7 min read
Updated on Apr 25, 2023
Health insurance has been an often-overlooked area for a majority of Indian households. While people place high importance on having an active life insurance policy for the breadwinner, having an active health insurance policy for the family gets neglected. The rising cost of medical facilities and the recent experience with the pandemic, however, have prompted people to re-evaluate their priorities and consider having a health insurance policy. This equips them to deal with medical emergencies by raising a health insurance claim against their medical expenses.
A health insurance claim occurs when you face a medical emergency and incur medical costs. If the costs are covered by the health insurance plan, the insurance company pays for the costs incurred. There are about two dozen health insurance companies in India. Among these companies, the company which settles the maximum health insurance claim is considered to be the best.
Also Read: Pradhan Mantri Suraksha Bima Yojana (PMSBY) Scheme
For a health insurance company, the claim settlement ratio is the ratio of claims that have been successfully settled and the total number of claims that they have received. A higher claim settlement ratio indicates that the claims raised by the customers have higher chances of being successfully settled. It, therefore, plays an important role when it comes to drawing a comparison between the policies.
A fair Incurred Claim Ratio should fall between 75% and 90%*. A percentage of less than 50% indicates that the firm has strict underwriting and claim processing standards, which result in many claims being denied. Though many companies have good insurance claim settlement records, here are the ten best health insurance companies having the best claim ratio of health insurance companies.
ICR or the Incurred Claim Ratio is the amount of money paid by the insurance company as claims as against the total premium collected. IRDA publishes this data in the Annual Report.
Comparing insurance providers based on their claim settlement ratio allows you accurately estimate the chances of your claim getting successfully settled. It can play an important role in deciding which insurance company you want to trust with your money with no chance of a shock when you raise your health insurance claim.
So, choose the best health insurance company and best medical insurance policy in claim settlement based on the claim settlement record and ensure speedy and easy settlement of your health insurance claims.
India is one of the biggest emerging insurance markets in the world. As more and more people are realizing the importance of health insurance for themselves and their families, they may face the challenge of finding the right health insurance provider that they can trust. When selecting the right health insurance provider, the customers need to keep in mind factors such as positive customer reviews, network hospitals, claim settlement ratio, and attractive plans.
The claim settlement ratio clearly differentiates between the health insurance companies. This data is maintained by the IRDAI and shared as a consolidated form at the end of each fiscal year. Here is the claim settlement ratio of leading health insurance providers.
|Insurance Company||Network Hospitals||Claim Settlement Ratio for FY 2021-22||Incurred Claim Ratio|
|Edelweiss General Claim Settlement Ratio (CSR)||Over 2,578||85.57%||113.05%|
|Star Health and Allied Claim Settlement Ratio (CSR)||Over 9,900||78.62%||65.91%|
|Kotak Mahindra Claim Settlement Ratio (CSR)||Over 4,000||96.38%||49.22%|
|HDFC ERGO Claim Settlement Ratio (CSR)||Over 10,000||86.52%||73.69%|
|IFFCO Tokio Claim Settlement Ratio (CSR)||Over 5,000||96.33%||95.66%|
|ICICI Lombard Claim Settlement Ratio (CSR)||Over 5,025||99.98%||81.96%|
|Bajaj Allianz Claim Settlement Ratio (CSR)||Over 6,500||92.24%||89.36%|
|Care Health Claim Settlement Ratio (CSR)||Over 8,250||92.83%||103.30%|
|National Insurance Claim Settlement Ratio (CSR)||Over 6,000||95.2%||–|
|Reliance General Claim Settlement Ratio (CSR)||Over 7,300||96.93%||69.90%|
Please note that the Claim Settlement Ratio is not published by the IRDAI in its annual report. Instead, they publish the Incurred Claim Ratio details and the claim settlement tenure.
Also Read: Health Insurance Claims Ratio of Top 28 Health Insurers in India
Edelweiss General Health Insurance Company by Edelweiss Group that is a homegrown multinational corporation, has been a trusted name for over 2 decades now. With the assurance of a simple and hassle-free claim procedure, Edelweiss General has a strong network of customers all across the country. The company offers comprehensive health insurance plans for its customers aged 3 months and above.
Star Health Insurance is a leading name in the health insurance industry. The company has an in-house claim settlement team that removes the hassles of dealing with third parties and settles claims quickly. The company has one of the largest networks of hospitals which helps in easy cashless settlements. Know more about Star Health Insurance Claim Settlement Ratio.
Kotak General Insurance is a 100% subsidiary of Kotak Mahindra Bank. With over 45 lakh customers, Kotak Mahindra is a trusted name in the insurance market. Since 2015, the company has launched many insurance plans and products. With 19 branches spread across the country, the Kotak Mahindra Health Insurance Company has established a strong service network for all its customers.
Apollo Munich Health Insurance is now HDFC ERGO Health Insurance. The company has over 1.5 crores happy customers and boosts of a 20-minute cash claim approval system. The company is a reputed health insurance company that also offers some of the best health insurance plans. Everyone frets out the best health insurance company in india as per claim settlement is concerned. HDFC ERGO is the one who usually tops the clart with one of the best claim settlement ratio in health insurance.
IFFCO Tokio offers a range of general insurance products, health insurance being one of them. The IFFCO Tokio Health Insurance Company has a network of 6400+ hospitals across India and helps in an easy settlement of cashless health claims.
Also Read: 3 Simple Steps for Making an Insurance Claim
With 24X7 customer support, the ICICI Lombard Health Insurance Company offers constant assistance in your time of need. The tailor-made plans allow the customers to keep themselves and their families covered and well protected. Through the IL Take Care App, claim intimidation is easy and very convenient.
Bajaj Allianz boasts of having the fastest claim settlement record by settling its claims within a turnaround time of only one hour. The Bajaj Allianz Health Insurance Company has an in-house claim settlement team and has serviced more than 2.9 lakhs claims in the year 2017-18.
Care Health Insurance Company earlier known as Religare Health Insurance Company Limited, Care Health Insurance offers cashless treatment all over the globe. The company has introduced revolutionary health plans and has maintained a good claim settlement record. In less than 2 hours, the in-house claim team assures us to process the claim with a strong Religare claim settlement ratio.
The Care Health Insurance Mobile App also makes the claim procedure simple. Know about the ratio of claim settlement at Care (Religare) Health Insurance.
National Insurance is a leading name in the health insurance industry in the public sector. It is one of the oldest insurers with a trusted network of customers and quick claim settlement records.
Another big name in the industry, Reliance offers a range of general insurance products. In the health insurance category, Reliance has a tie-up with more than 8000 hospitals and facilitates quick cashless claim settlement. With high medical treatments, the Reliance Health Insurance Company allows the customers to avail of quality treatment through affordable health insurance policies.
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Customer satisfaction is completely a matter of personal experience that might differ from one customer to another. Depending upon your needs and claims, you may have your experience. Before deciding, browse through company reviews, check the CSR, or speak to a customer care executive to get a fair idea about the company’s customer approach.
When you have a health insurance plan, you can receive cashless claim facilities at the network hospitals of the company. Apart from this, you can claim a reimbursement in case of both planned and emergency hospitalisation by submitting relevant bills and doctor’s certificates. Though most insurance companies, follow a similar claim procedure, you should read your policy documents carefully.
The claim settlement ratio of health insurance companies is the number of claims that a company settled out of the number of claims it received. The top claim settlement ratio could be the one above 99%. However, the settlement ratio of health insurance companies between 95-99% is considered good.
Some of the companies have shown a commendable claim payout ratio in 2021. HDFC ERGO claim settlement ratio is on the top list with a ratio of 99.8% followed by Edelweiss General with 99.72% of mediclaim claim settlement ratio.
Religare health insurance claim settlement ratio of 92.58% is also recommended by customers. These are some of the companies with the highest health insurance claim settlement ratio in 2021-22 that you can look forward to.
Health insurance claims must be filed as soon as you can. In case of planned hospitalisation, you can inform your insurance company in advance. Another rule is to be a quick respondent to the questions and queries of your company. Whenever there is a need to submit any document, you must do it as soon as possible so that further processes could be carried out without any delay.
Generally, you can receive your claim settlement within a month. A minimum of three weeks is taken for the processes and formalities to be completed.
The only golden rule to speed up your insurance claims is to stick to the company procedures. Raise your claim with the company without any delay. If it’s a planned hospitalisation, try to get in the network hospital. It is also important that a close member knows about the paperwork and other formalities.
You can choose the best insurance company by evaluating their claim settlement ratio, customer reviews, premium amount, network hospitals, and incurred claim ratio.
Based on the Claim Settlement Ratio (CSR), the top 5 health insurance companies operating in India are Bajaj Allianz Health Insurance, Reliance Health Insurance, National Insurance, ICICI Lombard Health Insurance, and Care Health Insurance.
India has more than two dozen health insurance providers operating within the country.
Paybima can help you compare the health insurance providers on critical parameters such as net promoter score, claim settlement ratio, network hospitals, incurred claim ratio, and premium amount so that you can take an informed decision.
Top standalone health insurance companies in India include Max Bupa Health Insurance Company Limited, Care Health Insurance Limited, Aditya Birla Health Insurance Company Limited, Star Health and Allied Company Limited, ManipalCigna Health Insurance Company Limited.
The best public insurance companies in India are Life Insurance Corporation of India, General Insurance Corporation of India, The New India Assurance Company of India, Oriental Insurance Company India, United India Insurance Company, and National Insurance Company Limited.
According to IRDAI data, Reliance Health Insurance Company leads the chart with a 100% claim settlement ratio, followed by Niva Bupa at a 96% claim settlement ratio.
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