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Top Health Insurance Companies in 2021 with best Claim Settlement Ratio
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Health Insurance Companies with the best Claim Settlement ratios

Mayukh (27-year-old) lives in Bangalore with his parents (Father: 58 years and mother: 51 years). Mayukh works as a team lead in a reputed IT company. Mayukh’s mother has some kidney problems and needs to visit the doctor at regular intervals. To combat the healthcare inflation of Bangalore and protect his parent’s medical needs, Mayukh is planning to purchase the best health insurance policy for his family. To make his purchase decision better, Mayukh should acquire some knowledge about the claim settlement ratio of health insurance companies.

These days, the markets are thronged with various health insurance companies that try to grab the customers’ attention with a chunk of health insurance policies. But you must remember that not all health insurance companies possess a good health insurance claim settlement ratio. Therefore, the claim settlement ratio of health insurance companies plays a pivotal role in your purchase decision. Because the health insurance claim ratio indicates how efficiently an insurer settles the claims of policyholders.

If your selected company doesn’t honor your claim during the time of an emergency, then why should you go with that insurer? That’s why you should consider the best claim settlement ratio in health insurance while pondering to purchase a health policy.

The claim settlement ratio: The best claim settlement ratio suggests how dependable the health insurance company is if you initiate a claim. Among all private insurance companies, HDFC ERGO General Insurance has the best health insurance claim settlement ratio (99.80%) in the financial year 2019-2020.

Claim settlement ratio formula: (Total claims calculated)/ (Total reported claims + outstanding claims at the beginning of the years-outstanding claims at the end of the year)

Top 14 Health Insurance Companies in 2021 with best Claim Settlement Ratio

Let’s take a look at IRDA health insurance claim settlement ratios of various health insurance companies as mentioned below:-

Insurers (Private and standalone health insurance companies) Claim settlement ratio (less than 3 months) Incurred health Claim ratio in 2019-2020
HDFC ERGO 99.8% 69.01%
Edelweiss General 99.72% 113.05%
Go Digit 99.65% 51.83%
Kotak Mahindra 98.68% 49.22%
Bajaj Allianz 98.61% 81.96%
ICICI Lombard 96.93% 69.90%
Acko general 93.49% 21.08%
Future Generali 93.34% 62.52%
Tata AIA 92.82% 66.61%
Bharti AXA 92.17% 77.50%
Religare Health 100% 59.13%
HDFC ERGO Health 99.99% 73.69%
Max Bupa 99.91% 53.51%
Star Health 99.9% 65.91%

Health insurance claim ratios

There are three types of health insurance claim ratios in medical insurance claim procedures.

  • Claim settlement ratio
  • Claim repudiation ratio
  • Claim pending ratio

 

Claim settlement ratio: A mediclaim claim settlement ratio indicates the claim-solving capacity of an insurer. If an insurer settles the claims when policyholders intimate them, then the insurer owns an impressive claim settlement ratio. A higher claim settlement ratio implies that the insurance company settles most claims. For example, if the claim settlement ratio of an insurance company is 60%, then this means the insurer settles 60 out of 100 claims.

Claim repudiation Ratio (Claims rejected/Total claims) %: This ratio indicates the percentage of claims rejected by an insurance company. A claim repudiation ratio of 30% means 30 claims are rejected out of 100.

Some common reasons for claim rejection in the health insurance claim process

  • If a policyholder raises a fraudulent claim
  • If you raise a claim for an excluded condition of your health insurance policy plan
  • If you initiate a claim for an expired insurance policy
  • If you make a claim for the treatment that is not mentioned in your health insurance plan
  • Getting treatment for a pre-existing illness without completing the waiting period

 

Claim pending ratio (claims outstanding/total claims)%: This ratio portrays the number of claims that have not yet been settled (neither approved nor rejected) by an insurer. For example, the claims pending ratio of 40% indicate 40 claims are not yet settled out of 100 claims.

 

5 things to understand the claim settlement ratio in the medical insurance claim procedure

  1. Understand the claim settlement ratio of health insurance companies: Many health insurance companies possess impressive claim settlement ratios. Customers think these companies are dependable and trustworthy. Policy buyers try to purchase health insurance policies from these companies.
  2. Consider all products of the company: Generally, the claim settlement ratio is calculated for all the products of an insurance company. For example, the claim settlement ratio of a life insurance company includes the claim settlement of all the plans it offers, ULIPs, and so on. Therefore, check the CSR for all products of an insurer before making any decision.
  3. Consistency: Choose a company that had a steady claim settlement ratio over the past financial years. It would be wise if you check the last 5 years’ claim settlement ratios of a company before making your purchase decision.
  4. Report by IRDAI: The IRDAI circulates the claim settlement ratio of all leading public and private insurance companies on its website every financial year. Visit the website and compare the ratios of various companies before making the final call.
  5. The number of claims received by an insurance company: Always check the number of claims received by an insurer in a financial year. Now, you can get an idea about how dependable and large the insurance company is.

 

Incurred claim ratio Vs claim settlement ratio

Though these two sound similar, they are not the same.

  • The claim settlement ratio (CSR) implies the number of claims settled by an insurance company against the total claims initiated in a year. On the other hand, the incurred claims ratio measures the total amount of claims an insurer gives against the accumulated premiums throughout the year.
  • CSR portrays the goodwill and dependency of a company paying its claims, and ICR displays its financial background.
  • The CSR value can never go beyond 100%, but the ICR can be.
  • Policyholders can go for a higher CSR, but a high ICR indicates that the insurance company is paying more amounts for claims settlement. This means the company is no longer financially strong in the health insurance industry.

 

This article gave you sufficient information about the claim settlement ratio in the medical insurance claim process.