Ritesh Sabharwal CFP®

W.M.W #8: 90% Claim Approval? Here's What's Hidden

Reading time: 4 minutes - August 9, 2025

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Hey Reader

If you’re comparing health insurance using 5-star ratings… you’re doing it wrong. I get it. That’s how we compare restaurants, hotels, and phones - so why not insurance?

Because health insurance is different. You’re not picking a vacation spot - you’re picking a lifeline for when things go sideways. And those stars? They don’t tell you if the policy will actually work for you when it matters most.

So today, let’s fix that. You’ll learn:

• How to judge whether the insurer is actually reliable
• What policy features actually matter (not just the price)
• How to actually compare health insurance policies and find what's right!

Let’s dive in.

2 Things You Need To Compare For Your Health Policy Without Regret

In order to pick a great health policy, you don’t need stars - you need systems. Let’s break this down step-by-step.

1. Compare the Insurer First (Yes, Before the Policy)

Before you look at premiums, fancy benefits, or even coverage - check the insurance company. Because a bad insurer will turn even the best policy into a nightmare. Here’s what you look at:

🕒 Track Record - If a company has been around for 10+ years, great. They’ve likely been through enough claims cycles to prove their consistency. Less than 5 years? You’re gambling.

🏥 Network Hospitals - If they don’t have 8,000+ hospitals in-network, you’ll struggle when you actually need cashless treatment. And god forbid you land in a non-network hospital - the paperwork alone will drain you before the hospital bill does.

📊 Claim Settlement Ratio - This tells you how many claims they actually paid. If it’s 90-95%+, that’s solid. 80–90%? Okay. Below 80%? Run.

📞 Claim Support - Will they ghost you when you file a claim? Or respond like they care? Hard to tell - unless you dig through complaints, online reviews, or ask advisors who’ve seen how they behave post-sale.

2. Now Compare the Policy Features (The Part Everyone Rushes Into)

Here’s how to actually compare the policies once you’ve shortlisted the insurer:

💰 Price vs Value - Don’t just buy the cheapest policy. Look at what you’re getting for the price - room rent rules, benefits, exclusions, etc. Value > low price.

👩‍⚕️ Co-payment Clause - Avoid policies that make you pay 20% of every hospital bill. Unless you enjoy paying ₹40,000 out-of-pocket on a ₹2 lakh bill.

🛏️ Room Rent Capping - Caps are dangerous. If your policy says “shared room only” and you opt for a private one during an emergency, you’ll end up footing most of the bill - not just the room difference. Ideally, pick “no capping” or “private single AC room” minimum.

⏳ Waiting Period for Pre-Existing Illness - Shorter = better. Look for 2-3 years max, not 4 years or more.

🎁 No-Claim Bonus - Some policies increase your coverage each year you don’t claim. Look for ones that give 50% per year up to 2x the base sum insured. Anything less is meh.

👶 Maternity and OPD - Great to have - but know they cost extra. Add them only if you actually need them soon.

🪔 AYUSH Coverage -Some policies cover alternative treatments (Ayurveda, homoeopathy, etc.). If that matters to you, pick one that does.

How to Actually Compare Two Health Insurance Policies (Step-by-Step)

Here’s how you can do this using https://joinditto.in:

1. Click on the “Health Insurance” dropdown and select “Compare Health Policies”.

2. You’ll now see a screen where you can pick the Insurer and the Policy you want to compare.

3. For example, let’s compare “HDFC Ergo Optima Restore” vs “Niva Bupa ReAssure”.

4. Hit Compare. You'll get a full-blown report side-by-side covering all the details we discussed above - from room rent limits to maternity cover and claim settlement.

✨The visual comparison (example below) makes it easier to spot the better value-for-money product based on your needs - not just premiums or brand names.

If you already have a policy but are not happy with it - you can actually Port your policy to another one.

Just like you would do with your mobile service provider.

Here is the process of how you can do this - https://www.policybazaar.com/health-insurance/portability/​

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Here's what you learned today:

• Comparing insurers > blindly chasing policy features
• Claim settlement ratio, network hospitals, and response time actually matter
• Room rent limits, co-pays, and waiting periods can ruin even a good-sounding policy

P.S - No affiliation with Ditto. The above comparison of Insurance policies is only for educational purposes.

Connect with me on LinkedIn, I write every day to help you make smarter money decisions👇

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