Top 10 Health Insurance Companies in India As Per Claim Settlement Ratio

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.

Claim Settlement Ratio of Health Insurance Companies with Incurred Claim Ratio:

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.

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.

What do you mean by the Claim Settlement Ratio of a Health insurance company?

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.

What is Incurred Claim Ratio?

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.

Also Read: Pradhan Mantri Suraksha Bima Yojana (PMSBY) Scheme

Where to Find Insurance Companies’ Incurred Claim Ratio (ICR)?

The incurred claim ratio of health insurance providers can be checked on the IRDAI or Insurance Regulatory and Development Authority website. This statutory body publishes the ICRs every year of all health insurance companies. They publish the overall ICRs of health insurers and offer specific ICRs for different insurance forms. Hence, you can use the annual IRDA report as an estimation of the Incurred Claim Ratios of health insurance providers.

Importance of Claim Settlement Ratio in Health Insurance

Every three months, IRDAI declares details regarding claims settled to give policy seekers an idea about claim support offered by the insurers.

Also Read: Health Insurance Claims Ratio of Top 28 Health Insurers in India

List of top 10 companies that have highest claim settlement ratio in health insurance

1. Edelweiss General Health Insurance Company Limited
2. Star Health and Allied Insurance Company Limited
3. Kotak Mahindra General Insurance Company
4. HDFC ERGO Health Insurance Company Limited
5. IFFCO Tokio General Insurance Company Limited
6. ICICI Lombard Health Insurance Company
7. Bajaj Allianz General Insurance Company Limited
8. Care Health Insurance Company Limited
9. National Insurance Company Limited
10. Reliance General Insurance Company Limited

Overview of best health insurance companies in claim settlement

1. Edelweiss General Health Insurance Company Limited

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.

2. Star Health and Allied Insurance Company Limited

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.

3. Kotak Mahindra Health Insurance Company

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.

4. HDFC ERGO Health Insurance Company Limited

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.

5. IFFCO Tokio Health Insurance Company Limited

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

6. ICICI Lombard Health Insurance Company

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.

7. Bajaj Allianz Health Insurance Company Limited

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.

8. Care Health Insurance Company Limited

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.

9. National Insurance Company Limited

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.

10. Reliance General Insurance Company Limited

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.

How to choose a Health Insurance Company in India?

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.

Where Can I Check the Claim Settlement Ratio of Health Insurance Companies?

Comparing different health insurance policies before opting for one plan for yourself is very crucial. To compare policies, there are certain parameters to consider. One such important parameter is to check the claim settlement ratio (CSR) of health insurers.

Buying a policy from an insurer with a good claim settlement ratio would mean that your claim will not be rejected and will be settled without any hassle through an easy claim settlement process. As such when a medical emergency strikes, you are in no mental state to go through further hassles, rather you would expect your claims to get settled easily. Hence, you would surely want to buy a health plan from a company offering good CSR and an easy process to settle claims smoothly.

Here is the process to check the CSR of health insurance companies:

• Look for the IRDA-released annual report (published every year). Here, you can find the CSR of all health insurance providers
• Find the CSR of the health insurers that you are interested in buying insurance from via the IRDA portal
• Now, enlist health insurers who have a high claim settlement ratio. You may note that the higher the CSR, the better it is for raising and settling claims
• Compare the features and coverage benefits of the health insurance plans that have a high CSR

Parameters to Consider While Choosing the Best Health Insurance Company

You may not find the same features and benefits in two different health insurance companies and their plans. Similarly, the same health insurance plan may not suit everyone because people have different requirements. Depending on the needs and health goals of people they choose the plan and the insurer that benefits them in the best possible way.

It is better to choose health insurance providers in terms of certain parameters, which we have discussed below:

• Cashless Hospitals: This is a very important factor to consider when choosing a health insurance company. Most insurers offer a wide list of network hospitals for the insured to avail of cashless treatment. Hence, knowing the strength of network hospitals of the insurer is important when choosing a health insurance policy.
• Claim Settlement Ratio (CSR): The CSR of the insurer will give you the details of the claims received by them in a year and how many of them were settled by the insurance company in the same fiscal year. This gives you an idea of how good the insurance company is at settling claims. You may look for a CSR between 80 to 90%, which is considered a good number to opt for an insurer.
• Variety of Policies Offered by the Insurer: You may also consider the types of policies offered by the insurer when planning to buy health insurance from the provider. Some insurers may have a limited scope of plans like individual and family floaters. On the other hand, some providers may offer specific policies catering to women, children, senior citizens, and more. Go for an insurer offering plans suitable for your particular purpose.
• Customer Care Support: Good availability of customer support is necessary to seek help when you need to resolve a query about claims or any other thing. Hence, quality customer support service is another important parameter to look at when opting for a health insurance company. With round-the-clock customer support, an insurer can address the concerns of the policyholder well.
• Reviews and Ratings: Ratings and reviews have turned out to be an excellent way to check the authenticity of insurers. Customer reviews/feedback and ratings play an important role in checking if the insurer is up to the mark and if you should consider buying a plan from them. This way, it helps in making a good decision. You can also do your research and comparisons to reach your conclusion about a policy.
• Smooth Claim Procedure: Getting your claims settled smoothly is another thing that every policyholder wants. A complicated and time-consuming process during emergencies can cause distress. Hence, it is better to opt for an insurer that allows a smooth claim process with minimal paperwork and TPA Intervention.Getting a health insurance policy at a reasonable premium with all-inclusive coverage and benefits will not suffice your needs if the CSR of the company is poor. This way, you may face hassles during claim settlement, which will nullify the whole point of purchasing the plan.

Claim Settlement Process of Health Insurance

Health insurance claims can be settled via cashless claim process and reimbursement claim process.

Cashless Claim

Cashless claims can be filed if the insured gets admitted at a network hospital for the treatment. Here are the steps to follow:

1. Claim Intimation – The insured is expected to inform the insurance company about the treatment (in case of planned treatment) at least 48-72 hours in advance via email or call. In case of emergency hospitalization, the insurer should be informed within 24 hours of getting admitted in the hospital.
2. Documents Approval – The next step is to show the health card that has been issued by the insurer to the hospital together with your ID proof. Once the hospital ensures the identity of the policyholder, they submit the form of pre-authorization to the insurer.
3. Claim Settlement – In this step, the insurer will approve the treatment if all the papers are in place. After the treatment is over, the hospital bills will be settled by the insurer directly.

Reimbursement Claim

Under reimbursement claims the policyholder avails the treatment at any of the preferred hospitals of their choice and pays the bill from their pocket and raises a reimbursement claim later from the insurer.

The steps are as below:

1. Claim Intimation – The first step is to inform the insurance company about the hospitalization and keep the documents like hospital bills and invoices safely to submit later
2. Documents approval – Once the treatment is over you have to pay the bill to the hospital. Later, within the stipulated time mentioned in the policy document, you can submit the claim along with the bills and related documents
3. Claim Reimbursement – Once the formalities of examining the papers is done, the claim will be settled by the insurer as per the terms of the policy and the money will be transferred to the bank account of the insured

Documents Required For Claim Settlement

Below are the documents required to submit:

• Claim form duly filled
• The medical certificate issued by the doctor along with the report of diagnosis
• Claimant’s ID proof
• Prescriptions of medications and cash invoice from the hospital
• FIR (if it is an accident) 

Grounds for Claim Rejection

There are some reasons because of which the claims could get rejected. Below are the points to remember:

• If the insured hides any pre-existing diseases
• If the insured doesn’t adhere to the insurance company process
• If the claim form is not complete or has incorrect information
• If the insured withholds personal information wrongfully

Best Health Insurance Companies 2024

Related Articles:

• What is Incurred Claim Ratio
• Pradhan Mantri Suraksha Bima Yojana (PMSBY) Scheme: Eligibility & benefits

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