IRDA Claims Settlement Ratio for Health Insurance or Mediclaim is the total no. of health claims approved by the insurance company divided by the total no. of claims filed by customers. Claims Settlement Ratio (CSR) shown here is different from Incurred Claims Ratio (ICR) published by the IRDA, which is just the ratio of total claim amount to total premium collected. ICR does not tell us what % of claims are approved or rejected. So in our view, CSR is a much better indicator for customers trying to decide which health insurance to buy, because it is the ratio of claims approved to total claims made.
We have computed CSR for Medical Insurance company-wise and you can see which companies approve more health claims than others.
Before you proceed to evaluate CSR, an important word of caution : Unlike CSR for Life Insurance, Claims Settlement Ratio for Health Insurance is indicative and the caveats need to be understood clearly. Death claim can be made only after a clear event (you are either dead or alive) but a Health Claim need not be as clear an event as Death. This is because when a health insurance claim is made, there is a probability that the claim reason (illness, expense incurred, etc.) may not even be covered by the health insurance product in the first place. And that could mean a VALID rejection of the claim. When you go through the Claims Settlement Ratio for Health Insurance, understand that a company with slightly higher or lower ratio is probably not very different from another which has almost the same CSR, say + / – 5%. However, very high or very low CSR will mean positive or negative implications respectively in product inclusions and exclusions, as well as the transparency with which the company sells health insurance products to its customers. Very high is great, very low is poor and best avoided. Hope this is understood.
We are now ready to see the Claims Settlement Ratios for Health Insurance for 2013-2014.
Which are the best Claims Settlement Ratio of Health Insurance Companies in India 2013-2014?
There are 24 companies which offer Health Insurance products in India. So if you have been confused till now, it is not surprising. The good thing is that you are researching before you buy – Claim Settlement Ratio for Health Insurance is something you should surely know before you go ahead with your choice of company and product. A higher claim settlement ratio for medical insurance means there is a higher probability of your claim getting passed.
Here are the details. Companies with >80% have been indicated in green.
Click here or anywhere else on the table below to see it full screen.
Summary
- Don’t choose a company just because of high Claims Settlement Ratio for Health Insurance. Do check the size of their operations, i.e. how many claims they have settled – Bigger is better since they will be able to offer better services.
- Anything above 80% is a decent CSR, but some good companies have high pending cases which brings down the CSR%. Therefore you should look at the CSR% only for claims where the decision has been made, i.e. approved or rejected. That will be much a better indicator. And you can see that comparison here. Use this list to create the list of companies that you should start with. Then move on to check the product features and price.
Time Taken to Settle Claims
Remember that you cannot decide on your Health Insurance plan simply based on claims settlement ratio for Health Insurance. A very important consideration is the time that companies take to pay your claim. What’s the point if a health insurance claim takes more than 3-4 months to be paid?
Be careful because some companies have an average claim settlement time of 131 days!
Here’s where you can check which companies are the fastest to settle your health insurance claims.
Let us know what the correct numbers should be. We will be happy to verify and correct.
As mentioned, the source of the data are the websites of the insurance companies. It is not readily available, you need to work it out.
Very good of you to take the time and effort to get into the fine print numbers. I am interested in the calculation of these numbers. When I was doing the same, I realized that every company publishes reports every quarter. However, the report of the last quarter contains the numbers for the whole year since the numbers are hugely disproportionate for all companies. Please check or do tell me if I have made an error of judgement?
Very good question, Pratima. There is yet another category – PSU health insurance companies.
While one could always imagine that standalone health insurance companies, by design, may appear more ‘committed’ to health insurance as a category and will be able to provide better services, there is no data to prove it. Also, standalone health insurance companies have not acquired the highest scale of operations in health insurance, yet.
Besides, there is always the possibility that standalone companies may eventually diversify to provide even travel insurance and other general insurance products, as they strive for growth.
So in our view, any company approved by the regulator is equal unless there is evidence to validate an alternative thought. Just understand your needs first, know the product you need and compare only within those needs to buy from the company that render the best service, whether it is a standalone health insurance company or otherwise.
Very good question, Pratima. There is yet another category – PSU health insurance companies.
While one could always imagine that standalone health insurance companies, by design, may appear more ‘committed’ to health insurance as a category and will be able to provide better services, there is no data to prove it. Also, standalone health insurance companies have not acquired the highest scale of operations in health insurance, yet.
Besides, there is always the possibility that standalone companies may eventually diversify to provide even travel insurance and other general insurance products, as they strive for growth.
So in our view, any company approved by the regulator is equal unless there is evidence to validate an alternative thought. Just understand your needs first, know the product you need and compare only within those needs to buy from the company that render the best service, whether it is a standalone health insurance company or otherwise.
Is it better to buy from standalone Health Insurance companies or from other GI companies selling health insurance or from life insurance companies selling health insurance?
Is it better to buy from standalone Health Insurance companies or from other GI companies selling health insurance or from life insurance companies selling health insurance?
If you look hard, you will find the information in the websites of the companies. We looked hard.
If you look hard, you will find the information in the websites of the companies. We looked hard.
Dear on irda website this report is not available where did you get this Report?it only available up to 2012-2013
Dear on irda website this report is not available where did you get this Report?it only available up to 2012-2013
That’s a common and valid query, Lokesh. Please refer to the link below for our views on that topic.
https://www.mintwise.com/blog/family-floater-mediclaim-individual-health-insurance-india/
That’s a common and valid query, Lokesh. Please refer to the link below for our views on that topic.
https://www.mintwise.com/blog/compare-online-term-insurance-plans-india-2014/
Very good articles across the blog on various topics. Can you please share you thoughts on which kind of health insurance is better – family floater or separate policies for each? thanks in advance.
Very good articles across the blog on various topics. Can you please share you thoughts on which kind of health insurance is better – family floater or separate policies for each? thanks in advance.
We are unclear why would you want to reject it at that stage without proceeding to get the policy issued. However if you do, the cost of the medicals are deducted by most companies. Roughly about Rs. 2,500.
We are unclear why would you want to reject it at that stage without proceeding to get the policy issued. However if you do, the cost of the medicals are deducted by most companies. Roughly about Rs. 2,500.
In case I reject the policy after undergoing all the tests what will be the penalty?
In case I reject the policy after undergoing all the tests what will be the penalty?
More articles on Health Insurance shortly, Mahendra.
More articles on Health Insurance shortly, Mahendra.
best way to look at health insurance claim settlement ratio is this way. the other option of incurred claims ratio is not of any use for customers. thanks for a superb analysis, mintwise. please write more on health insurance.
best way to look at health insurance claim settlement ratio is this way. the other option of incurred claims ratio is not of any use for customers. thanks for a superb analysis, mintwise. please write more on health insurance.
Yes i was also looking for this. thanks for showing this information table.
Yes i was also looking for this. thanks for showing this information table.
hi. for last 2-3 months i was searching to get claims ratio for health insurance in a proper way like this one. i could not understand incured claims ratio. this is very easy to understand. great job and big thank you to Mintwise.
hi. for last 2-3 months i was searching to get claims ratio for health insurance in a proper way like this one. i could not understand incured claims ratio. this is very easy to understand. great job and big thank you to Mintwise.