A comprehensive health insurance plan can significantly reduce the stress of unexpected medical emergencies. Hence, there are a few things that you should consider while buying a health plan to make an informed decision. One of such thing is the claim settlement ratio (CSR) of health insurance companies. Every health insurance company in India has a claim settlement ratio.
The ratio between the number of claims resolved and the total number of claims in a financial year is known as Claim Settlement Ratio or CSR in health insurance. It helps determine whether the insurer can settle the claims of the customers. For example, if 100 claims were filed during a financial year and 97 of those claims could be settled, then the claim settlement ratio for that particular year for that health insurance company would be 97%.
Claim Settlement Ratio is calculated as (total claims settled / total claims filed) multiplied by 100.
Mentioned below are some points that show us the importance of the claim settlement ratio in health insurance:
It is essential to compare the health insurance claim ratios of all health insurance companies when purchasing health insurance. A claim settlement ratio (CSR) of more than 85% is considered good. Check out the table below for the claim settlement and solvency ratio of health insurance companies in India:
*Disclaimer: We RenewBuy do not endorse any specific insurance company or insurance product offered by any insurer. This list is just an illustration of different health insurance companies available in India.
Insured Claims Ratio (ICR) is the ratio of the total claim amount paid by the health insurance company to the total premium amount collected in a financial year. For example, if a health insurance company has a claim ratio of 88%, it means that the insurer pays INR 88 for claim payments for every Rs 100 premium. The remaining INR 12 represents the profit of the insurance company.
Every year IRDAI publishes the incurred claim ratio of all health insurance companies. The insurance regulator provides specific ICRs for various forms of insurance along with the overall incurred claim ratio (ICR) of the health insurance company. Thus, the annual report of IRDAI can be used to estimate the claim ratio incurred by an insurance company for health insurance.
The Incurred Claims Ratio (ICR) is a critical metric used to assess the financial health and claims-settling efficiency of a health insurance company. It tells you how much of the premium income the company actually pays out in claims. Below, we have mentioned the incurred claim ratio of every health insurance company:
S.No. | Company Name | Incurred Claim Ratio (2022-23) | Solvency Ratio (2022-23) |
---|---|---|---|
Acko General Insurance Co. Ltd. | 83.88 | 4.26 | |
Bajaj Allianz General Insurance Co. Ltd. | 74.27 | 3.68 | |
Cholamandalam MS General Insurance Co. Ltd. | 67.88 | 2.07 | |
Future Generali India Insurance Co. Ltd. | 79.18 | 1.86 | |
Go Digit General Insurance Ltd. | 71.87 | 1.96 | |
HDFC ERGO General Insurance Co. Ltd. | 79.04 | 1.75 | |
ICICI Lombard General Insurance Co. Ltd. | 77.33 | 2.51 | |
IFFCO Tokio General Insurance Co. Ltd. | 111.18 | 1.73 | |
Kotak Mahindra General Insurance Co. Ltd. | 56.01 | 2.95 | |
Liberty General Insurance Co. Ltd. | 74.17 | 2.34 | |
Magma General Insurance Co. Ltd. | 72.10 | 2.19 | |
Navi General Insurance Co. Ltd. | 59.28 | 2.69 | |
Raheja General Insurance Co. Ltd. | 138.67 | 1.96 | |
Royal Sundaram General Insurance Co. Ltd. | 83.36 | 2.17 | |
SBI General Insurance Co. Ltd. | 73.92 | 1.86 | |
Tata General Insurance Co. Ltd. | 78.33 | 1.97 | |
Universal Sompo General Insurance Co. Ltd. | 82.84 | 1.73 | |
Zuno General Insurance Co. Ltd. | 89.59 | 1.72 | |
National Insurance Co. Ltd. | 102.35 | 0.16 | |
The New India Assurance Co. Ltd. | 103.33 | 1.82 | |
The Oriental Insurance Co. Ltd. | 130.09 | -0.63 | |
United India Insurance Co. Ltd. | 89.57 | 0.15 | |
Aditya Birla Health Insurance Co. Ltd. | 64.68 | 2.37 | |
Care Health Insurance Ltd. | 53.82 | 1.83 | |
ManipalCigna Health Insurance Co. Ltd. | 64.66 | 1.57 | |
Niva Bupa Health Insurance Co. Ltd. | 54.05 | 1.79 | |
Reliance Health Insurance Ltd. | 86.31 | 1.60 | |
Star Health and Allied Insurance Co. Ltd. | 65.00 | 2.03 |
*Disclaimer: We RenewBuy do not endorse any specific insurance company or insurance product offered by any insurer. This list is just an illustration of different health insurance companies available in India.
Finding the best health insurance company can be a daunting task for anyone as around 28 health insurance companies are available in the market. You can choose the health insurance company based on the claim settlement ratio. Hence, we have made a list of the top 10 health insurance companies based on their claim settlement ratios. Below mention is the list of the top 10 health insurance companies based on their claim settlement ratios in the year 2021-22:
Name of the Company | Claim Settlement Ratio (2022-23) |
---|---|
Care Health Insurance CSR | 100 |
Niva Bupa Health Insurance CSR | 100 |
ManipalCigna Health Insurance CSR | 99.96 |
Star Health Insurance CSR | 99.21 |
Aditya Birla Health Insurance CSR | 99.01 |
Reliance Health Insurance CSR | 98.75 |
HDFC Ergo Health Insurance CSR | 98.59 |
Zuno Health Insurance CSR | 98.54 |
ICICI Lombard Health Insurance CSR | 98.53 |
Acko Health Insurance CSR
| 97.68 |
*The above mentioned data has been sourced from the annual report of IRDAI 2022-23.
There are two types of claim settlement processes in health insurance, i.e. cashless claim process and the reimbursement claim process. Below mentioned are both the claims processes in detail:
Such claims can be filled in case of health insured avail of treatment at the network hospital of the health insurance company.
If a policyholder decides to get medical treatment at a hospital that is not a part of the insurance company's network hospitals, the policyholder can file a reimbursement claim. In such situations, the policyholder must pay the cost out of his pocket before submitting the claim to the health insurance company for reimbursement.
Below mentioned are the documents that you need to submit to fill up the claim in health insurance:
*Disclaimer: The documents mentioned above may vary from insurer to insurer.
You must check and compare the claim settlement ratio of health insurance companies before buying a health plan. This is due to the fact that a medical emergency will already give you a lot of mental stress. The last thing you would want to do in such a situation is to file a claim through a complex claim settlement process and worse, have your claim rejected. An easy and hassle-free claim settlement process will be provided to you by an health insurer with a high claim settlement ratio. So, below mentioned is the process to check the health insurance claim settlement process (CSR):
A health insurance plan can be offered at an affordable premium amount with comprehensive coverage and many additional benefits. However, if that health insurance company has a poor claim settlement ratio, you may find it difficult to settle claims when you need it the most. The whole point of buying health insurance would be failed.
Most health insurance claims are accepted due to the network hospitals of health insurance companies having the cashless facility. Claims will also be accepted if the policyholder is treated in a non-network hospital as long as the treatment is covered within the coverage benefit. Understanding that no insurance company will deny legitimate claim requests is essential.
The details, facts, or figures given here are intended solely for the reader's informational purposes and should not be relied upon for personal, medical, legal, or financial decisions. Please visit the insurer's website for the latest updates. We do not endorse any particular insurance company or insurance product provided by any insurer.