Objective: This paper examines the effect of risk culture on the performance of risk management in insurance companies providing complementary health insurance, in terms of neoclassical economics and enterprise risk management. Methodology: The Analytic hierarchy process (AHP) was used in this study. Findings: The principles of risk management as well as four cultures-based theory of multiple rationality were presented and the principles of neoclassical economics and enterprise risk management were analyzed for insurance companies offering complementary health insurance. The principles of "enterprise risk management" with weight of 62. 1% has gained the highest rank compared to "neoclassical economics" with weight of 37. 9% in relation to overall goal. Also, "risk appetite" and "separate measurement and management of risk" criteria in selection of enterprise risk management gained the highest weight compared to other criteria. Conclusion: The principles of risk culture is best compatible with the principles of enterprise risk management, but this does not mean that the principles of enterprise risk management and the neoclassical economy cannot be used simultaneously in a company. Generally, the insurance companies choose a combination of these principles. In other words, insurance companies select a combination of four approaches based on the theory of multiple rationality. Also, considering that the attitude of Central Insurance Organization of Islamic Republic of Iran to the risk strategy has the impact on the risk culture of insurance companies, it is recommended that Central Insurance Organization adopts an optimal attitude according to the conditions and necessities of the insurance industry.