Mint ILM Health Insurance Ratings 2026

13. Benefit-Level Marking Approach

The following section provides a high-level view of how products have been marked under different product benefits and claims track record parameters.

Please note that the examples mentioned below are only indicative. They do not represent the full list of parameters considered under each benefit. For every benefit, several underlying conditions, limits, restrictions, sub-limits, availability, claim usability and customer impact points have been evaluated.

Another important point to note is that each benefit may carry both positive and negative markings. A plan may score higher for offering a benefit more comprehensively, but it may also receive negative marking if the benefit comes with restrictive conditions that can impact the customer at the time of claim. For example, if a plan covers domiciliary treatment but states that cashless claims will not be allowed and only reimbursement claims will be permitted, the plan receives negative marking for that restriction.

Below is an indicative explanation of how scoring has been approached across key parameters:

1. Inpatient Hospitalization Benefits - Higher marks are given to products that offer broader hospitalization coverage with fewer restrictions. For example, plans with no room rent limit, wider day care coverage, broader modern treatment coverage, better domiciliary treatment terms, AYUSH cover, organ donor cover, home healthcare cover and more customer-friendly hospitalization conditions score better.

2. Pre & Post Hospitalization - Plans score higher when pre and post-hospitalization expenses are covered without sub-limits, and when the number of covered days before and after hospitalization is higher.

3. Bonus - Higher marks are given when the bonus can accumulate to a higher or unlimited level, and when the bonus does not reduce or is not impacted because of claims.

4. Restoration Benefit - Plans score higher when the restoration benefit is available unlimited times, applies to both related and unrelated illnesses, triggers on partial utilization of sum insured.

5. Ambulance - Products receive higher marks when ambulance cover is available as an in-built benefit and there is no sub-limit on road ambulance and air ambulance expenses.

6. Non-Medical Expenses - Plans score higher when non-medical expenses are covered in-built, when a wider list of non-medical items is covered, and when there is no sub-limit on such expenses.

7. Maternity - Higher marks are given when maternity coverage is higher, the waiting period is lower, multiple deliveries are covered, newborn-related and vaccination expenses of the newborn are covered.

8. Health Check-Up - Plans score higher when the health check-up benefit has a higher sub-limit, is available in-built, offers both cashless and reimbursement options.

9. Cost Sharing & Financial Limits - Products score higher when they do not impose restrictive financial limits such as co-pay or deductible mandatorily or surgery-specific limits for procedures like cataract, joint replacement.

10. Exclusions - Plans with fewer exclusions and lower waiting period score higher. The scoring considers the initial waiting period, specified illness/treatment waiting period and listed conditions / treatments, and permanent exclusions.

11. Claim Complaints - Insurers receive higher marks when the number of claim-related complaints is lower, when measured in relation to the volume of claims handled.

12. Claims Ageing - Insurers receive higher marks when a larger proportion of claims are settled within 30 days, as this indicates faster claim processing.

13. Incurred Claim Ratio - Insurers receive higher marks when the incurred claim ratio is within a balanced range, typically 60% to 80%, as this may indicate a healthier balance between claim payouts and premium collections.

14. CSR (No. of Claims) - A higher ratio receives better marks, as it indicates that the insurer has settled a higher number of claims out of the total claims received.

15. CSR (Value of Claims) - A higher ratio receives better marks, as it indicates that the insurer has settled a higher value of claims out of the total claim amount received.

16. CRR (Repudiation + Rejection) - A lower ratio receives higher marks, as it indicates that the insurer is rejecting or repudiating a smaller proportion of claims.

17. Ombudsman Complaints Settled in Favour of Customers - Insurers receive higher marks when fewer complaints are settled in favour of customers at the Ombudsman level. This indicates that fewer customers had to escalate their disputes to the Ombudsman and win relief there, suggesting that the insurer may be resolving more cases appropriately at its own level.