Health Insurance claim settlement ratio or CSR is the percentage of total claims settled out of the total claims received by a health insurance company in a given fiscal year. The CSR figure helps in assessing the credibility of a health insurer. The higher the ratio of claim settlement, the more reliable an insurer becomes for easy claim settlement..
CSR helps buyers to compare health insurance companies and choose the most dependable insurer to meet their healthcare needs. This is often the most important factor when selecting a health insurance policy for yourself and your loved ones. A higher claim ratio assures a higher possibility of hassle-free claim settlement. Else, a delayed or denied claim will defeat your purpose of investing in health insurance plans.
How is Health Insurance Claim Ratio Calculated?
The Insurance Regulatory Authority of India (IRDAI) calculates and publishes the claims ratio of all the health insurance companies in India in its annual report. The ratio takes into account the annual public disclosures of the number of claims received, settled, and outstanding by health insurers at the end of every year.
Below is the basic formula for calculating the claim ratio-
ClaimS Settlement Ratio = (Total Number of Claims Settled / Total Number of Claims Received) x 100
Let’s understand the calculation of claims ratio with an example. For instance, suppose a health insurer received 2 lakh claims in a policy year and settled approximately 1,98,000 claims out of it. The insurer’s claims settlement ratio = (1,96,500/2,00,000) X 100 = 98.25%.
The good news is that most health insurance companies publish their ratio of claims settled annually across their digital portals. It helps customers easily compare and choose the ideal ratio.
The Claim Settlement Record of Care Health Insurance- Your Reliable Health Partner
At Care Health Insurance, we are always striving to serve our customers to the best of our abilities. Our primary objective is to deliver comprehensive healthcare coverage when our customers need it the most. With a wide network of 21,500+ cashless healthcare providers, we promise access to quality medical care while processing your claims in less than 2 hours approximately. That’s how we have successfully settled over 38lakh claims till date.
With these features, Care Health Insurance has a record of one of the best claim settlement ratios in the health insurance industry.
How Does Claim Settlement Ratio Help You Choose the Right Health Insurer?
If you are in the process of selecting an ideal health insurer, you must check the claims settlement ratio by IRDAI. The report provides a detailed view of the annual claims processing status of leading health insurance companies in India. The health insurance claim settlement ratio helps you identify the insurer settling the highest number of claims and simplifies the choice of a perfect health insurer.
Also, below are other reasons why you must check an insurer’s claims ratio before finalizing the health coverage-
- CSR reveals how many claims have been rejected by the insurer every year
- It helps you compare different insurers easily
- An upward track record Of CSR shows an improved claim handling process
- A higher ratio indicates instant health and financial support by the insurer.
Apart from the claim ratio of medical insurance, you must also consider an insurer’s incurred claim ratio before buying any health policy. Incurred claims ratio is the percentage of the total value of claims paid to the total premium received by an insurer in a given fiscal year.
For instance, an insurer has received a total amount of 5 lakhs under premium and settled claims worth INR 4,25,000. Here, the incurred ratio would be 85% which translates to greater chances of receiving a higher claim amount when needed. So, do check these two important ratios to pick the right health cover for your loved ones.
Types of Claim Settlement Processes
Claim settlement is all about providing optimum financial support to insured members as applicable under their health policies. Every health insurer should address justified mediclaims with reasonable claim payouts. Cashless and reimbursement are two ways in which you can file a claim under health coverage.
Below is a complete differentiation between the steps involved under the two types of claim settlement processes-
| Cashless Claim Settlement Process |
Reimbursement Claim Process |
| Step 1: Fill out the pre-authorization form available at the insurance desk and send it to our claim management team |
Step 1: Submit your claim form along with the required documents. |
| Step 2: You will get an approval letter once your claim is verified. |
Step 2: Get the approval letter from the claim management team. |
| Step 3: Make sure to respond to queries from the claim management team. |
Step 3: Respond to queries raised by our claim management team. |
| Step 4: File a reimbursement claim request in case your cashless claim request doesn't go through. |
Step 4: In case your claim is rejected, our claims team will contact you and share the reasons of rejection at the earliest. |
You should inform the claims team for a smooth settlement in both cases. You must inform us within 24 hours of hospitalization during emergency hospitalization while intimating us 48 hours before planned hospitalization.
Factors to Consider while Evaluating Claim Settlement Ratios of Health Insurance Companies
While Care Health Insurance promises one of the highest claims settlement ratios, we ensure transparent accounts of our claim figures. You can check everything about our claims team to processes and accounts of claims settled right on our digital portal. It helps us establish ourselves as a trustworthy health insurer serving households and group medical needs across India.
Below are some significant factors to consider while assessing a health insurer and its claims ratio-
- Check the insurer’s past record of claim settlement through the IRDAI website.
- Carefully understand the insurer’s claim settlement process and timelines
- Map the network hospitals located around your area of residence
- Go through the genuine reviews shared by the insurer’s customers over the website
- Compare the healthcare benefits of different insurers along with premium calculator
Choosing a suitable health cover is a challenge, especially when there are plenty of options to consider. That’s why it is better to rely on facts about an insurer along with their service network.
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