Top Health Insurance Companies by Claim Settlement Ratio
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Health insurance is a vital necessity safeguarding us against the exorbitant medical care cost. Over the years the importance of health insurance coverage has increased and people have realized the significant role it plays in their lives in terms of managing their health-related expenses. With a comprehensive health insurance plan, one can lower the stress of unforeseen medical expenses significantly.
It is important to consider several key factors before buying a health insurance plan. Among the various other factors, the claim settlement ratio (CSR) of the insurance company is one key aspect to consider here. A claim settlement ratio of 80% and above is considered a good health insurance claim settlement ratio. Let’s understand the claim settlement ratio in detail below. Also, we will discuss the best health insurance companies in terms of the latest updated claim settlement ratio.
Table of Contents
- What is the Claim Settlement Ratio in Health Insurance?
- Why is it Important to Consider Claim Settlement Ratio in Health Insurance?
- Top 15 Health Insurance Companies in India as per Claim Settlement Ratio
- Health Insurance Claim Settlement Process
- Cashless Claim Process
- Reimbursement Claim Process
- How to Check Health Insurance Claim Status?
What is the Claim Settlement Ratio in Health Insurance?
The Claim Settlement Ratio or CSR in health insurance refers to the ratio between the number of claims settled and the total number of claims received by an insurance company in a financial year. Claim Settlement Ratio is calculated with the help of the following formula = (total claims settled / total claims filed) multiplied by 100. The CSR helps to determine if a health insurance company is capable of settling the claims of the customers.
Why is it Important to Consider Claim Settlement Ratio in Health Insurance?
The health insurance claim settlement ratio is important because it offers details about the ability of the insurer to pay claims. It serves as an efficient measurement for comparing health insurance companies. It keeps a tab on the insurer's claim settlement position and their reliability.
Top 15 Health Insurance Companies in India as per Claim Settlement Ratio
It is essential to compare health insurance companies in terms of their claim settlement ratio (CSR) when purchasing health insurance plans to ensure the settlement of your claims. A health insurance claim settlement ratio of 85% or more is considered good for a health insurance company.
| Serial No. | Company | Claim Settlement Ratio (CSR) FY - 2022-23 | Incurred Claim Ratio (ICR) FY – 2022-23 |
| 1 | Care Health Insurance Ltd. | 100% | 53.82% |
| 2 | Niva Bupa Health Insurance Co. Ltd. | 100% | 54.05% |
| 3 | ManipalCigna Health Insurance Co. Ltd. | 99.96% | 64.66% |
| 4 | Star Health and Allied Insurance Co.Ltd. | 99.21% | 65% |
| 5 | Aditya Birla Health Insurance Co. Ltd | 99.01% | 64.68% |
| 6 | Reliance General Insurance Co. Ltd. | 98.75% | NA |
| 7 | HDFC ERGO General Insurance Co. Ltd. | 98.59% | 79.04% |
| 8 | Zuno General Insurance Ltd. | 98.54% | 89.59% |
| 9 | ICICI Lombard General Insurance Co. Ltd. | 98.53% | 77.33% |
| 10 | Acko General Insurance Ltd. | 97.68% | 83.88% |
| 11 | Kotak Mahindra General Insurance Co. Ltd. | 97.61% | 56.01% |
| 12 | Liberty General Insurance Ltd. | 97.46% | 74.17% |
| 13 | Raheja QBE General Insurance Co. Ltd. | 97.30% | 138.67% |
| 14 | Go Digit General Insurance Ltd. | 96.83% | 71.87% |
| 15 | SBI General Insurance Co. Ltd. | 96.47% | 73.92% |
Note: 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.
Health Insurance Claim Settlement Process
Health insurance claims can be settled in two different ways - the cashless claim process and the reimbursement claim process:
Cashless Claim Process
The health insurance claim form for cashless claims can be filled in case the policyholder avails the treatment at a network hospital of the health insurance company. Here are the steps to follow:
- Intimating the insurer about the treatment/emergency
- The insurer will verify the documents
- The documents were approved
- The insurance company will settle the claims directly with the hospital
Reimbursement Claim Process
If policyholders get medical treatment at a hospital of their choice which is not a part of the network hospitals of the insurance company, they can get the claim amount reimbursed by filing a reimbursement claim. Here, the policyholder has to pay the treatment cost out of his pocket at the time of discharge. Later, he can submit the claim to the health insurance company for reimbursement. Below are the steps:
- Intimate the health insurance company about the claim
- Submit documents
- The documents get approved
- The claim amount is reimbursed
How to Check Health Insurance Claim Status?
Health insurance claim status can be checked online by following the below steps:
- Go to the official portal of the Health Insurance Company
- Look for the ‘Claim’ icon on their website homepage
- Choose the option ‘Track Claim Status’
- You will reach a new page. Submit your Customer ID, Policy Number, Claim Number, and date of birth, etc.
- Enter the ‘Submit’ button
- You can now check the status of your health insurance claim on your screen.
FAQs
A claim settlement ratio of 80% and above is considered a good claim settlement ratio in health insurance.
Claim Settlement Ratio is calculated with the help of the following formula: (total claims settled / total claims filed) multiplied by 100
The Insurance Regulatory and Development Authority (IRDAI) offers the details of CSR. They publish annual reports every year with information on the Claim Settlement Ratio of all the Health insurance companies selling plans in India.
As per IRDAI, health insurance companies must settle health insurance claims within 30 days of receiving the claim.
There are 25 general health insurance companies available in India.
Author Bio
Paybima Team
Paybima is an Indian insurance aggregator on a mission to make insurance simple for people. Paybima is the Digital arm of the already established and trusted Mahindra Insurance Brokers Ltd., a reputed name in the insurance broking industry with 17 years of experience. Paybima promises you the easy-to-access online platform to buy insurance policies, and also extend their unrelented assistance with all your policy related queries and services.
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