB): The health insurance company is mandatorily expected to send an EOB, a written statement explaining the reasons for the amount paid for the claim, which treatments were paid for, why certain payments were not paid as requested or why a claim was denied.
14. Appeal: If a claim has been rejected by an insurance company, the patient or healthcare provider may make a request, or appeal, that they review or change their claim decision.
15. Organisational Determination: A health insurance company, upon receiving an appeal from the healthcare provider or policyholder, reviews the claim once again. The decision then made is known as the organisational determination.

For more insurance-related terminologies and their descriptions, read Part 1 and Part 2 of the same article.

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1. Inpatient Care: Inpatient care refers to treatment received by the policyholder at a healthcare facility for more than 24 hours/with an overnight stay.
2. Outpatient Care: Outpatient care refers to healthcare treatment that does not require an overnight hospital stay or a hospital admission. It is important to note that some insurance plans do not cover outpatient treatment costs.
3. Ancillary Services: These include services provided by the healthcare facility other than the treatment. Biometric tests, physical therapy, and physician consultations are some such services. Policies have certain limits on the kind of refunds offered towards ancillary services.
4. Applied to Deductible (ATD): The amount paid by the policyholder for healthcare services to the hospital/healthcare provider and goes towards the payment of the annual deductible.
5. Capitation: Capitation is a fixed payment that a patient makes to a health insurance company or healthcare provider if they have availed various healthcare services to recoup costs incurred.
6. Pre-authorisation: Certain health insurance policies require that their policyholders avail their permission prior to planned hospitalisations. Coverage may be denied if a policyholder has not received authorisation.
7. Pre-Certification: A process similar to preauthorization whereby patients must check with insurance companies to see if a desired healthcare treatment or service is deemed medically necessary (and thus covered) by the company.
8. Pre-existing Condition (PEC): A pre-existing condition refers to a medical condition that the policyholder had and was aware of before taking up the policy. In the case of treatments for such conditions, the insurance company may levy a waiting period before coverage. A PEC may also make an individual ineligible for certain types of policies as well.
9. Waiting Period: The waiting period is a fixed period of time a policyholder might have to wait before availing certain benefits from the policy. come in effect.
10. Self-Pay: When a policyholder goes for treatment to a healthcare provider not within the network of the insurance company, then they will be expected to pay from their own pocket or self-pay. They can then apply for a reimbursement from the insurance company.
11. Cumulative Bonus: If a policyholder does not make any claims during a year, the sum insured for the same policyholder will be increased by a certain small percentage during the next year, without an increase in the monthly premiums paid.
12. Supplemental Insurance: A supplemental insurance is a secondary insurance policy that can help cover for deductibles and copays incurred by the policyholder from the first/primary health insurance policy.
13. Non-Covered Charge (NC): Before you sign up for an insurance policy or file for a claim, you need to know that there are certain treatments and health services that will not be covered by your policy. These are known as non-covered charges. A cosmetic surgery is an example of an NC.
14. Usual Customary and Reasonable (UCR): For each type of treatment, there is a UCR or a stipulated amount determined by the insurance company. If the healthcare provider charges more than the UCR for a certain treatment, the policyholder will be expected to pay the difference.
15. Patient Responsibility: Payments for anything beyond the Usual Customary and Reasonable (UCR) or Non-Covered Charge (NC) and will not be covered by the insurance company inevitably becomes the patient’s responsibility. This could also refer to the policyholder’s share in a  co-pay or co-insurance policy.

For more terms related to health insurance, read Important Health Insurance Terms & What They Mean: Part 1.

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Here is a handy list of 15 such important terms and their meaning to help you in the process:

1. Premium: This is the sum of money the insured/policyholder has to pay on a monthly (sometimes quarterly) basis to an insurance company. Once you sign the policy documents and provide your bank information, this sum may be arranged to be auto-deducted from your account.
2. Allowed Amount: The allowed amount is the maximum sum of money that an insurance company offers to cover a specific healthcare service or procedure. If the treatment cost exceeds this amount, the policyholder will have to pay the balance amount on their own. This is different from the total sum insured, which is the overall amount an insurance company will spend for a single policy.
3. Term Date: The insurance policy you are signing up for is a contract for a limited period – typically a year. The term date refers to the last date of this contract. Beyond the term date, you will no longer be eligible for the insurance cover.
4. Healthcare Provider: These are the entities that offer healthcare services to patients, including hospitals, physicians, and private clinics, hospices, nursing homes, and other healthcare facilities.
5. Network Providers: Healthcare providerS that have entered into a contract of partnership with the insurance company to provide cashless benefits to insured/policyholders. IThe list of network providers/hospitals is usually provided along with your policy document.
6. Out-of-Network: Out-of-network refers to healthcare providers that are not part of an insurance company’s list of network. Cashless claims cannot be made by policyholders if they visit an out-of-network hospital. Instead, they will have to pay from their pockets and later submit a claim for reimbursement.
7. Indemnity: An indemnity is a type of health insurance plan where a person is eligible to receive care with any healthcare provider in exchange for higher deductibles and co-pays. It is also referred to as a fee-for-service insurance.
8. Managed Care Plan: A managed care plan is a type of health insurance that will only cover treatments made through network providers and will not offer any cover (including reimbursement) for treatment through out-of-network providers.
9. Deductible: A deductible is the amount a policyholder must pay towards his/her healthcare treatment before an insurance company begins to cover the costs as part of the policy. Deductibles range in price according to terms set in a person’s health plan.
10. Co-Insurance: In certain policies, the policyholder is expected to pay a certain percentage of the treatment cost while the insurance company pays the remaining. This is known as co-insurance.
11. Co-Pay: A co-pay is the amount that must be paid to a healthcare provider by the policyholder before they receive any treatment or services. Co-pays are applicable only in certain insurance policies.
12. Maximum Out of Pocket: The amount amount a patient is required to pay whether in terms of deductibles, co-pays or co-insurance.
13. Guarantor: The party paying for an insurance plan who is not the patient. Parents, for example, would be the guarantors for their children’s health insurance.
14. Third Party Administrator (TPA): A TPA is a third-party organisation, hired by the insurance company to act as the intermediary between the policyholder, the healthcare provider and the insurance company.
15. Subscriber: If your insurance is part of a group policy (such as one that an employer takes on behalf of employees), then each individual who is covered under the policy is a subscriber.

The post Important Health Insurance Terms & What They Mean: Part I appeared first on Attune Technologies Pvt Ltd.

A deductible is the amount up to which the policyholder is expected to pay for availing healthcare services before the insurance company steps in and begins to pay/cover. Only once the deductible is met does the insurance company pay for the policyholder’s treatment or care. In other words, this is similar to self-insuring yourself before you start to claim from your insurance company. Usually, policies with lower premiums will have higher deductibles and vice versa.

The following are the different types of deductibles:

Comprehensive Deductible

The comprehensive deductible is the deductible that is applied across all types of treatment costs and other healthcare-related expenses that will be covered under the policy. It adds up until you have met the maximum deductible for the given period.

Non-Comprehensive Deductible

The non-comprehensive deductible is a deductible that only applies to specific costs towards certain medical treatments in a health insurance policy. This means that, for some treatments, there will be no deductible and for some others, the deductible will apply.

Cumulative Deductible

If members of a family are covered under a single family health insurance policy, then a cumulative deductible or a family deductible may apply. This means that a single deductible applies for all members of the family cumulatively. However, it is important to note that some family insurances may have individual deductibles as well.

Once you have met your deductibles, you think you need to make no more additional payments to the health insurance company? Well, that is where you would be wrong.

Typically, there are three types of “out-of-pocket expenses” a policyholder will incur in addition to the monthly premiums paid towards a health insurance. These are what limit the liability of the insurance company to a certain extent. The maximum amount paid cumulatively through all the three make up the “out-of-pocket maximum”. Different health insurance policies have different amounts predefined as the “out-of-pocket maximum”.

The post All You Need to Know About Deductibles in Health Insurance appeared first on Attune Technologies Pvt Ltd.

Here are some of the most important factors to keep in mind when choosing your health insurance company.

1 Claim Settlement Ratio

Claim Settlement Ratio (CSR) is a percentage that reflects the total number of claims settled with respect to the total number of claims received by the insurance company. In other words, the CSR gives you an idea of the possibility for the insurance company to settle a claim that you are likely to make. While it is justified for insurance companies to reject duplicate or fake insurance claims, it is peculiar if an insurance company rejects most of the claims it receives. Therefore, insurance companies that have a low claim settlement ratio are likely to reject most claim requests received by them – which puts you in a vulnerable position at the time of an emergency need.

CSR = Number of claims settled / total number of claims received

2 Incurred Claim Ratio

Incurred Claim Ratio (ICR) refers to the total amount paid by the insurance company to settle insurance claims in a year with respect to the total amount collected by the company as premiums from all its insured. If the amount paid by the company is more than the premium it receives, this means that the company is running on a loss and may not be able to pay for claim requests in the future. However, if the ICR is too low (less than 50%), then it means that the company is not paying enough in terms of settlements. Therefore, a balanced ICR (between 75% – 90%) is what establishes an insurance company’s ability to pay and its reliability.

ICR = Net Claims Incurred / Net Earned Premium

3 Solvency Ratio

Solvency Ratio (SR) is used to measure a company’s ability to meet its debt and other obligations by determining if its incoming cash flow is sufficient to meet liabilities. It is preferred to opt for an insurance company with a higher solvency ratio as this means that it has a higher proportion of asset holdings. is preferred while a low solvency ratio indicates that the company may not be able to pay for claims.

SR = Net Income / Total Liabilities

4 Network Hospitals

Most insurance companies today come with a list of network hospitals they are affiliated with. At these hospitals, the insured are allowed to opt for cashless treatment. Cashless treatment means that the insured patient need not pay for the treatment they are availing (other than co-pay/co-insurance amounts). The hospital will directly deal with the insurance company or its TPAs and arrange to get paid for the services it has offered free of cost to the insured patient.

On the other hand, if the insured patient avails treatment in a non-network hospital, he/she will first have to pay for the treatment and then apply for a reimbursement from the insurance company. A good health insurance company will have a long list of network hospitals – with plenty of options for the insured to choose from, preferably within their own locality.

5 Business Volume

Business volume refers to the total number of active customers, who are paying monthly or quarterly premiums to the insurance company. This can also be determined by the number of policies sold by the insurance company in any given year.

Naturally, the company with with a large business volume is considered to be more trustworthy, simply because it is likely to have the resources required to pay for claims.

The importance of making an informed choice when investing your money cannot be emphasised enough. We hope that this list will enable you to choose wisely.

You may also refer our blog on Top 10 Insurance Companies in India to guide you in the quest for the right insurance company.

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