Comprehensive Review of National Health Insurance (2024)

National Insurance Company Limited (NICL), an age-old insurance company founded in 1906, is one of the household names in the insurance sector. Now, it’s true that this popularity can be attributed to its affordability and diverse range of financial products portfolio. However, regarding health insurance, the insurer is falling behind, considering its issues across overall operational efficiency.

Being a public company, reaching out to insurers, getting optimum support for claims or queries, etc., is truly a hassle. Hence, despite having a few affordable, comprehensive health insurance plans (even with premium features like maternity coverage), the insurer is losing out to its private competitors.

However, the question is, can/should you trust National Insurance Health Insurance despite its lack of innovative features in its policies? Should you overlook its shortcomings and focus on its market-built credibility and extensive insurance track record? And, is National Insurance Health Insurance as credible as claimed?

Let’s find out about this public insurer & assess if their health insurance plans are worth availing!


Pros and Cons

Pros Cons
Good claim settlement ratio Measly network of partner hospitals
Low complaint volume Lack of comprehensive plans
  Very high Incurred Claim Ratio

Metrics of National Insurance Health Insurance

National Insurance Health Insurance is a public company owned by the Ministry of Finance, Government of India. Founded in 1906 and nationalised in 1972, this is one of the country’s oldest standalone health insurance companies. Despite its years of experience in the industry, the insurer has failed to occupy the position of a top-notch health insurance provider.

Considering the insurer’s pros, you can think of – affordable plans, diversity in features, multiple options across its health insurance plans, and an excellent Claim Settlement Ratio. Unfortunately, its cons outweigh its pros. The cons for National Insurance Health Insurance include – lack of comprehensiveness in its plans, rising complaint volume, skyrocketing Incurred Claim Ratio, issues with its overall operational efficiency, and more.

Now, before we discuss the health insurance policies from the National Insurance Health Insurance stable, let’s determine the insurer’s credibility!

Metrics of National Insurance Health Insurance

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Claim Settlement Ratio of National Insurance Health Insurance

Policyholders typically check a health insurer’s Claim Settlement Ratio (CSR) as a critical metric before considering any provider. While CSR isn’t the sole metric to assess a health insurance provider’s reliability, it remains a crucial determining factor.

CSR is calculated as follows:

(The total number of claims settled in a year by an insurer / The total number of claims raised in the year to the insurer) * 100

  • Below 80 – If a CSR falls below this mark, the insurer is not recognised for efficient claim settlements. As a policyholder, it’s advisable to steer clear of such providers due to the heightened risk of claim rejections.
  • Above 90, but below 100 – This range represents the optimal performance for health insurers; such providers are esteemed for their excellence in CSR. Opting for such insurers ensures choosing a reputable provider.
  • Above 100 – Despite being marketed as exceptional insurers, a CSR surpassing 100 is a warning sign, suggesting delayed claim settlements. Since this concerns health insurance claims, the last thing you want is any delay in the settlement process, potentially leading to tapping into your savings, even temporarily, which undermines the purpose of having health insurance plans.


CSR for National Insurance Health Insurance

Years CSR for National Insurance Health Insurance Industry Average
2020 – 2021 95.55 91.484
2021 – 2022 90.14 89.967
2022 – 2023 95.6 91.460
Average (2020 – 2023) 93.76 90.970

Insight: National Health Insurance’s CSR track record for the last 3 years is highly encouraging. The numbers have stayed above the industry average (year-on-year and average) and consistently above 90. This is an excellent sign for its policyholders.

Incurred Claim Ratio of National Insurance Health Insurance

The Claim Settlement Ratio of a health insurer can never be the sole metric to consider when choosing and finalising a provider. An insurer’s CSR fails to shed any light on its sustainability. And since health insurance policies are meant to be long-term financial commitments between the insurer and the insured, such nuances must be prioritised. Otherwise, you might look at partial claim settlements or rejections of valid claims in the long term.

Hence, you should consider the Incurred Claim Ratio (ICR) of an insurer, which is given by –

(Total amount of claim settled / Total amount of claim filed for a single year) * 100

Here is an interpretation of the range for ICR for health insurance providers –

  • If the ICR is below 50 – This indicates that they insurer is more focused on securing its business profits and is ignoring multiple claims. As a policyholder, this is a red flag for you, considering you face a high risk of valid claim rejections.
  • If the ICR is between 50 and 70 – This is the ideal range for health insurers, signifying the perfect balance between focusing on business profitability and client prioritisation towards claim settlement. If you come across an insurer with this range of ICR, you are good to go.

Also, if the ICR numbers are in the 80s, you can go ahead with the provider (provided they meet the other requirements of CSR, complaint volume, and network hospitals as well). This merely signifies that the company is a tad bit more focused on claim settlement than its business profits, which is a good sign for its existing and potential policyholders.

  • If the ICR is above 100 – Avoid such insurers at all costs. Such a high ICR indicates that the insurer is paying out a massive number and amount of claims. While this might seem appealing to you as a policyholder, this is only temporary. In the long run, the insurer will most likely face issues across its financial stability and, thus, sustainability.


ICR for National Insurance Health Insurance

Years ICR for National Insurance Health Insurance Industry Average
2020 – 2021 101.09 78.27
2021 – 2022 125.53 91.79
2022 – 2023 102.35 78.82
Average (2020 – 2023) 109.66 82.96

Insight: The ICR numbers for National Insurance Health Insurance aren’t promising. Such high numbers across the board for the last 3 years indicate that the insurer has been paying out substantial amounts. This later might develop into an issue for the insurer’s sustainability.

Complaint Volume of National Insurance Health Insurance

When availing of a health insurance plan, one of your primary concerns must be the claim settlement experience extended by the insurer. You need to get an insight into the claim settlement experience of the insurer’s existing policyholders. A convenient method to get this data is to look at the insurer’s complaint volume.

The number of complaints per 10,000 claims will help you understand more about the insurer’s overall operational and claim settlement efficiency. The lower the numbers, the better the insurer.


Complaint Volume for National Insurance Health Insurance

Years Complaint Volume for National Insurance Health Insurance Industry Average
2020 – 2021 1.76 13.212
2021 – 2022 24.12 35.969
2022 – 2023 22.81 19.578
Average (2020 – 2023) 16.23 24.029

Insight: The complaint volume numbers for National Insurance Health Insurance experienced a sudden surge from 2020-21 to 2021-22. While we can attribute this to the pandemic outbreak and the subsequent spike in hospitalisations and claims, the numbers haven’t yet dropped by much. If the numbers remain high, this might be an issue for its existing and potential policyholders.

(Please remember: We have considered the metrics data for the last 3 years to get a deeper insight into the insurer’s consistency regarding its credibility and operational efficiency.)

Top Health Insurance Plans Offered by National Insurance Health Insurance

  1. National Mediclaim policy

This is one of the most basic health insurance plans from the National Insurance Health Insurance stable. While the plan is affordable, it’s not comprehensive and has many restrictions, sublimits, and exclusions. The plan offers an optional co-payment feature, reducing your premiums further. Fortunately, the plan doesn’t have any disease-wise sub-limits and offers coverage for AYUSH treatments and daycare treatments, among other things.

Drawbacks: The policy has a room rent restriction, which is a huge no-no if you consider that exceeding the limit will lead to paying a pro-rata share of the total hospital bill. There is no domiciliary coverage, an extensive waiting period of 4 years for policyholders with pre-existing medical conditions, a nominal No-Claim Bonus (capped at 50%), a limited restoration perk, and free health checkups only once every 4 years.

2. National Mediclaim Plus policy

This health insurance plan is a decent pick if you seek an affordable policy with in-built maternity perks. The plan is not without its caveats; however, it has several pros – no disease-wise sub-limits, daycare coverage, free annual health check-ups, and more.  The plan’s speciality or USP lies in its offering of maternity coverage. However, please remember that this perk has a 2-year waiting period and a capping of ₹50,000.

Drawbacks: The plan comes with a room rent restriction, forced copayment if you are getting treated at a non-network hospital, a measly No-Claim Bonus (capped at 50%), and no restoration perks.

3. National Parivar Mediclaim policy

This is an average health insurance plan that is not exactly comprehensive. The policy is affordable and has a few decent features like no disease-wiser sub-limits, no copayment, pre and post-hospitalisation expense coverage, daycare treatment coverage, AYUSh coverage, and maternity coverage of up to ₹50,000, among others.

Drawbacks: The plan has a room rent restriction of up to 1% of the base sum insured, a 4-year waiting period for pre-existing medical conditions, partial coverage for domiciliary treatments, and more. The most crucial missing feature of the National Parivar Mediclaim policy is the restoration feature, considering that this is a family floater health insurance plan with no No-Claim Bonus.

Conclusion

National Insurance Health Insurance has been an evergreen health insurer in the industry for a long time. Unfortunately, this public health insurer hasn’t adapted well to policyholders’ varying medical and financial goals. Subsequently, the health insurance plans from this stable lack the much-required comprehensiveness that is readily available in the case of plans from other top-notch health insurance providers at affordable premiums.

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