Sector Update |
Update | Financials
Sector
28 February 2024
Indian Health Insurance
Loss ratios likely to moderate from the elevated 3QFY24 levels
Loss ratio trends for 9MFY24
9mFY23
79 78 78 74
9mFY24
67 65
66
55
82 80 84
78
67 60 66 76
Source: MOFSL
As a follow up to our
SAHI thematic report,
we analyze the industry trends along with
the financial performance of SAHIs and the health segment of key private players.
Slow growth and high loss ratios have been the key concerns for STARHEAL. However,
we note that the growth has been steady (16-18% YoY) and is driven by price hikes
and the sum assured. The policy growth rate has been restricted, though, owing to the
company’s conscious strategy of exiting certain cohorts.
Loss ratios for HDFC Ergo/ICICI Lombard/BAGIC rose 210bp/110bp/1,520bp YoY in
3QFY24, while Star Health/Care Health/Aditya Birla Health reported 390bp/620bp/
360bp YoY increase in loss ratios during the quarter. The increase was primarily due to
the elevated claims for respiratory disorders until Oct'23.
However, our channel checks have indicated an improved trajectory over the past
three months, which would help improve the loss ratios in 4QFY24.
Overall premiums in the health insurance segment continue to grow at a healthy pace,
with 10MFY24 growth at 20.8% YoY vs. overall general insurance industry growth of
13.1% YoY. The segment contributed 37.7% of the total premium vs. 35.3% in 10MFY23.
The retail health insurance segment recorded healthy growth of 19.1%/21.5% YoY in
10MFY24/Jan'24. Within this, SAHIs/Private/PSUs grew 24%/17%/10% YoY over
10MFY24 and rose 26%/17%/14% YoY in Jan'24.
With EOM regulations in force, the group segment posted a robust growth of 20%/
16% YoY in 10MFY24/Jan'24. Within this, SAHIs/Private/PSUs grew 36%/31%/9% YoY
over 10MFY24 and rose 36%/19%/1% YoY in Jan'24.
Considering the long-term growth potential for the industry, along with investments
by STARHEAL in profitable channels and products, we reiterate our BUY rating on the
stock with a TP of INR730 (based on 30x FY26E EPS).
Premium growth remains healthy across segments
During 10MFY24, the overall health insurance industry posted a growth of
20.8% YoY fueled by 19.1%/20.0%/27.0% YoY growth in Retail/Group/Govt.
schemes. SAHIs/Pvt/PSUs recorded a growth of 27%/41%/5% YoY. Ex-BAGIC,
which saw a 126% YoY surge, the private players posted a growth of 28% YoY.
In the retail health segment, SAHIs/Pvt/PSUs registered growth of 24%/
17%/10% YoY. The growth was fueled primarily by the price hikes implemented
and increase in the sum assured.
In terms of growth in retail health, CARE led the SAHI pack (~46% growth) over
10MFY24. Growth for STARHEAL was restricted to 17% YoY, owing to its
conscious strategy of exiting certain high-loss ratio cohorts. Similarly, among
private companies, TATA AIG/ILOM/HDFC Ergo/BAGIC reported growth of 30%/
20%/14%/12% YoY.
During 9MFY24, the policy growth rate for STARHEAL/CARE/Manipal
Cigna/Aditya Birla Health stood at 1.8%/13.1%/2.8%/6.7% YoY. For private
sector players, the rate of policy growth/decline for ILOM/Tata AIA/HDFC Ergo
was 6.8%/6%/-3.2% YoY.
In terms of growth in group health, Niva led the SAHI pack (~75% growth) over
10MFY24. Among private companies, TATA AIG/ILOM/HDFC Ergo/BAGIC
reported growth of 25%/31%/24%/46% YoY.
Investors are
28 February 2024
Research Analyst: Prayesh Jain
(Prayesh.Jain@MotilalOswal.com) |
Nemin Doshi
(Nemin.Doshi@MotilalOswal.com)
Research Analyst: Nitin Aggarwal
(Nitin.Aggarwal@MotilalOswal.com) |
Muskan Chopra
(Muskan.Chopra@MotilalOswal.com)
advised to refer through important disclosures made at the last page of the Research Report.
1
Motilal Oswal research is available on www.motilaloswal.com/Institutional-Equities, Bloomberg, Thomson Reuters, Factset and S&P Capital.
 Motilal Oswal Financial Services
Sector Update | Financials
Profitability to rebound
During 2Q and 3QFY24, loss ratio for the industry was elevated due to the spike
in monsoon-related respiratory disorders. Against previous year trends, the
incidences were significantly higher in Oct'23, as the month had sporadic rains.
However, our recent channel checks have indicated that the loss ratios have
normalized since Nov'23, and have extended in 4QFY24 as well.
Among SAHIs, STARHEAL/CARE/Aditya Birla posted an increase in the loss ratios
to 67%/60%/76% for 9MFY24. Manipal Cigna, on the other hand, recorded a
slight moderation in the loss ratio to 66% during the period.
Among private health insurance players, ILOM/HDFC Ergo/BAGIC reported an
increase in the loss ratios to 80%/82%/84% for 9MFY24. TATA AIG, on the other
hand, recorded a moderation in loss ratio to 77.6% during the period.
The insurance companies have implemented price hikes across the retail and
group health insurance products. The benefits of these hikes will be reaped over
the next 3-4 quarters.
From a profitability perspective, the claim ratios would normalize as price hikes
would offset medical inflation. The Expense of Management (EOM) ratios
should moderate with scale benefits. The EOM regulations will help companies
manage between commissions and expenses, thus enabling growth across all
channels. Consequently, with these benefits, we believe that the overall
combined ratio will improve going forward.
Among SAHIs, STARHEAL/CARE/Aditya Birla reported an increase in combined
ratios to 98%/97%/121% for 9MFY24. Manipal Cigna, on the other hand, posted
a slight improvement in the combined ratio to 116% for the period.
Among private health insurance players, ILOM/HDFC Ergo recorded an increase in
combined ratios to 107%/104% for 9MFY24. TATA AIG/BAGIC, on the other hand,
posted an improvement in the combined ratios to 112%/101% for the period.
Considering the long-term potential, the overall health insurance industry is well
poised for growth and is on track to achieve 5x-8x industry size by 2030. We
remain optimistic on the overall prospects for STARHEAL, backed by: a) its
strong growth in the retail health industry, given the under-penetration, b) its
increasing focus on tightening the underwriting standards, c) the strong push
from the banca channel, where it will underwrite benefit-based products that
have a relatively better profitability, d) the sustained growth in specialized
products, and 5) its deepening presence. We expect STARHEAL to report a
NEP/PAT CAGR of 17%/34% during FY23-26.
We reiterate our BUY rating with a
TP of INR730 (based on 30x FY26E EPS).
Exhibit 2:
Retail health growth continues to be healthy
GWP (INR b)
60%
45%
30%
15%
0%
60
45
30
15
0
Growth % (YoY)
48%
36%
24%
12%
0%
Valuation and view
Exhibit 1:
Health insurance GWP remains strong
GWP (INR b)
120
90
60
30
0
Growth % (YoY)
Source: MOFSL
28 February 2024
Source: MOFSL
2
 Motilal Oswal Financial Services
Sector Update | Financials
Exhibit 3:
Group segment premiums continue to grow
GWP (INR b)
80
60
40
20
0
Growth % (YoY)
60%
40%
20%
0%
-20%
Exhibit 4:
SAHI’s market share in retail health continues to
trend up
60%
55%
50%
45%
40%
SAHI
Source: MOFSL
Source: MOFSL
Exhibit 5:
Loss ratio trends for 3QFY24
Loss ratio (%)
79
77
78
81
78
79
71
Exhibit 6:
Loss ratio trends for 9MFY24
3QFY24
66
61
64
73
77
3QFY23
64
9mFY23
79
78
78
78
74
84 66
67
9mFY24
65
86
68
55
82
80
67 55 60
66
76
Source: MOFSL
Source: MOFSL
Exhibit 7:
Combined ratio trends for 3QFY24
Combined ratio (%)
119
108
104
103
113
109
112
112
3QFY23
126
95
98
94
100
115
3QFY24
118
125
Exhibit 8:
Combined ratio trends for 9MFY24
Combined ratio (%)
119
106
104
99
97
112
107
104
101
98
9mFY23
118
116
9mFY24
114
121
93
97
Source: MOFSL
Source: MOFSL
Note – For multi-line players, the above charts reflect data points only for the Health segment
28 February 2024
3
 Motilal Oswal Financial Services
Sector Update | Financials
Exhibit 9:
STARHEAL’s performance
INR m
Retail
Group
PA
Travel
GDP
NWP
NEP
Net claims
Claims ratio
Net commission
Commission ratio
Opex
Opex ratio
U/W Profit/(Loss)
Combined ratio
3QFY24
33,012
2,535
490
11
36,058
31,519
32,936
22,295
67.7
3,499
11.1
6,001
19.0
1,142
97.8
3QFY23
28,306
2,171
487
4
30,967
29,434
28,672
18,278
63.7
4,026
13.7
5,115
17.4
1,253
94.8
% YoY
16.6
16.8
0.6
158.5
16.4
7.1
14.9
22.0
394bp
-13.1
-258bp
17.3
166bp
302bp
9mFY24
94,346
7,032
1,431
45
1,02,861
94,974
95,430
64,226
67.3
12,021
12.7
17,370
18.3
1,813
98.2
9mFY23
80,455
5,717
1,335
13
87,532
83,264
83,491
55,150
66.1
11,210
13.5
14,436
17.3
2,695
96.9
% YoY
17.3
23.0
7.2
243.8
17.5
14.1
14.3
16.5
125bp
7.2
-81bp
20.3
95bp
139bp
Source: Company, MOFSL
Exhibit 10:
Care Health’s performance
INR m
Retail
Group
PA
Travel
GDP
NWP
NEP
Net claims
Claims ratio
Net commission
Commission ratio
Opex
Opex ratio
U/W Profit/(Loss)
Combined ratio
3QFY24
9,416
6,319
493
204
16,432
14,490
12,834
7,851
61.2
2,451
16.9
3,141
21.7
-609
99.8
3QFY23
6,416
4,981
874
237
12,508
11,178
9,696
5,334
55.0
1,342
12.0
3,030
27.1
-11
94.1
% YoY
46.8
26.9
-43.6
-14.0
31.4
29.6
32.4
47.2
616bp
82.6
491bp
3.6
-544bp
563bp
9mFY24
26,484
19,226
1,632
930
48,271
42,534
37,316
22,416
60.1
6,999
16.5
8,709
20.5
-808
97.0
9mFY23
18,076
14,766
2,611
1,008
36,461
32,573
27,304
14,958
54.8
3,384
10.4
8,998
27.6
-35
92.8
% YoY
46.5
30.2
-37.5
-7.8
32.4
30.6
36.7
49.9
529bp
106.8
607bp
-3.2
-715bp
421bp
Source: Company, MOFSL
28 February 2024
4
 Motilal Oswal Financial Services
Sector Update | Financials
Exhibit 11:
Manipal Cigna’s performance
INR m
Retail
Group
PA
Travel
GDP
NWP
NEP
Net claims
Claims ratio
Net commission
Commission ratio
Opex
Opex ratio
U/W Profit/(Loss)
Combined ratio
3QFY24
1,758
2,106
77
5
3,946
3,775
3,524
2,244
63.7
843
22.3
1,095
29.0
-658
115.0
3QFY23
1,362
1,982
88
4
3,436
3,274
2,815
1,871
66.5
353
10.8
1,589
48.5
-997
125.8
% YoY
29.1
6.3
-13.0
22.7
14.8
15.3
25.2
19.9
-279bp
139.2
1157bp
-31.1
-1952bp
-1074bp
9mFY24
5,063
6,091
238
17
11,409
10,916
9,946
6,568
66.0
2,112
19.3
3,328
30.5
-2,062
115.9
9mFY23
3,883
5,271
221
11
9,387
8,972
7,758
5,177
66.7
942
10.5
3,690
41.1
-2,051
118.4
% YoY
30.4
15.6
7.8
44.7
21.5
21.7
28.2
26.9
-70bp
124.2
885bp
-9.8
-1064bp
-249bp
Source: Company, MOFSL
Exhibit 12:
Aditya Birla Health’s performance
INR m
Retail
Group
PA
GDP
NWP
NEP
Net claims
Claims ratio
Net commission
Commission ratio
Opex
Opex ratio
U/W Profit/(Loss)
Combined ratio
3QFY24
2,609
5,167
534
8,389
6,588
5,809
4,465
76.9
1,080
16.4
2,078
31.5
-1,814
124.8
3QFY23
1,826
3,639
413
5,878
4,861
4,100
3,002
73.2
397
8.2
1,793
36.9
-1,092
118.3
% YoY
42.9
42.0
29.4
42.7
35.5
41.7
48.7
364bp
172.0
822bp
15.9
-534bp
653bp
9mFY24
7,325
14,966
1,443
23,994
18,747
16,941
12,870
76.0
3,036
16.2
5,350
28.5
-4,314
120.7
9mFY23
5,753
11,633
1,199
18,584
15,366
12,495
8,126
65.0
804
5.2
6,684
43.5
-3,118
113.8
% YoY
27.3
28.7
20.4
29.1
22.0
35.6
58.4
1093bp
277.8
1096bp
-20.0
-1496bp
694bp
Source: Company, MOFSL
28 February 2024
5
 Motilal Oswal Financial Services
Sector Update | Financials
Exhibit 13:
ICICI Lombard’s performance (Health segment)
INR m
Retail
Group
PA
Travel
GDP
NWP
NEP
Net claims
Claims ratio
Net commission
Commission ratio
Opex
Opex ratio
U/W Profit/(Loss)
Combined ratio
3QFY24
2,868
10,922
1,996
464
16,251
14,741
15,473
12,261
79.2
1,609
10.9
2,726
18.5
-1,123
108.6
3QFY23
2,468
8,586
1,564
438
13,057
11,007
11,230
8,776
78.1
56
0.5
3,183
28.9
-785
107.6
% YoY
16.2
27.2
27.6
5.9
24.5
33.9
37.8
39.7
109bp
2,768.6
1041bp
-14.4
-1042bp
107bp
9mFY24
8,475
37,121
5,711
1,885
53,192
47,574
42,406
34,007
80.2
4,417
9.3
8,481
17.8
-4,499
107.3
9mFY23
7,112
28,215
4,353
1,714
41,393
35,692
31,903
24,876
78.0
216
0.6
9,806
27.5
-2,995
106.1
% YoY
19.2
31.6
31.2
9.9
28.5
33.3
32.9
36.7
222bp
1,948.8
868bp
-13.5
-965bp
125bp
Source: Company, MOFSL
Exhibit 14:
BAGIC’s performance (Health segment)
INR m
Retail
Group
Govt
PA
Travel
GDP
NWP
NEP
Net claims
Claims ratio
Net commission
Commission ratio
Opex
Opex ratio
U/W Profit/(Loss)
Combined ratio
3QFY24
2,329
5,892
2,280
540
408
11,450
7,445
7,532
6,495
86.2
618
8.3
1,323
17.8
-905
112.3
3QFY23
2,039
4,347
0
635
341
7,361
6,199
5,764
4,093
71.0
208
3.4
1,836
29.6
-374
104.0
% YoY
14.3
35.6
-
-15.0
19.8
55.5
20.1
30.7
58.7
1521bp
197.3
495bp
-27.9
-1185bp
832bp
9mFY24
6,871
21,364
25,325
1,840
1,526
56,926
25,663
20,629
17,277
83.8
168
0.7
4,143
16.1
-959
100.6
9mFY23
6,175
14,640
1,927
1,669
1,277
25,689
18,544
16,773
12,421
74.1
64
0.3
5,471
29.5
-1,183
103.9
% YoY
11.3
45.9
10.2
19.5
121.6
38.4
23.0
39.1
970bp
161.4
31bp
-24.3
-1336bp
-335bp
Source: Company, MOFSL
28 February 2024
6
 Motilal Oswal Financial Services
Sector Update | Financials
Exhibit 15:
HDFC Ergo’s Health performance
INR m
Retail
Group
PA
Travel
GDP
NWP
NEP
Net claims
Claims ratio
Net commission
Commission ratio
Opex
Opex ratio
U/W Profit/(Loss)
Combined ratio
3QFY24
9,221
4,285
1,257
55
14,818
8,807
9,786
7,887
80.6
1,000
11.4
1,757
19.9
-857
111.9
3QFY23
7,941
3,228
1,292
56
12,517
8,085
8,859
6,951
78.5
-62
-0.8
2,010
24.9
-40
102.6
% YoY
16.1
32.7
-2.7
-1.6
18.4
8.9
10.5
13.5
213bp
-1,707.6
1212bp
-12.6
-492bp
933bp
9mFY24
26,135
12,809
4,428
269
43,641
27,009
29,001
23,909
82.4
1,368
5.1
4,424
16.4
-700
103.9
9mFY23
22,910
10,250
4,862
248
38,270
25,108
25,789
20,114
78.0
-328
-1.3
5,688
22.7
315
99.3
% YoY
14.1
25.0
-8.9
8.7
14.0
7.6
12.5
18.9
445bp
-517.3
637bp
-22.2
-627bp
454bp
Source: Company, MOFSL
Exhibit 16:
Tata AIG’s Health performance
INR m
Retail
Group
PA
Travel
GDP
NWP
NEP
Net claims
Claims ratio
Net commission
Commission ratio
Opex
Opex ratio
U/W Profit/(Loss)
Combined ratio
3QFY24
1,975
3,904
475
803
7,158
6,261
6,095
4,681
76.8
1,171
18.7
1,078
17.2
-836
112.7
3QFY23
1,522
3,280
1,663
600
7,064
5,577
5,178
4,071
78.6
379
6.8
1,851
33.2
-1,122
118.6
% YoY
29.8
19.0
-71.4
33.9
1.3
12.3
17.7
15.0
-181bp
209.5
1192bp
-41.8
-1598bp
-586bp
9mFY24
5,810
12,686
1,494
2,677
22,667
20,116
17,669
13,708
77.6
3,535
17.6
3,313
16.5
-2,887
111.6
9mFY23
4,464
9,930
3,812
2,071
20,277
16,670
15,175
12,013
79.2
1,042
6.3
5,610
33.7
-3,491
119.1
% YoY
30.1
27.8
-60.8
29.3
11.8
20.7
16.4
14.1
-158bp
239.1
1132bp
-40.9
-1718bp
-745bp
Source: Company, MOFSL
Investment in securities market are subject to market risks. Read all the related documents carefully before investing
28 February 2024
7
 Motilal Oswal Financial Services
Sector Update | Financials
NOTES
28 February 2024
8
 Motilal Oswal Financial Services
Sector Update | Financials
Explanation of Investment Rating
Investment Rating
BUY
SELL
NEUTRAL
UNDER REVIEW
NOT RATED
Expected return (over 12-month)
>=15%
< - 10%
> - 10 % to 15%
Rating may undergo a change
We have forward looking estimates for the stock but we refrain from assigning recommendation
*In case the recommendation given by the Research Analyst is inconsistent with the investment rating legend for a continuous period of 30 days, the Research Analyst shall within following 30 days take
appropriate measures to make the recommendation consistent with the investment rating legend.
Disclosures:
The following Disclosures are being made in compliance with the SEBI Research Analyst Regulations 2014 (herein after referred to as the Regulations).
Motilal Oswal Financial Services Ltd. (MOFSL) is a SEBI Registered Research Analyst having registration no. INH000000412. MOFSL, the Research Entity (RE) as defined in the Regulations, is engaged in
the business of providing Stock broking services, Depository participant services & distribution of various financial products. MOFSL is a listed public company, the details in respect of which are available on
www.motilaloswal.com.
MOFSL (erstwhile Motilal Oswal Securities Limited - MOSL) is registered with the Securities & Exchange Board of India (SEBI) and is a registered Trading Member with National Stock
Exchange of India Ltd. (NSE) and Bombay Stock Exchange Limited (BSE), Multi Commodity Exchange of India Limited (MCX) and National Commodity & Derivatives Exchange Limited (NCDEX) for its stock
broking activities & is Depository participant with Central Depository Services Limited (CDSL) National Securities Depository Limited (NSDL),NERL, COMRIS and CCRL and is member of Association of Mutual
Funds of India (AMFI) for distribution of financial products and Insurance Regulatory & Development Authority of India (IRDA) as Corporate Agent for insurance products. Details of associate entities of Motilal
Oswal Financial Services Ltd. are available on the website at
http://onlinereports.motilaloswal.com/Dormant/documents/Associate%20Details.pdf
Details of pending Enquiry Proceedings of Motilal Oswal Financial Services Limited are available on the website at
https://galaxy.motilaloswal.com/ResearchAnalyst/PublishViewLitigation.aspx
MOFSL, it’s associates, Research Analyst or their relatives may have any financial interest in the subject company. MOFSL and/or its associates and/or Research Analyst or their relatives may have actual
beneficial ownership of 1% or more securities in the subject company at the end of the month immediately preceding the date of publication of the Research Report or date of the public appearance. MOFSL
and its associate company(ies), their directors and Research Analyst and their relatives may have any other potential conflict of interests at the time of publication of the research report or at the time of public
appearance, however the same shall have no bearing whatsoever on the specific recommendations made by the analyst(s), as the recommendations made by the analyst(s) are completely independent of the
views of the associates of MOFSL even though there might exist an inherent conflict of interest in some of the stocks mentioned in the research report.
In the past 12 months, MOFSL or any of its associates may have:
a) received any compensation/other benefits from the subject company of this report
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Companies where there is interest
Analyst ownership of the stock
No
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28 February 2024
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 Motilal Oswal Financial Services
Sector Update | Financials
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Registration details of group entities.: Motilal Oswal Financial Services Ltd. (MOFSL): INZ000158836 (BSE/NSE/MCX/NCDEX); CDSL and NSDL: IN-DP-16-2015; Research Analyst: INH000000412 . AMFI:
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28 February 2024
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