Find your suitable insurance plan
5035
3 min read
Updated on Jan 30, 2023
The Insurance Regulatory and Development Authority of India (IRDAI) is an apex body that 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.
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.
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.
Also Read: Pradhan Mantri Suraksha Bima Yojana (PMSBY) Scheme
| 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 |
Browse PayBima Blogs to read interesting posts related to Health Insurance, Car Insurance, Bike Insurance, Term Life Insurance, and Investment section. You can visit PayBima to Buy Insurance Online.
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.
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.
Health insurance companies in India in the year 2022-23 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)
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
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.
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.
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.
In recent times, wellness benefits have become a part of the regular health insurance policies as offered by several health insurance providers. Let’s take a.
Jan 31, 2023
3 min read 
World Cancer Day aims at educating people and spreading awareness about detecting cancer and its prevention and treatment. Let us get further details about World.
Jan 30, 2023 3 min read 
Started by the Rheumatoid Patient Foundation, the Rheumatoid Arthritis Awareness Day is observed every year on 2nd of February to make people aware about this.
Jan 30, 2023 3 min read 
A limb lengthening surgery, commonly known as height increasing surgery, is done to rectify any discrepancies in the legs in terms of length. Let us.
Jan 23, 2023 3 min read 
Did you know India is one of the countries in the world with the highest number of Asthma patients? Out of 10 patients, one is.
Jan 23, 2023 3 min read 
No matter how planned our life is, health issues never come announced. And a stay at a hospital even for a day can sometimes make.
Jan 23, 2023 3 min read 
The stiff competition and the day to day hurdles in a student’s life make them vulnerable for several mental and physical stress and illnesses. Hence,.
Jan 23, 2023 3 min read 
Have you ever thought of a situation where you or any of your family members is facing a severe health situation requiring a huge expense..
Jan 19, 2023 3 min read 
Corporate health insurance policy and family-floater health insurance plans are two different plans that are different from each other in several ways. Let’s take a.
Jan 19, 2023 3 min read 
Mental illness is a serious health condition that is hardly being talked about in India. Even the health insurance providers are not giving much attention.
Jan 19, 2023 3 min read 
Corporate Office : Mahindra Insurance Brokers Ltd ( A Mahindra Group Company ) Sadhana House, Ground Floor, 570 P. B. Marg, Behind Mahindra Towers, Worli, Mumbai 400018.
Licenced by IRDAI License No. 261; License Validity : 17-05-2025; Category : Composite Broker; CIN : U65990MH1987PLCO42609 Member of Insurance Brokers Association of India (IBAI).
Insurance is the subject matter of solicitation.
For a seamless experience, use the latest version of Chrome/Firefox/Internet Explorer.
Copyright © 2023 Mahindra Insurance Brokers. All Right Reserved.
Get A Call Back