Methodology

What the health insurance plan offers, in terms of coverage, conditions and limitations.

How consistently and effectively the insurer delivers on those promises, assessed through:

• Claims performance
• Customer service experience

The insurer's long-term institutional strength and reliability in the Indian insurance ecosystem is assessed. This assessment captures the insurer's ability to honour commitments over time and is evaluated using multiple parameters.

Product Benefits assess coverage elements that most materially impact real-world hospitalisation claims over the long term.

Each plan is evaluated on the following:

• In-patient Hospitalisation Cover
• Pre & Post-Hospitalisation Cover
• Day Care Treatment Cover
• Domiciliary Hospitalisation Cover
• Modern Treatments Cover
• Organ Donor Cover
• Bonus (Bonus / Super Bonus, as applicable)
• Refill / Restoration Benefit
• Waiting Periods
• Permanent Exclusions

All hidden and special conditions under each parameter are assigned separate weightage. We are also continuously expanding the framework by adding more parameters to the rating.

• Each sub-parameter is scored out of 5
• A relative scoring approach is used
• Plans are compared against each other, not against an absolute benchmark
• Pre-defined internal weightages are applied to each sub-parameter
• Weighted scores are consolidated to arrive at the Product Benefits score

• All products data are collected for a Sum Insured of ₹10 lakh
• This ensures uniformity and comparability across plans

Claims Experience reflects insurer-level performance, not product-specific outcomes.

• Percentage of claims settled within 30 days
• Claims Incurred Ratio (ICR)
• Claim-related complaints per 10000 claims registered
• Claim rejection ratio (Based on rejection & repudiation cases)
• Claim Settlement Ratio (Based on number & value of claims)
• Cashless hospital network size

• Public disclosures of respective insurers

• Policy-related complaints (Public disclosures)
• Responsiveness on X (Twitter)
• Toll-free helpline response experience

• Complaint data is taken from public disclosures of insurers
• Social media and helpline responsiveness are:
  • Observed manually
  • Recorded using structured observations
• Scored using a separate relative scoring framework

Insurer legacy is evaluated as one of the core parameters in the rating framework.

Legacy assesses the insurer's institutional strength and long-term presence in the Indian insurance ecosystem. It is evaluated under four sub-parameters, combined using predefined internal weightages:

• Years of Presence of Regulatory Financial Service
• Ombudsman Awards and Recommendations: Total number of awards and recommendations passed against the insurer. Evaluated relative to peers, considering scale and volume.
• Ownership and Regulatory Structure
• Multi-Line Insurance Experience: Whether the insurer operates across multiple insurance lines (health, motor, fire, marine, etc.) or is mono-line

• Each sub-parameter is scored independently with customized scoring methodology
• Insurers are compared against peers with absolute benchmarks
• Predefined internal weightages are applied to each sub-parameter
• Weighted scores are combined to arrive at the Legacy score

• Official disclosures and declarations published on the insurer's website
• Insurance Ombudsman Annual Report