• Health Insurance: Agent vs. Broker

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    In this day and age, medical inflation, risk of unforeseen/untoward medical emergencies and tax benefits are often cited as some of the reasons to opt for a health insurance cover. You typically buy a health insurance cover from either a broker or an agent. More often than not, many often use the words broker and agent interchangeably without understanding the difference between the two.

    Who is a Health Insurance Agent?

    An insurance agent, more often than not, represents an insurance provider’s interests given that the latter cannot reach out to the target customers. Although licensed by IRDA and trained, insurance agents are not accountable in that they cannot be dragged to court. In case of any disputes, it is the insurance company which will be in the dock and find itself in legal wrangles. An agent, can however, get his or her license cancelled in case of any wrongdoings.

    Who is a Health Insurance Broker?

    A broker claims to act in the interest of the customer and can be dragged to court by the latter in case of any disputes. A broker offers a comparative analysis of various health insurance policies to the customer so the latter can opt for the best policy. Brokers and customers, therefore, share a fiduciary (legal) relationship based on trust. Brokers have a responsibility to help the customer choose an insurance policy most suitable to latter’s financial requirements.

    Differences between Health Insurance Agents and Brokers:

    The following table shows various differences between insurance brokers and agents

    Feature Insurance Agent Insurance Broker
    Loyalty Given that an insurance agent in most cases, represents the interests of only one insurance company, his or her main objective is to sell the maximum number of policies of the company A health insurance broker’s is not concerned with generating revenue for any single health insurance company. As a result, he or she works in the interest of the customer. Brokers help customers decide upon a policy
    Personalised service A health insurance agent works in an individual capacity, offering services to a specific number of clients to whom he can reach out at any time. Consequently, insurance agents provide more personalised services and attention to all customers As opposed to insurance agents, health insurance brokers, by and large, function by way of organizations. As a result, brokers may be more professional. All the same, the personalised attention, often cited as one of the strengths of agents is often lacking amongst brokers
    Knowledge Agents have to clear an exam and therefore have an in-depth and often thorough knowledge of their company’s health insurance policies. Also, in-house training is provided to agents. However, an agent does not have a proper understanding of health insurance policies offered by other companies apart from the one he or she represents Given that brokers are not attached to any single company and sell insurance policies of many companies, they have a wide knowledge base of all policies. There is a strict criteria in place for a broker to receive a license. A broker is also more accountable given that he or she is under the purview of IRDA for audit and other compliance procedures
    Negotiation Agents present the case of customers on an as-is basis and do not have the mandate to endorse or support the stand of the latter in case of any disputes Brokers have superior negotiation skills thanks to their enhanced domain knowledge. As a result, brokers are in a better position to address, negotiate and resolve any outstanding issues
    Specialization Agents, in most cases, sell various insurance products apart from health insurance and therefore, do not specialize in the said field There are brokerage firms which are specialized in the health insurance sector. The firms primarily sell health insurance policies
    Strict criteria Health insurance agents, in most cases, do not have to fulfill any strict eligibility criteria and regulations to receive their IRDA license since they do not have high stakes as compared to health insurance brokers Brokers have to meet strict regulations including investment in their business to receive the license. By default, therefore, brokers have more bigger stakes in their business and have more additional capabilities
    Robust processes Agents’ service largely depends upon their level of interaction with customers rather than an established process Brokers forms are more process-driven and have robust end-to end established processes in place
    All India Agents’ services are more or less restricted to his or her vicinity and depend upon TPAs for support of any kind Most broker firms have a pan-India presence and therefore, offer service sans support of any external agency
    Escalation Customers who wish to escalate any issue may not stand a good chance with agents given the latter’s limited exposure in his or her company Broker firms have several experts and liaise with various offices. As a result, brokers can help customers who wish to escalate any issue
    Volume Agents do not conduct huge volumes of business owing to their limited financial outlay Broker firms have more financial reach, brokers have higher volumes of business
    Value added services Agents, in most cases, provide health insurance policy services only Many brokers offer some services related to health insurance such as check-ups, wellness programmes and so forth
    TPAs Agents, by and large, interact with officials in their insurance office only and have little or no contact with TPAs (third party administrators) Brokerage firms or organisations have greater interface with various hospitals and third party administrators across the country on a regular basis
    Credibility Given that agents sell only one insurance product, they may not honestly reveal or focus on the flip side or drawbacks of a product. Customers should, therefore, examine the policy document carefully Brokerage firms or organizations, in all likelihood, may provide an honest assessment and comparison of various health insurance policies available in the market for the benefit of customers

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Health Insurance: Agent vs. Broker Reviews

  • Page 1 of 5 1 2 3 4 5
    • Apollo Munich Health Insurance
      "Health Security"
      0.5 5.0/5 "Blown Away!"
      Its a good product I got my Apollo Munich, the agent suggested best health policy. I have paid the premium around Rs.7000 for Life restore plan. I have taken the sum assured Rs. 5 lakhs its covers only for me. They are providing cash less facilities, financial security for unforeseen events. After one year they are providing 50% of medical benefits.
      Was this review helpful? 0
      , mumbai
      Reviewed on Jan 29, 2018
    • Star Health Health Insurance
      "Average"
      0.5 4.0/5 "Great!"
      I have taken a Health Insurance with Star Health through agent. I am happy with the service. The policy was taken seven years back. The customer service is good. I have taken coverage of 6lakh rupees. It is a family policy and I am paying around 12K yearly through cheque.
      Was this review helpful? 0
      , pune
      Reviewed on Nov 30, 2017
    • SBI General Health Insurance
      "Awesome "
      0.5 5.0/5 "Blown Away!"
      I do have health insurance policy with the SBI general insurance and I can say its the best one because of the requirement and plan. I used to dealt with the agent only and have not interacted with them directly. Plan benefits are also fine.
      Was this review helpful? 1
      , hyderabad
      Reviewed on May 22, 2017
    • Oriental Insurance Health Insurance
      "Need to explore"
      0.5 3.0/5 "Satisfactory"
      I do have health insurance policy with the Oriental insurance company and I have faced claims before fifteen days of time, also its still under the process. The premium is around 100000 Rupees and the coverage is for myself and my full family and the agent really worked well for me.
      Was this review helpful? 0
      , vadodara
      Reviewed on Apr 26, 2017
    • National Insurance Health Insurance
      "Good coverage for Entire Family"
      0.5 4.0/5 "Great!"
      National Insurance is a Trusted institute, I am holding this Health Insurance with them for past 15 Years, I used to pay Rs.4600 as a premium its per annum, They provided the policy coverage of Rs. 75,000 for three person in my family for a tenure of one annum then I will getting 10% of bounce insurance of another one year. I used to pay by cheque to the agent it was convenient. I have taken an individual policy but it covers my entire family.
      Was this review helpful? 0
      , kolkata
      Reviewed on Feb 15, 2017
    • HDFC Ergo Health Insurance
      "CHEATERS_HDFC ERGO "
      0.5 0.5/5 "Unacceptable"
      While taking the policy 'The HDFC ERGO' agent who had called to take the policy. I had clearly explained the condition stating ' My mother has sugar (it is under border) not taking any medications for now. She is under diet control' the agent mentioned ' it is not a diabetic since she is not undergoing any medications' you can mention she is not a diabetic. I have always opted corporate insurance and this is the first time I had opted external insurance. she had explained me the policy and procedures on how to claim and when the recording started she had asked me not to mention about diabetic. I had no issues of disclosing the information about diabetics as per the agent I mentioned 'no' since she is not undermedications.CHEATING,MAKING THE PUBLIC FOOL and selling the insurance policies. My mother was admitted in the hospital last week, the claim was not processed due to this reason. Is this my mistake?These guys are cheaters, they follow terms and conditions only while claiming.
      Was this review helpful? 1
      , bangalore
      Reviewed on Dec 24, 2016
    • Cigna TTK Health Insurance
      "Don't take any Policy of Cigna TTk/they will cheat you "
      0.5 0.5/5 "Unacceptable"
      Iam Manoj Pandey,a media professional, was having medicalim+accidental policy with HDFC Ergo since 2 years which was to be renewed on 9th Sept 2016. Meanwhile I got call from one of the agent Mr Sushant Badtiya (Mob-8097781336,email- sushantb@bajajcapital.com) somewhere on 18th August 2016 for porting my policy from HDFC Ergo to CignaTTK. Going through his lucrative plans I changed my mind to port my policy to cignattk for which I made payment also of Rs 6744 on 20th August 2016. But on my repeated followups I got the policy softcopy only on 30th Sept 2016. Now while going through the policy document I found myself cheated by Mr Sushant Badtiya. He told me on phone call and also through email that I will be getting OPD benefit of Rs 20000 in a year against my policy and accidental benefit of Rs 10 lacs in case of death and permanent disabilty. I have his phone call recorded in my cell phone for which I confirmed it many times.
      Was this review helpful? 2
      , ghaziabad
      Reviewed on Nov 10, 2016
    • Oriental Insurance Health Insurance
      "Excellent medical service"
      0.5 5.0/5 "Blown Away!"
      OBC Medical insurance came to my rescue once when my son was hospitalized once they had provided an amount of 17k I was expecting around 20k. I had just inquired about this to the policy agent and they took around a month's time to sanction it. I had just filled the application form and the rest was taken care by OBC,.
      Was this review helpful? 0
      , chennai
      Reviewed on Oct 21, 2016
    • New India Health Insurance
      "Worst Insurance"
      0.5 0.5/5 "Unacceptable"
      My dad was diagnosed with cancer and admitted to Fortis Mulund. He was in the hospital for about 2 weeks and then he passed away on June 20th. Both my parents were paying premiums for almost 15 years. There would be calls from the agent when it was close to paying premiums. He was very prompt in collecting the premium. Now when it is time to get reimbursed nobody even answers their phone. The cashless service through the hospital was a joke. Every day they would ask for 1 document or another. Eventually my dad passed away but the document list would just keep changing. It was something new everyday. Finally they ran out of documents that they could ask for. Now they don't even answer calls. If by chance we get a hold of some one they would say it is in process or the process hasn't even started. The answer depends on who we get on the line. When I asked why hasn't the process started yet after more than 2 months, the answer was "I don't know". This was the biggest joke.
      Was this review helpful? 2
      , mumbai
      Reviewed on Sep 05, 2016
    • United India Health Insurance
      "100% is always very good coverage"
      0.5 5.0/5 "Blown Away!"
      I have my two wheeler insurance with United Insurance for the past 7-8 years which I renew every year through payment of Rs.1600 to my agent. The insurance has a 100% coverage and covers accidental damages, theft, third party cover etc. The agents are quite helpful and approachable and handle everything and there is no need to run from pillar to post.
      Was this review helpful? 1
      , chennai
      Reviewed on May 21, 2016
    • National Insurance Health Insurance
      "Small scale mediclaim"
      0.5 5.0/5 "Blown Away!"
      I have a health insurance policy with National Insurance.I pay a premium of around Rs.8k on a yearly basis to my agent. It has a coverage amount of Rs.3 Lakhs and covers hospitalisation , bed charges and critical illness cover etc. I have had this since 8 years and have had the experience of claiming it once for an emergency. The claim process was easy and took just about 10 days as I have a very efficient agent and I got the full reimbursement.
      Was this review helpful? 2
      , kolkata
      Reviewed on May 20, 2016
    • United India Health Insurance
      "i got best of best"
      0.5 5.0/5 "Blown Away!"
      i just heard about online policy comparison but i am not convinced by the online as i have never done same before and i like to done it by agent, i just visit bankbazzar for just inquiry and i just got best of best that i never thought with much less amount the discussed with agent with lots of other policy comparision
      Was this review helpful? 1
      , surat
      Reviewed on Apr 28, 2016
    • ICICI Lombard Health Insurance
      "Very good experience"
      0.5 4.0/5 "Great!"
      I have an medical insurance or a health-care policy from ICICI Lombard which I took about a year back. I pay a premium of Rs.5000-6000 on a yearly basis by cheque to their agent. It has a good cover. It has a tax exemption benefits. It has been a hassle free experience so far with them.
      Was this review helpful? 1
      , secunderabad
      Reviewed on Apr 18, 2016
    • Star Health Health Insurance
      "RE:- Policy no P/* Policy. Senior Citizen Red Carpet Policy"
      0.5 1.0/5 "Really Bad"
      Even after informing the Agent all about the diseases they have not informed the company and provided me the insurance . Next year before renewal I revalided the same and norticed that the agent had fooled me and he hasnt provided any supporting document which could help Star in declining the claim. On top when I addressed this this is the reply given by the company . They tell al lthe mistakes are customers and agents dosent have any role in this . This is how they ash away . So never go with a company which is already predecided to be with fraud agent and cheat customers Dear Sir/Madam, We acknowledge your representation regarding the issue in incorporating PED in the above mentioned policy. In this connection, we would like to inform you that it is the responsibility of every customer to disclose all the previous medical history in the proposal form and our intermediary assist only to fill up the form. Informing orally to the agent/SM is not sufficient and the declaration
      Was this review helpful? 0
      , bangalore
      Reviewed on Apr 01, 2016
    • National Insurance Health Insurance
      "Excellent...."
      0.5 4.0/5 "Great!"
      I give nearly five thousand for one year where my entire family is been covered. Coverage value is three lakhs. One time I got reimbursement of 7k for my spouse. Claim experience was so nice and no flaws. My National Insurance agent look everything on this health insurance.
      Was this review helpful? 1
      , kolkata
      Reviewed on Mar 16, 2016
    • HDFC Ergo Health Insurance
      "Its okay"
      0.5 3.0/5 "Satisfactory"
      I get accidental claims through the HDFC health insurance policy. I took this accidental policy last year from an agent who approached me. I can get the claims up to 5 lakhs. Yearly basis I need to make a payment of 30,000. Itâ??s going good and fine.
      Was this review helpful? 0
      , navi mumbai
      Reviewed on Mar 09, 2016
    • L and T Health Insurance
      "Good..."
      0.5 4.0/5 "Great!"
      Agent suggested and also compared as I liked the policy at L&T General insurance. The no claim bonus in a year is is 5% and it does not come down. Normally companies give 30% for no claim and if we claim anything the bonus will be not there. Though we claim, the bonus remains the same as 5%. Ayurvedic medicines and treatments also claimable.
      Was this review helpful? 0
      , thane
      Reviewed on Feb 20, 2016
    • New India Health Insurance
      "Good for medical insurance..."
      0.5 4.0/5 "Great!"
      My friend is an agent of New India Assurance. Basically everything is covered and it is infact a cashless. Pregnancy, dental, cosmetic surgeries are not included, I guess. I can claim up to 5 lakhs for my entire family. In fact this is a group health insurance plan.
      Was this review helpful? 0
      , faridabad
      Reviewed on Feb 05, 2016
    • Religare Health Insurance
      "worst! claim did not pass "
      0.5 0.5/5 "Unacceptable"
      i got arthroscopic injury while playing badminton. i asked my agent if it will be covered under insurance, he said yes. so i asked surgeon to make a file for claim processing, for which he also charged extra. after 3 months of claim processing, they rejected claim on false accusation saying that injury is old!?
      Was this review helpful? 1
      , rajkot
      Reviewed on Jan 07, 2016
    • Religare Health Insurance
      "Excellent "
      0.5 4.5/5 "Excellent!"
      I have taken insurance by an agent....... I got dengue fever and it went to worst condition like the platelets count came to 30000 and doctor insisted me to join in the hospital..although I didn't get cardless treatment but they have done the claim amount very quickly to my account and I am willing to do it to my parents also. Totally very good experience and I recommend it to others also.
      Was this review helpful? 1
      , vijayawada
      Reviewed on Jan 06, 2016
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