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Top Health Insurance Companies by Claim Settlement Ratio

Until recently health insurance has been overlooked by many as not a very significant requirement of life. Although the life insurance of the breadwinner has always been an area of prime importance for many families, the health insurance of the entire family has been neglected. However, things are changing, especially after COVID-19, and family health plans are getting prominence. Moreover, the high cost of medical treatments and the rising number of lethal diseases are other reasons for prioritizing health insurance. In this post, we are discussing the top 10 health insurance companies in India in terms of their claim settlement ratio (CSR).

Table of Contents

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.

Conclusion

Most policyholders like to settle claims via the cashless claim option by getting the treatment at a network hospital. Reimbursement claims are also accepted in case the policyholder likes to get the treatment at a hospital of their choice rather than visiting a network hospital. It is good to understand that legitimate claim requests cannot be denied by any insurer. However, it is also good to check the claim settlement ratio and other factors when buying a health insurance plan to ensure that your claims are settled quickly and smoothly.

If you are looking for all-inclusive health insurance plans from the best insurers in terms of CSR, visit the Paybima portal to get them. You can seek help from Paybima health advisors to help you choose the plan that suits your requirements best.

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.

Young and healthy? Find out which of these plans rewards you with lower premiums. Click here to check now!

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 21 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.

Over to You

Health emergencies don’t come with a calendar invite. Whether you're planning for your own future or looking out for your parents, choosing the right health insurance plan can make all the difference. That’s where a deeper look at the fine print helps. When you compare Star Health’s Red Carpet Plan vs Care Health Enhance Plan, what you’re really doing is choosing the kind of financial backup you want in your corner.

The Star Health Red Carpet Plan is made with senior citizens in mind. With benefits like annual preventive check-ups, it helps you or your ageing parents get covered without the usual hassles. On the other hand, the Care Health Enhance Plan acts as a top-up cover, ideal if you already have a base health policy and want to increase your shield without increasing your premium by too much.

While health insurance takes care of medical needs, don’t forget to plan for life’s bigger what-ifs. A term Insurance policy, especially a 1 crore term insurance plan, can be the long-term security net your family needs. Health and life coverage go hand in hand. And when chosen right, they help you face the future with confidence, not chaos.

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