We presume you have already had a look at the Claims Settlement Ratio for Health Insurance in India for 2013-2014. And you must have already had some companies in mind by now. Good. But CSR for Health Insurance Claims alone is not good enough. Also important are…
1. How soon does the company settle the Health Insurance Claims?
2. What is the average claim amount?
3. And of course, the product features and coverage.
So here is our analysis on Health Insurance Claims for the year 2013-2014. This is collated from publicly available data. We must also mention here that we have used mean time for each time interval (15 for <1month, 60 for 1 – 3 months, etc. and 366 for >1 year) to estimate the average settlement time. When analyzed, this becomes a great input for making the choice on the Health Insurance company you will eventually choose to cover your family’s health expenses.
Click here or anywhere on the table below to see it full screen.
A few things emerge.
- There are quite a few companies who pay the claim amount within 30 days. Most health insurance companies offer cashless claims for hospitals in the network, which is a great thing for customers and which brings down the claims payout time significantly. Companies like Chola MS, Bharti Axa, ICICI Lombard and Religare Health settle your health insurance claims the fastest! Even Tata AIG, Max Bupa, Star Health, HDFC Ergo, Apollo Munich and Liberty Videocon have health insurance claims settlement time less than 30 days.
- National Insurance, Reliance General and United India Insurance take more than 100 days to settle claims. They will need to speed up on this front.
- There is a wide range in the average claims amount paid to customers. Some companies have very low average claims amount perhaps because of a multitude of business coming from low insurance cover health policies.
- Companies such as National Insurance, IFFCO Tokio, Liberty Videocon, L&T General, Bharti Axa, Max Bupa, Univeral Sompo and Apollo Munich have good average claim payout amount.
We will cover Health Insurance product features and compare the coverage of each policy through more articles shortly. In the meanwhile, do sign up by submitting your email and ensure you get the article in your inbox whenever we publish it.
To connect with one of our Trained & Certified Insurance Counselors, please call our Customer Care No. +91 1800 2121 344
You can go with that.
I think ICR 14-15 I got it from this website basunivesh
The information you see is laboriously calculated from multiple sources. It takes a lot of time and needs multiple checks before publishing.
We wish we could have helped you on this right away, but that will not be possible at this point in time. You can, in the meanwhile, use the previous year information (in this article) as guidance. Better still, you can also use the Incurred Claims Ratio for 2014-2015 published in the IRDA Annual report (you’ll find it on the IRDA website).
🙂 !! one request.. Can you send whatever raw data you have now to my mail id… bcos 15 days seems to be too much of a time. I have to proceed for my next assignment. Right now I am free and I can initiate the process within that. At least please send the info for FGI, Bajaj allianz, Star,Apollo. These are the products I am looking at.
The choice of brand comes after you are clear of your needs in the first place. Decide the type of product you need and then decide the brand.
We are not qualified or have enough data to give opinions about brands – that’s your call. We only provide factual information, like what you might have read in this article. Anyone giving you an ‘opinion’ is very likely to have a reason for doing so.
Future Generali has great credentials. If Future Generali’s products offer you the benefits you exactly need, and if you are yourself comfortable with the brand, just go ahead!
Hope this helps.
We hope to release these numbers in the next 15 days.
how about future generali?
Please release the 2014-15 numbers soon… I am going to take 3 policies now and it is extremely important I see this data before taking a final decision
That will be a good insight to unearth. We are not aware of a study as such, but agree that the findings will be a great input for insurers and in the interest of health insurance policyholders.
We thank you, Nakul, for your points of view.
In that case, is there a study which shows the point of view of small hospitals and individual docs who still form over 75% of the medical fraternity in India? From my few conversations, none of the small providers are keen on taking cashless insurance. It would be good to understand the key inhibitors for accepting insurance by these such doctors – since the advantages of being in the insurance network are obvious.
A few points in response.
1. The information is dated (it is for 2013-2014, as mentioned). The new numbers (2014-2015) are being worked on. It should be released in a few days’ time. Rankings and numbers could change, and yes, they would hopefully improve.
2. This data is an overall summary and is published by the regulator that way. Breakups (cashless, out-of-pocket, etc.) are unfortunately not available and we wouldn’t want to guess. Companies do announce their own numbers but the methodology and time periods differ so there is no like-to-like comparison possible.
3. Your point on claims affecting policyholders – completely agree. One reason why cashless is the way to go.
It’s been a year since this research and article was published. Would the editorial team or Mintwise readers still concur with these estimates around number of claims outstanding post 1 month and the rankings published above? As a current policy holder, I would be keen to see change and hopefully improvements in the claim process / settlement metrics.
In a related note, since it was not explicitly mentioned in the original article, are the numbers published above claim settlement time periods for cashless policy to the doctors / service providers? If so, the policy holders and patients should not be impacted by speed of cashless settlement with the doctors & hospitals, would you agree?
There is an IRDAI norm for General Insurance as a whole. As per the IRDA Handbook on Health Insurance, settlement/rejection of Claim after receiving first/addendum survey report should be done within 30 days.
Some of the delays could be genuine since there have been cases of frauds which will need investigation and some do result in eventual settlement. These case get included in the calculation and may skew it in the case of low bases. But assuming this effect is common to all, fast servicing definitely is a priority for some other companies and it shows.
On the average time to settle a claim, is there a reason why some insurers delay so much? Is there no IRDA guideline here to settle the payment?
Cigna TTK is a recently-initiated IRDA-approved insurance company. Both partners have very strong credentials. We see no reason why it isn’t a good company.
Cigna TTK is a recently-initiated IRDA-approved insurance company. Both partners have very strong credentials. We see no reason why it isn’t a good company.
is cigna ttk is worth buying. is it a good company?anybody takes plan in this?
is cigna ttk is worth buying. is it a good company?anybody takes plan in this?
Thanks for all that appreciation, Kedar. We hope to live up to your expectations. We will guide and provide generic qualitative analysis and comparisons but will be careful not to recommend companies or products per se. That’s a decision we want to leave completely to our customers based on individual needs.
Thanks for all that appreciation, Kedar. We hope to live up to your expectations. We will guide and provide generic qualitative analysis and comparisons but will be careful not to recommend companies or products per se. That’s a decision we want to leave completely to our customers based on individual needs.
Thanks for insightful , precise, data analysis and recommendations. Superb articles ! Look forward to more articles on specific product analysis/qualitative comparisons, which can be combined with above quantitative analysis , for making right decisions. As HI are multi year investments, with considerable ‘wait periods’ etc… starting with a right company and right product is very essential , to avoid loss of time/ crucial coverage.
Thanks for insightful , precise, data analysis and recommendations. Superb articles ! Look forward to more articles on specific product analysis/qualitative comparisons, which can be combined with above quantitative analysis , for making right decisions. As HI are multi year investments, with considerable ‘wait periods’ etc… starting with a right company and right product is very essential , to avoid loss of time/ crucial coverage.
Shailesh, thanks for the appreciation and the inputs. You will get many more articles on Health Insurance – don’t forget to sign up so that you get an email immediately when we publish them.
Thanks again.
Shailesh, thanks for the appreciation and the inputs. You will get many more articles on Health Insurance – don’t forget to sign up so that you get an email immediately when we publish them.
Thanks again.
Very useful advice. Did not find this anywhere else. In fact, all your articles are absolutely superb!
Please also write more articles on how to choose Health Insurance policies. it is very confusing with so many types available.
thanks mintwise team.
Very useful advice. Did not find this anywhere else. In fact, all your articles are absolutely superb!
Please also write more articles on how to choose Health Insurance policies. it is very confusing with so many types available.
thanks mintwise team.