IRDA Health Insurance Claim Settlement Ratio 2022 for Top Health Insurance Companies

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What is Insurance Regulatory and Development Authority (IRDA)? – Know in Detail

The Insurance Regulatory and Development Authority of India (IRDAI) is an apex body which governs the workings of the life and non-life insurance companies operating in the market. Every insurance company is required to follow the rules and guidelines laid down by the IRDAI. IRDA also publishes regular reports on the performance of insurance companies. The amount of business done by insurers, their claim settlement ratios, incurred claim ratios, etc. are computed and published by IRDA regularly. Amongst these publications, the claim settlement ratio of insurance companies is very widely used. Let’s understand what this is.

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How is Claim Settlement Ratio Calculated – Claim Settlement Ratio Calculation of Insurance Companies

The claim settlement ratio of an insurance company measures the proportionate claims which the company has settled from the total number of claims made on it in a financial year. The ratio is calculated using the following formula –

Health Insurance Claim Settlement Ratio = (total claims paid by the company / total claims made on it) * 100

The ratio is expressed as a percentage. Higher the percentage the better are the chances of the claims being settled by the insurance company.

Insurance Regulatory and Development Authority (IRDA) Health Insurance Claim Settlement Ratio 2022

IRDA also publishes the claim settlement ratio and incurred claim ratio of health insurance companies. The ratios are calculated and published at the end of each financial year. The ratio shows policyholders the probability of their health insurance claims being settled.

Since health insurance policies are important and have also become quite popular, a potential customer can judge the performance of a health insurance company based on the claim settlement ratio published by the IRDA. This makes choosing the health insurance company easy. It helps customers make informed choices.

There are more than twenty health insurance companies in the insurance market. Comparing and selecting the best insurer, therefore, becomes quite difficult. However, with IRDA’s health insurance claim settlement ratios, this comparison becomes easy. Individuals can choose a company after choosing the best health insurance plan and then comparing the claim settlement ratios.

IRDA Claim Settlement Ratio of Health Insurance Companies 2022

Health Insurance Company Claim Settlement Ratio Cashless Hospitals
Care Health Insurance Company 95% 9,592
Niva Bupa (formerly known as Max Bupa) Health Insurance Company 96% 8,701
Star Health Insurance Company 90% 11,035
Aditya Birla Health Insurance Company 94% 8,787
DIGIT Health Insurance Company 96% 5,479
Reliance Health Insurance Company 100% 8,014
Royal Sundaram Health Insurance Company 89% 8,332
Oriental Health Insurance Company 89% 2,716
Liberty Health Insurance Company 94% 5,552
Future Generali Health Insurance Company 92% 6,303

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FAQs on IRDA Health Insurance Claim Settlement Ratio 2022

What is claim settlement ratio (CSR)?

Claim Settlement Ratio (CSR) is the ratio of the total number of claims settled by an insurance company against the total number of claims that the company receives for processing for a financial year.

What is a good claim settlement ratio in health insurance?

Claim Settlement Ratio (CSR) is the ratio of the total number of claims settled by an insurance company against the total number of claims that the company receives for processing for a financial year. The CSR customers to identify the ability of an insurance company to meet claim requests. A ratio above 80% is generally considered as a good claim settlement ratio in health insurance.

Which health insurance company has best claim settlement?

Health insurance companies in India in the year 2022 with best Claim Settlement Ratio are:
IFFCO Tokio General Insurance (96.57%)
Magma HDI (96.41%)
New India Assurance (95.92%)
(Source - IBAI Claims Insight Handbook 5th Addition)

Which are the top 5 health insurance companies on the basis of claim settlement ratio CSR?

The top health insurance companies on the basis of Claim Settlement Ratio (CSR) are:
IFFCO Tokio health insurance
Aditya Birla Health Insurance
Bajaj Allianz Health Insurance
Tata AIG Health Insurance
Bharti AXA Health Insurance
Care Health Insurance
United India Health Insurance
Universal Sompo Health Insurance
SBI Health Insurance

How is health insurance claim ratio calculated?

The formula to calculate health insurance claim ratio is:
Incurred Claim Ratio = Net claims incurred / Net Premiums collected.
Thus, health insurance claim ratio is the overall value of total claims that insurance company has paid divided by the total sum of premium collected during the same period.

Why do insurance claims get rejected?

Insurance claims might get rejected if the information offered is wrong or if you miss to add any information. Thus, wrong information is the most common factor for claims getting rejected. This is because personal information such as age of the insured, profession of the insured, his/her health condition as well as medical history etc. determines the premium and risk coverage of a health insurance policy.

Mar 18, 2021
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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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