- Explore Claim Settlement Ratio
- What is ICR?
- Claim Settlement Process
Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.
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Health Insurance Claim Settlement Ratio
Health Insurance is a modern-day necessity. Many of us who want the best health insurance plan for ourselves and our families are sure to gather every piece of information regarding the big purchase. One can only hope to get financial support from their health insurance providers when a medical need arises.
However, do you know how reliable your health insurer is regarding claim settlements? How long does it take for your insurer to settle claims? Or How many claims have they rejected in the past years? The next question is which health insurance has the best claim settlement ratio and how to check it. Let us find out the answers to all these questions.
What Is Claim Settlement Ratio In Health Insurance?
The claim settlement ratio is the percentage of several claims an insurance company settles within a specific period against the number of claims received. In simple words, a claim settlement ratio of 92% for a health insurance provider means that for every 100 claims filed, 92 were settled successfully within a fixed period.
traordinary Facts
The Insurance Regulatory and Development Authority of India (IRDAI) published its latest annual report for the financial year of 2023-24. In a recent change in trend, the regulator has started publishing only the Incurred claims ratio (ICR) of general insurers rather than the claim settlement ratio, as in previous years.
Claim Settlement Ratio Of Health Insurance Companies In India
| Company | Network Hospital | Claim Settlement Ratio (FY 2022-23) | Incurred Claims Ratio (FY 2023-24) |
| Star Health Insurance | 14,000+ | 99.21% | 66.47% |
| HDFC Ergo | 16,000+ | 98.59% | 87.70% |
| ICICI Lombard | 10,800+ | 98.53% | 70.79% |
| IFFCO Tokio | 7,000+ | 90.65% | 86.33% |
| Kotak Mahindra | 11,200+ | 97.61% | 65.56% |
| Aditya Birla | 11,000+ | 99.01% | 68.31% |
| Care Health | 24,800+ | 100% | 57.69% |
| ManipalCigna | 8,500+ | 99.96% | 63.78% |
| Niva Bupa | 10,000+ | 100% | 59.02% |
| Acko General | 10,500+ | 97.68% | 69.57% |
| Bajaj Allianz | 18,400+ | 93.54% | 73.80% |
| Cholamandalam | 12,000+ | 93.63% | 73.66% |
| Zuno | 10,000+ | 98.54% | 82.64% |
| Future Generali | 8,430 | 94.98% | 71.85% |
| Godigit | 8,800+ | 96.83% | 70.32% |
| Liberty | 5,000 | 97.46% | 75.29% |
| Magma | 8,400+ | 94.72% | 79.88% |
| Navi General | 12,000+ | 95.13% | 52.40% |
| Raheja QBE | 5,000+ | 97.30% | 77.91% |
| Reliance Health | 10,000+ | 98.75% | 81.06% |
| Royal Sundaram | 11,800+ | 96.17% | 77.62% |
| SBI General | 16,625+ | 96.47% | 85.90% |
| Shriram General | 9,500+ | 86.86% | 63% |
| Tata AIG General | 11,000+ | 95.46% | 71.43% |
| Universal Sompo | 4,000+ | 91.58% | 81.74% |
| National Insurance | 3,000+ | 91.31% | 95.90% |
| New India | 3,000+ | 90.73% | 97.36% |
| Oriental | 3,500+ | 91.62% | 98.89% |
| United India | 14,000+ | 91.10% | 96.50% |
How To Check Claim Settlement Ratio Of Health Insurance Companies?
To get insights on each company’s health insurance claim settlement ratio, visit PolicyX and check out our data labs section. Each year, the governing body (IRDAI) publishes the statistics of Indian health and life insurance providers for the financial year which are published on our website for a better idea of Indian health insurance claim settlement status.
How Is the Health Insurance Claim Settlement Ratio Calculated?
The formula given below is how CSR is calculated for general insurance companies
Claim Settlement Ratio = (Total number of claims settled/Total number of claims received) x 100
Let us understand this with an example,
An insurer received 2 Lakh claims in a year and settled 1,98,000 claims the same year. The claim settlement ratio for the same would be
CSR for the health insurer = (1,98,000/2,00,000) x 100 = 99%
Incurred Claims Ratio: How Is It Different From Claim Settlement Ratio?
The claims settlement ratio is the percentage of the total claims paid by the insurance company in a particular period. However, the incurred claim ratio, on the other hand, is the percentage of the total claim amount paid against the total premium collected in a given time.
In simpler words, a 90% incurred claim ratio means that for every Rs 100 of collected premiums, the insurance company spends Rs 90 on claims within the year.
Health Insurance Claim Settlement Process
There are 2 types of health insurance claim settlement processes you must know of:
| Cashless Claim Settlement | Reimbursement Claim Settlement |
| Fill out the pre-authorized form available at the TPA desk of the hospital | Submit your claim form along with all necessary documents to your health insurer |
| You will receive an acknowledgement message from your insurer | Get the discharge summary and approval letter from the hospital management |
| Submit all your documents and answer all enquires to your health insurer | Respond to all queries raised by your health insurance provider |
| Once verified your health insurer will settle the claim with the hospital directly. | Once all details are verified, your health insurer will reimburse your medical bills in your account as per the policy sub-limits. |
What Is the Importance of Claim Settlement Ratio In Health Insurance?
The importance of the claim settlement ratio in health insurance can not be overlooked. It is an important deciding factor of an insurer’s reliability.
- Helps you understand how many claims were rejected by the insurer
- Helps you compare all health insurance providers in the market
- A consistently upward track of a health insurer is a promise that it will help you financially in times of medical emergencies
- A higher CSR indicates financial support and mental peace
Documents Required For Claim Settlement
Below are the documents that you need to submit for the claim request for your health insurance:
- Pre-authorized claim form
- ID proof
- Address proof
- Discharge summary and diagnostic reports
- FIR (In case of an accident)
- Prescription and cash invoice from pharmacy/hospital
Additional documents may vary from insurer to insurer and may vary depending on your medical case.
Concluding Note
Selecting an ideal health insurance provider is tricky when you have multiple options in the market. This is why relying on insurance advisors and gaining insights into factors like the highest claim settlement ratio in health insurance is important.
Schedule a 30-minute personalized call with PolicyX advisors. We Do Not Sell Gimmicks, Only Genuine Insurance Solutions.
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Health Insurance Claim Settlement Ratio: FAQs
1. What is the Claim Settlement Ratio in health insurance?
Claim Settlement Ratio in health insurance indicates how many claims an insurer has settled against the number of claims received during a financial year. A high claim settlement ratio showcases that the company can offer you cashless treatment in times of medical need.
2. What is the highest claim settlement ratio in health insurance?
As per the IRDAI reports, the highest claim settlement ratio has gone to 100% for Niva Bupa and Care Health Insurance for FY 2022-23.
3. What is considered the best claim settlement ratio?
A good claim settlement ratio is anywhere above 80%.
4. What documents do I need for claim settlement?
You will need identity proof, address proof, discharge summary, diagnostic reports, pharmacy bills, and pre-authorized forms.
5. How much time does it take for a cashless claim settlement?
A cashless claim is settled before the discharge. However, a reimbursement claim settlement may take 15 days depending on the insurer.
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Written By: Simran Kaur Vij
Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.
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