Please help choosing Health insurance - Niva Bupa Reassure 2.0 or HDFC Ergo Optima restore

See, ICR alone does not provide entire picture. You need to also look more closely at claims paid ratio, claims rejected + repudiated ratio, and claims pending ratio.

- Claims paid ratio needs to be high, as simple as that.
- Claims rejected + repudiated ratio needs to be low.
- Claims pending ratio also needs to be low.

PS: Claims pending ratio won't be much useful if you only plan to go for cashless admission, but the thing is you never know. Also, claims pending ratio tells you about attitude of the company.

Now, as per latest data uploaded by IRDAI in its annual report:
- HDFC ERGO GI's health insurance part had 15% increase in premium collection (India) over last year, but 22.9% increase in ICR, so that's a negative for us in a manner to say. However, it had 92% claims paid ratio and 4% claims rejected and pending ratio each.
- Niva Bupa had 60% growth in premium collection, but only 10.75% increase (56 to 62) in ICR from previous FY. That's a positive as compared to HDFC, but ruko zara sabar karo. Claims paid ratio was 89%, claims rejected ratio was 9% and 2% claims pending ratio.

So rejection rate is actually higher in Niva even though its growth was much higher than HDFC. And now if you read this info in conjunction with ICR, you can see that out of every 100 claims:
- Niva Bupa paid 89 claims and spent only 62% of their funds collection.
- Whereas HDFC ERGO paid 92 claims and spent 97.5% funds.

This can imply 3 things:
1. Either average claim size (amount) in Niva is very low, or
2. Niva has relatively low package rates, which is definitely a bummer, or
3. Niva is rejecting/delaying large amount claims.

This may or may not be intentional from Niva's side, I don't know, but data sure tells this story. If some dimers can think of more reasons/points or a different PoV, pls feel free to add.

But you also have to see things in full perspective. Even with this negative picture, Niva is still 3rd from top if claims paid ratio (89%) is considered. New India Assurance and HDFC are the only ones to beat it. However, I feel if your claim is genuine, then you don't really need to worry much (except if package rates themselves are low then helpless). TBH, even I'm more inclined towards Niva as both Elephant insurance and InsuranceDekho suggested Niva, and its pricing & features are also better than others.

Niva Bupa Reassure 2.0 has restriction on robotic surgery(1L per claim) ... which is big drawback. 

Lot of surgeries this days are done via robotic