Health Insurance

Health Insurance Claim Settlement Ratio

Health insurance can help us avoid financial stress, an important lesson the pandemic has taught us and continues to teach us today. Given the rise in hospital bills and medical costs associated with…

Health insurance can help us avoid financial stress, an important lesson the pandemic has taught us and continues to teach us today. Given the rise in hospital bills and medical costs associated with critical illnesses, the importance of a health insurance policy cannot be overstated at this point in time. 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.

Claim Settlement Ratio in Health Insurance

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.

Importance of Claim Settlement Ratio (CSR) in Health Insurance

Mentioned below are some points that show us the importance of the claim settlement ratio in health insurance:

  • Provides information regarding the company's ability to pay claims.
  • An effective metric for comparing health insurers
  • A look at the constancy of insurers in settling claims
  • An excellent way to measure a company's reliability

Health Insurance Companies Claim Settlement Ratio

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

S.No

Health Insurance Company

Claim Settlement Ratio (2021-22)

1.

Acko General Insurance Ltd.

97.20

2.

Aditya Birla Health Insurance Co. Ltd

99.41

3.

Bajaj Allianz General Insurance Co. Ltd

96.59

4.

Care Health Insurance Ltd.

100

5.

Cholamandalam MS General Insurance Co. Ltd.

93.23

6.

Go Digit General Insurance Ltd.

96.09

7.

Edelweiss General Insurance Co. Ltd.

97.26

8.

Future Generali India Insurance Co. Ltd.

96.01

9.

HDFC ERGO General Insurance Co. Ltd.

98.49

10.

ICICI Lombard General Insurance Co. Ltd.

97.07

11.

IFFCO Tokio General Insurance Co. Ltd.

89.38

12.

Kotak Mahindra General Insurance Co. Ltd.

96.90

13.

Liberty General Insurance Ltd.

97.30

14.

Magma HDI General Insurance Co. Ltd.

92.34

15.

ManipalCigna Health Insurance Co. Ltd.

99.90

16.

Niva Bupa Insurance Company

99.99

17.

National Insurance Co. Ltd.

86.28

18.

Navi General Insurance Ltd.

99.99

19.

The New India Assurance Co. Ltd.

92.93

20.

The Oriental Insurance Co. Ltd.

90.18

21.

Raheja QBE General Insurance Co. Ltd.

93.30

22.

Royal Sundaram General Insurance Co. Ltd.

95.95

23.

Reliance General Insurance Co. Ltd.

98.65

24.

SBI General Insurance Co. Ltd.

95.04

25.

Star Health and Allied Insurance Co. Ltd.

99.06

26.

Tata AIG General Insurance Co. Ltd.

93.55

27.

Universal Sompo General Insurance Co. Ltd.

95.77

28.

United India Insurance Co. Ltd.

97.25

*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.

What is Incurred Claim Ratio (ICR) in Health Insurance?

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.

Where can I Check Incurred Claim Ratio of an 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.

Incurred Claims Ratio of Health Insurance Companies

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)

  1.  

Acko General Insurance Co. Ltd.

83.88

4.26

  1.  

Bajaj Allianz General Insurance Co. Ltd.

74.27

3.68

  1.  

Cholamandalam MS General Insurance Co. Ltd.

67.88

2.07

  1.  

Future Generali India Insurance Co. Ltd.

79.18

1.86

  1.  

Go Digit General Insurance Ltd.

71.87

1.96

  1.  

HDFC ERGO General Insurance Co. Ltd.

79.04

1.75

  1.  

ICICI Lombard General Insurance Co. Ltd.

77.33

2.51

  1.  

IFFCO Tokio General Insurance Co. Ltd. 

111.18

1.73

  1.  

Kotak Mahindra General Insurance Co. Ltd.

56.01

2.95

  1.  

Liberty General Insurance Co. Ltd.

74.17

2.34

  1.  

Magma General Insurance Co. Ltd.

72.10

2.19

  1.  

Navi General Insurance Co. Ltd.

59.28

2.69

  1.  

Raheja General Insurance Co. Ltd.

138.67

1.96

  1.  

Royal Sundaram General Insurance Co. Ltd.

83.36

2.17

  1.  

SBI General Insurance Co. Ltd.

73.92

1.86

  1.  

Tata General Insurance Co. Ltd.

78.33

1.97

  1.  

Universal Sompo General Insurance Co. Ltd.

82.84

1.73

  1.  

Zuno General Insurance Co. Ltd.

89.59

1.72

  1.  

National Insurance Co. Ltd.

102.35

0.16

  1.  

The New India Assurance Co. Ltd.

103.33

1.82

  1.  

The Oriental Insurance Co. Ltd.

130.09

-0.63

  1.  

United India Insurance Co. Ltd.

89.57

0.15

  1.  

Aditya Birla Health Insurance Co. Ltd.

64.68

2.37

  1.  

Care Health Insurance Ltd.

53.82

1.83

  1.  

ManipalCigna Health Insurance Co. Ltd.

64.66

1.57

  1.  

Niva Bupa Health Insurance Co. Ltd.

54.05

1.79

  1.  

Reliance Health Insurance Ltd. 

86.31

1.60

  1.  

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.

List of Top 10 Claim Settlement Ratio Health Insurance Companies 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 (2021-22)

Care Health Insurance CSR

100

Niva Bupa Health Insurance CSR

99.99

Navi Health Insurance CSR

99.99

ManipalCigna Health Insurance CSR

99.90

Aditya Birla Health Insurance CSR

99.41

Liberty General Health Insurance CSR

99.30

Edelweiss Health Insurance CSR

99.26

Star Health Insurance CSR

99.06

Reliance Health Insurance CSR

98.65

HDFC Ergo Health Insurance CSR

98.49

*The above mentioned data has been sourced from the annual report of IRDAI 2021-22.

Health Insurance Claim Settlement Process

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:

Cashless Claim Process

Such claims can be filled in case of health insured avail of treatment at the network hospital of the health insurance company.

  • Claim Intimation
  • Documents Verification
  • Documents Approval
  • Claim Settlement

Reimbursement Claim Process

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.

  • Intimate the claim to the health insurance company
  • Document Submission
  • Document Approval
  • Claim Reimbursement

Required Documents For Claim Settlement

Below mentioned are the documents that you need to submit to fill up the claim in health insurance:

  • Duly-filled claim form
  • ID proof of the claimant
  • Medical certificate issued by the doctor
  • FIR (In case of an accident)
  • Prescription and cash invoice from pharmacy/hospital

*Disclaimer: The documents mentioned above may vary from insurer to insurer.

How to Check Health Insurance Claim Settlement Ratio

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):

  • The IRDA (Insurance Regulatory and Development Authority) releases their annual report every year, where you can check the list of all the health insurance claim settlement ratio.
  • Check the IRDA health insurance claim settlement ratio of your desired insurance provider by visiting the official website of IRDA. View IRDA Annual Report and save the PDF for the most recent financial year.
  • Make a list of the health insurance companies with claim settlement ratio in 2022. Higher the claim settlement ratio, better are the chances of getting the claim amount in case of a medical emergency.
  • Compare the coverage benefits of the health insurance plans that are now offered by health insurance companies with a high claim settlement ratio.

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.

Conclusion

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.

Health Insurance Claim Settlement Ratio: FAQs

As per the annual report of IRDAI, Care Health Insurance has the highest claim settlement ratio of 100% in the year 2021-2022.

Generally, a claim settlement ratio of above 80% is considered a good claim settlement ratio in health insurance.

The health insurance claim settlement ratio is a percentage that shows the number of claims settled out of the total number of claims filed by a health insurance company. For example, a claim settlement ratio of 90% shows that the health insurance company has settled 90 claims out of 100 claims filled by the policyholders.

Claim Settlement Ratio is calculated as (total claims settled / total claims filed) multiplied by 100.

The claim settlement ratio is very much different from the incurred claim ratio. The below table shows the difference between the claim settlement ratio and incurred claim ratio:

Incurred Claim Ratio Claim Settlement Ratio
It tells us about the amount spent on claims It tells us about the number of claims settled by a health insurance company
Higher percentage may not be an indicator of performance High percentage shows the good claim settling ability

Insurance Regulatory and Development Authority (IRDAI) publishes annual reports every year in which they provide information on the Claim Settlement Ratio of each Health insurance company available in India.

As per IRDAI instructions, health insurance companies need to settle claims within 30 days.

There are 25 general health insurance companies available in India. Below mentioned is the list of all 25 general health insurance companies in India:

  • Acko General Insurance
  • Bajaj Allianz General Insurance Co. Ltd.
  • Bharti AXA General Insurance Co. Ltd.
  • Cholamandalam MS General Insurance Co. Ltd.
  • Zuno General Insurance Co. Ltd.
  • Future Generali India Insurance C. Ltd.
  • Go Digit General Insurance Ltd.
  • HDFC ERGO General Insurance Co. Ltd.
  • ICICI Lombard General Insurance Co. Ltd.
  • IFFCO Tokio General Insurance Co. Ltd.
  • Kotak Mahindra General Insurance Co. Ltd.
  • Liberty General Insurance Ltd.
  • Magma HDI General Insurance Co. Ltd.
  • Navi General Insurance Ltd.
  • Raheja QBE General Insurance Co. Ltd.
  • Reliance General Insurance Co. Ltd.
  • Royal Sundaram General Insurance Co. Ltd.
  • SBI General Insurance Co. Ltd.
  • Shriram General Insurance Co. Ltd.
  • Tata AIG General Insurance Co. Ltd.
  • Universal Sompo General Insurance Co. Ltd.
  • National Insurance Co. Ltd.
  • The New India Assurance Co. Ltd.
  • The Oriental Insurance Co. Ltd.
  • United India Insurance Co. Ltd.

There are 7 standalone health insurance companies available in India. Below mentioned is the list of all 7 standalone health insurance companies in India:

  • Aditya Birla Health insurance Co. Ltd.
  • Care Health Insurance Ltd.
  • HDFC ERGO Health Insurance Co. Ltd.
  • ManipalCigna Health Insurance Co. Ltd.
  • Niva Bupa Health Insurance Co. Ltd.
  • Reliance Health Insurance Ltd.
  • Star Health and Allied Insurance Co. Ltd.

There are 4 public health insurance companies available in India. Below mentioned is the list of all 4 public health insurance companies in India:

  • National Insurance Co. Ltd.
  • The New India Assurance Co. Ltd.
  • The Oriental Insurance Co. Ltd.
  • United India Insurance Co. Ltd.

There are 2 specialized insurance companies available in India. Below mentioned is the list of specialized insurance companies in India:

  • Agriculture Insurance Co. of India Ltd.
  • ECGC Ltd.

There are more than 20 private health insurers available in India. Below we have mentioned the list of all private health insurers in India:

  • Bajaj Allianz General Insurance Co. Ltd.
  • Cholamandalam MS General Insurance Co. Ltd.
  • Zuno Health Insurance Co. Ltd.
  • Future Generali India Insurance C. Ltd.
  • Go Digit General Insurance Ltd.
  • HDFC ERGO General Insurance Co. Ltd.
  • ICICI Lombard General Insurance Co. Ltd.
  • IFFCO Tokio General Insurance Co. Ltd.
  • Kotak Mahindra General Insurance Co. Ltd.
  • Liberty General Insurance Ltd.
  • Magma HDI General Insurance Co. Ltd.
  • Navi General Insurance Ltd.
  • Raheja QBE General Insurance Co. Ltd.
  • Reliance General Insurance Co. Ltd.
  • Royal Sundaram General Insurance Co. Ltd.
  • SBI General Insurance Co. Ltd.
  • Shriram General Insurance Co. Ltd.
  • Tata AIG General Insurance Co. Ltd.
  • Universal Sompo General Insurance Co. Ltd.
  • Aditya Birla Health insurance Co. Ltd.
  • Care Health Insurance Ltd.
  • ManipalCigna Health Insurance Co. Ltd.
  • Niva Bupa Health Insurance Co. Ltd.
  • Reliance Health Insurance Ltd.
  • Star Health and Allied Insurance Co. Ltd.
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