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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

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  • National Insurance Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my health insurance with National insurance from past few years, there service is good, they have tie up with many hospital , and they have shared me an excel with there location, and the agent had explained me clearly about the policy benefit, and i use to pay premium on yearly basis, they have charged nominal premium amount.
    Was this review helpful? 0
    , patna
    Reviewed on Dec 08, 2018
  • Religare Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my health insurance with Religare insurance from past few years, there service is good, they have tie up with many hospital , and they have shared me an excel with there location, and the agent had explained me clearly about the policy benefit, my company pay this health insurance premium.
    Was this review helpful? 0
    , hosur
    Reviewed on Dec 08, 2018
  • Religare Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been using my health insurance with National insurance from past few years, there service is good, they have tie up with many hospital , and they have shared me an excel with there location, and the agent had explained me clearly about the policy benefit, my company pay this health insurance premium.
    Was this review helpful? 0
    , hosur
    Reviewed on Dec 08, 2018
  • ICICI Lombard Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have taken my health insurance with ICICI lombard, there service is good, there agent had explain me about the policy which is covered in this insurance and they have tie up with many hospital and they have shared me there location , and the premium amount they have charged me was nominal.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Dec 07, 2018
  • Apollo Munich Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have taken my health insurance with Apollo Munich, there service is good, there agent had explain me about the policy which is covered in this insurance and they have tie up with many hospital and they have shared me there location , and the premium amount they have charged me up to 11,000, i use to pay through on line.
    Was this review helpful? 0
    , bhubaneshwar
    Reviewed on Dec 07, 2018
  • Cigna TTK Health Insurance
    "Best service"
    0.5 4.5/5 "Excellent!"
    I have been using my health insurance with Cigna TTK health insurance, i have just been a year ago i have applied this insurance , and there agent had explain me about the policy of this insurance and they have tie up with many hospital and i use to pay premium up to 8,000 it is nominal for me and it is yearly basis, till now i have not use policy yet.
    Was this review helpful? 0
    , mumbai
    Reviewed on Nov 28, 2018
  • United India Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have been using my health insurance with UNITED INDIA , and there agent had explain me about the policy of this insurance and they have tie up with many hospital and i use to pay premium up to 13,000 it is bit high , there overall service is good.
    Was this review helpful? 0
    , pune
    Reviewed on Nov 28, 2018
  • Star Health Health Insurance
    "Good policy"
    0.5 4.0/5 "Great!"
    I have taken a health insurance policy with Star Health. The services are good and my father had a good experience. I don't have any claim experience. The customer service is good. The agent will intimate early for the policy renewal. The policy coverage is 10L.
    Was this review helpful? 0
    , chennai
    Reviewed on Nov 23, 2018
  • ICICI Lombard Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have been holding my health insurance with ICICI prudential , i have been using this increase from past 10 years and the premium they have charged me up to 18,000 it is nominal for me and i use to pay premium amount in yearly basis and i use to pay in off line mode i usually give cheque to agent to pay , and this insurance has many tie up with different hospitals.
    Was this review helpful? 0
    , new delhi
    Reviewed on Nov 22, 2018
  • Star Health Health Insurance
    "Excellent Service"
    0.5 5.0/5 "Blown Away!"
    I've a health insurance policy from the Star health Insurance. I Can contact agent directly, claim processing easy . They offer excellent service. I've availed cashless treatments. For the surgery of my father I even claimed 4 lacs which was a best experience. Overall I am really impressed with their services.
    Was this review helpful? 1
    , mumbai
    Reviewed on Jun 27, 2018
  • National Insurance Health Insurance
    "Average"
    0.5 3.0/5 "Satisfactory"
    I took my health insurance with National Insurance through an agent. The policy coverage was 5L which covers the entire family. The customer service was not good. They don't respond properly. I don't have any claim experience. I am paying 11,000 rupees yearly through cheque.
    Was this review helpful? 0
    , kolkata
    Reviewed on Mar 13, 2018
  • National Insurance Health Insurance
    "Decent insurer"
    0.5 4.0/5 "Great!"
    I took my health insurance in National Insurance for last 3 years. As of now I don't have any claim experience. The policy was taken through family agent. The premium was decent and good compared to others. The policy coverage was 5L for the entire family. They have a good network of hospitals for the cashless treatment.
    Was this review helpful? 0
    , faridabad
    Reviewed on Mar 10, 2018
  • 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
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