ICR or Incurred Claims Ratio for Health Insurance Companies in India is published by IRDA every year. In Jan 2014, IRDA published the incurred claims ratio for Health Insurance 2012-2013. Incurred Claims Ratio is nothing but the total value of all claims paid by the company divided by the total amount of premium they collected in the same period. This is generally calculated for each financial year.
What does Incurred Claims Ratio indicate?
Incurred Claims Ratio for Health Insurance indicates the company’s ability to pay the claims.
- If it is >100%, it means that the company has given more money away as claim than what it has collected as premium. This is not sustainable for the company and they will tend to either start rejecting some borderline claims, change their product, or increase the price to help manage the claims.
- If it 50-100%, it means that the company has given lesser amount as claims than what it has collected. They are therefore making profits. That is a good sign and it means that the company has not just created a good product but has sold it transparently so that customers are able to understand where to make a claim, and where not to. The company will be able to provide good service as well.
- If ICR is <50%, the company is either selling a high-priced product successfully and/or hardly giving out claims. The company is making very big profits and that is NOT as good as it sounds. Any health insurance company must provide products which actually pay out claims within the right limits. If claims are low, then over time, customers of such products will realize that the health insurance cover is expensive and/or there are too many exclusions in the insurance plan, and they may change to a more efficient product.
So in our view, the ideal value of Incurred Claims Ratio for Health Insurance is in the 75-90% range..
Important : All this assumes that the average age of the customers is the same. If a company is able to get more young customers who are less risky, they will have a low incurred claims ratio, sometimes as less as 40%. This is an indicator of a good company which has successfully marketed its products to acquire a relatively healthy pool of customers. Profits follow, and so does good customer service.
IRDA Incurred Claims Ratio for Health Insurance and Mediclaim companies in India 2011-2012-2013
We have collated the data for the last 2 financial years and they are presented below. We have also shown you the premium collected and claims values so that you also get an idea of how big or small each company is in Health Insurance.
Click on the image below to see it full screen.
Remember that a preferred range of ICR should be 75-90%, with those closer to 85-90% being the best. In this range, companies are making reasonable profits and will be able to service customers well.
Now, this was about Incurred Claims Ratio for Health Insurance. But if your intention is to actually BUY a health insurance plan, then you need to decide on a specific insurance company or health insurance product. And for that, you need to know what % of claims are settled by the company. So don’t forget to see the Claims Settlement Ratio for Health Insurance, which gives you exactly that information. Also, to know the speed of settling claims, don’t forget to find out which health insurance company in India settles claims the fastest!
Mr. Babu, sorry for the delayed response.
This looks like a group health plan. If that is the case, you can change your insurer when the policy comes up for next yearly renewal. If you still want to do it midway, I would recommend you check with United India Insurance and first identify a similar policy. Am sure they will help you with the porting part.
Let us know if you still need our help.
Agree with you, Raju. But it is not entirely true. Since the period is 1 year always, it averages out, half the customers are from the previous pool, but half of the current pool spills over to the next pool. We have to draw a line somewhere so that measurement can be done, so it is not a bad metric to rely upon.
Also, it is the only metric published, and to go by. In fact, as mentioned towards the end of the article, the claim settlement ratio 2014 for health insurance linked below is a far better indicator in our view.
https://www.mintwise.com/blog/claim-settlement-ratio-for-health-insurance-india-2014/
Generally, public companies have fared better on ICR. But do check their CSR as well.
Agree with you, Raju.
Unfortunately, it is the only metric published, and to go by. In fact, as mentioned towards the end of the article, the claim settlement ratio 2014 for health insurance linked below is a far better indicator in our view.
https://www.mintwise.com/blog/claim-settlement-ratio-for-health-insurance-india-2014/
Generally, public companies have fared better on ICR. But do check their CSR as well.
Article is good. But I did not understand a few.
How can this be a good indicator? Where Premium is collected from new customers and the claim settled is for old customers. In which case earlier the company might have collected premiums from old customers and paid from the profits.
One more question: Is it even the public companies do it for business? Because the ICR for such companies is higher.
Article is good. But I did not understand a few.
How can this be a good indicator? Where Premium is collected from new customers and the claim settled is for old customers. In which case earlier the company might have collected premiums from old customers and paid from the profits.
One more question: Is it even the public companies do it for business? Because the ICR for such companies is higher.
You can find the details here.
https://www.mintwise.com/blog/claim-settlement-ratio-for-health-insurance-india-2014/
Hope this helps you.
You can find the details here.
https://www.mintwise.com/blog/claim-settlement-ratio-for-health-insurance-india-2014/
Hope this helps you.
Karthik, you can find it in the link below.
https://www.mintwise.com/blog/claim-settlement-ratio-for-health-insurance-india-2014/
And here you can also check the time taken by each company to settle claims.
https://www.mintwise.com/blog/health-insurance-claims-india-fastest-settle/
Hope this helps you.
Karthik, you can find it in the link below.
https://www.mintwise.com/blog/claim-settlement-ratio-for-health-insurance-india-2014/
And here you can also check the time taken by each company to settle claims.
https://www.mintwise.com/blog/health-insurance-claims-india-fastest-settle/
Hope this helps you.
Hi,
I’m panning to purchase Religare care health insurance for my parents.They are just above 50 .Can you please provide the claim settlement ratio of Religare Care?
Hi,
I’m panning to purchase Religare care health insurance for my parents.They are just above 50 .Can you please provide the claim settlement ratio of Religare Care?
Hi,
Any updated on the latest CSR of health insurance companies?
Hi,
Any updated on the latest CSR of health insurance companies?
1. Kedar, no article has been deleted. The link you are mentioning is a menu link and not for an article per se.
2. Our expectation of increase in the Sec 80D limit beyond the existing Rs. 15,000 p.a. has not been met in this budget. So nothing changes.
1. Kedar, no article has been deleted. The link you are mentioning is a menu link and not for an article per se.
2. Our expectation of increase in the Sec 80D limit beyond the existing Rs. 15,000 p.a. has not been met in this budget. So nothing changes.
Hello ,
1. can you re-post the old article : ” I want to buy Health Insurance , but with so many options I am confused”.
2. Any comment on post budget recommendations for Health insurance ? any new considerations/benefits to take into consideration/await ? Thanks in advance.
Hello ,
1. can you re-post the old article : ” I want to buy Health Insurance , but with so many options I am confused”.
2. Any comment on post budget recommendations for Health insurance ? any new considerations/benefits to take into consideration/await ? Thanks in advance.
Of course you can. It is like buying a shirt and a trouser from 2 different shops. No problem as long as they both fit you!
Of course you can. It is like buying a shirt and a trouser from 2 different shops. No problem as long as they both fit you!
Thankyou so much for your help. But if I get Term Plan From HDFC can I buy a PA policy from anyone else? Is there any problem??
Thankyou so much for your help. But if I get Term Plan From HDFC can I buy a PA policy from anyone else? Is there any problem??
Praveen,
ICR alone need not be the reason and is not entirely reliable. Please await our article on Claims Settlement Ratio for Health Insurance, that will explain it better.
Praveen,
ICR alone need not be the reason and is not entirely reliable. Please await our article on Claims Settlement Ratio for Health Insurance, that will explain it better.
Ideally a plain term insurance with a separate PA policy is recommended, because a PA policy also covers instances such as loss of income or disability, due to accident, in addition to cover for accidental death.
If you go for a PA policy (recommended), you don’t need a separate accidental death policy which cover only accidental death. In case you don’t, add a rider to your term plan.
Whatever you do, ensure that the cover size and cover period, are adequate.
Ideally a plain term insurance with a separate PA policy is recommended, because a PA policy also covers instances such as loss of income or disability, due to accident, in addition to cover for accidental death.
If you go for a PA policy (recommended), you don’t need a separate accidental death policy which cover only accidental death. In case you don’t, add a rider to your term plan.
Whatever you do, ensure that the cover size and cover period, are adequate.
L&T Insurance – what specific details are you looking for?
Yes, HDFC Life is a life insurance company selling only life insurance products, and HDFC Ergo is a non-life (general) insurance company selling health, motor, home, travel and other non-life insurance products.
L&T Insurance – what specific details are you looking for?
Yes, HDFC Life is a life insurance company, and HDFC Ergo is a non-life (general) insurance company.
Hi, Could You Please provide me details of L & T Insurance Company.. Also are HDFC Life and HDFC Ergo Different Companies??
Hi, Could You Please provide me details of L & T Insurance Company.. Also are HDFC Life and HDFC Ergo Different Companies??
Dear Mintwise Team
I have just taken Max Bupa Family First sliver Plan in this i cover my (33Y) ,My spouse (28Y) & my child (5yr) in this we all having 5 Lakhs individual cover & got additional 15 Lakhs floater cover over this.
Please suggest me that ICR is maxbupa is very low & weather i have continue the policy with max bupa or i have to port my policy in other company because max bupa increased premium every year.
But they are cover every type of illness after 90 days.
Dear Mintwise Team
I have just taken Max Bupa Family First sliver Plan in this i cover my (33Y) ,My spouse (28Y) & my child (5yr) in this we all having 5 Lakhs individual cover & got additional 15 Lakhs floater cover over this.
Please suggest me that ICR is maxbupa is very low & weather i have continue the policy with max bupa or i have to port my policy in other company because max bupa increased premium every year.
But they are cover every type of illness after 90 days.
Hi, I was planning on taking the SBI Life Insurance With Accidental Death Cover.
Also I Want a Health Insurance
But My Confusion is Should I Take SBI Life Insurance Without Accidental Death Cover and Then take A Separate Personal Accident Policy
or Just A Regular Health Insurance along with SBI Life Insurance With Accidental Death Cover.
Hi, I was planning on taking the SBI Life Insurance With Accidental Death Cover.
Also I Want a Health Insurance
But My Confusion is Should I Take SBI Life Insurance Without Accidental Death Cover and Then take A Separate Personal Accident Policy
or Just A Regular Health Insurance along with SBI Life Insurance With Accidental Death Cover.
Surely. Thanks for understanding, Sailesh. We appreciate it.
Surely. Thanks for understanding, Sailesh. We appreciate it.
Yes, clearly I need a personal accident policy covering the things I mentioned. Mintwise team has not disappointed me for sure, it’s my bad that I have asked for the names / brands. I look forward to your guidelines on getting the right plan. I hope it comes soon.
Yes, clearly I need a personal accident policy covering the things I mentioned. Mintwise team has not disappointed me for sure, it’s my bad that I have asked for the names / brands. I look forward to your guidelines on getting the right plan. I hope it comes soon.
Sailesh, what you clearly need is a Personal Accident policy.
Unfortunately, we do not recommend brands on this website. We only give you all the information, reasons and principles one should see when buying a financial product. So we may not be able to recommend a brand per se.
Sorry to disappoint you there.
Sailesh, what you clearly need is a Personal Accident policy.
Unfortunately, we do not recommend brands on this website. We only give you all the information, reasons and principles one should see when buying a financial product. So we may not be able to recommend a brand per se.
Sorry to disappoint you there.
Thank you Mintwise Team. Yes, the term insurance is in place and emergency fund is being created. My focus in covering accidents leading to partial disability. Infact I am planning to buy it sooner than later. Hence any valuable advice on which plan from which insurer would make most send would be really helpful.
Regards,
Sailesh
Thank you Mintwise Team. Yes, the term insurance is in place and emergency fund is being created. My focus in covering accidents leading to partial disability. Infact I am planning to buy it sooner than later. Hence any valuable advice on which plan from which insurer would make most send would be really helpful.
Regards,
Sailesh
Sailesh, our section on accident cover is in the pipeline, and will be released shortly.
It is good that you are thinking of an accident cover. We hope that before that you have taken care of some other things in this order… an emergency fund and a term insurance plan. In case you still haven’t, we suggest you do that. Here are an article that will help.
https://www.mintwise.com/blog/basic-financial-plan/
For covering death in an accident, we suggest you buy it with your term insurance plan itself. Do read this article for clarity.
https://www.mintwise.com/blog/accidental-death-benefit-rider-term-insurance/
But if you are looking at covering accident leading to disability, medical costs and loss of income, you need a personal accident policy offered by a general insurance company. Buy it for the highest term available since it covers not just death but disability and medical costs as well. Buy it for the maximum value available.
Accidental deaths are generally scrutinized in a similar fashion by each company. So you can choose any. Claims Settlement Ratio for Personal Accident Insurance published by IRDA (will be included in our new section when launched) is one way to make a choice of company.
Sailesh, our section on accident cover is in the pipeline, and will be released shortly.
It is good that you are thinking of an accident cover. We hope that before that you have taken care of some other things in this order… an emergency fund and a term insurance plan. In case you still haven’t, we suggest you do that. Here are an article that will help.
https://www.mintwise.com/blog/basic-financial-plan/
For covering death in an accident, we suggest you buy it with your term insurance plan itself. Do read this article for clarity.
https://www.mintwise.com/blog/accidental-death-benefit-rider-term-insurance/
But if you are looking at covering accident leading to disability, medical costs and loss of income, you need a personal accident policy offered by a general insurance company. Buy it only till you are earning, i.e. till the period of retirement and not beyond. Buy it for the maximum value available.
Accidental deaths are generally scrutinized in a similar fashion by each company. So you can choose any. Claims Settlement Ratio for Personal Accident Insurance published by IRDA (will be included in our new section when launched) is one way to make a choice of company.
Dear Mintwise Team,
I find the info really useful. One question I have is regarding accidental insurance for which I don’t see any other section and hence putting the question here.
Both me and my wife are working and I am planning to buy an accidental cover for each of us separately. I want to know what and how the right amount should be decided and the right players whom I can consider for buying this accidental cover. What are the things I should look out for in buying accidental cover and till what age do we need this?
Regards,
Sailesh
Dear Mintwise Team,
I find the info really useful. One question I have is regarding accidental insurance for which I don’t see any other section and hence putting the question here.
Both me and my wife are working and I am planning to buy an accidental cover for each of us separately. I want to know what and how the right amount should be decided and the right players whom I can consider for buying this accidental cover. What are the things I should look out for in buying accidental cover and till what age do we need this?
Regards,
Sailesh
Yes Abhilasha, we will be putting it up shortly.
Yes Abhilasha, we will be putting it up shortly.
Hi,
Any updates on CSR of health insurance companies ?
Hi,
Any updates on CSR of health insurance companies ?
1. With just Rs. 4 lakhs of cover, you clearly need more. Go for a family floater instead of individual policies. It is cost-efficient that way.
2. We would recommend a family floater option of about Rs. 10 lakhs at least + a CI cover.
3. No, Kedar. Would recommend a floater for reasons in 1 above.
4. If you feel they are the best value, no need to change. In case another provider has better benefits, go for a different one. You may lose some marginal discounts but from a coverage perspective, diversification is indeed recommended for a Health Insurance cover.
Let us await the Budget offerings for complete clarity.
1. With just Rs. 4 lakhs of cover, you clearly need more. Go for a family floater instead of individual policies. It is cost-efficient that way.
2. We would recommend a family floater option of about Rs. 10 lakhs at least + a CI cover.
3. No, Kedar. Would recommend a floater for reasons in 1 above.
4. If you feel they are the best value, no need to change. In case another provider has better benefits, go for a different one. You may lose some marginal discounts but from a coverage perspective, diversification is indeed recommended for a Health Insurance cover.
Let us await the Budget offerings for complete clarity.
Thank you! current health insurance from employer is 4L for immediate family(self, spouse,kid). For parents, I have taken 2L each(my current choice, it could be upto 4 each as well). Both are under 2 separate policies – but with HDFC Ergo itself. I note your advise to go for CI .
1.My feeling is that 4L+2L+2L is possibly on the lower side.
2. After the budget, is it good idea to look at raising it to 6 & 2+2 plus CI for both ?
3. Any advise on whether to choose a product covering all 5 members or maintain separate as 3 + 2 (parents) ?
4. Continuity with the same insurer (as for employer) advised or better to look for alternate?
Thank you! current health insurance from employer is 4L for immediate family(self, spouse,kid). For parents, I have taken 2L each(my current choice, it could be upto 4 each as well). Both are under 2 separate policies – but with HDFC Ergo itself. I note your advise to go for CI .
1.My feeling is that 4L+2L+2L is possibly on the lower side.
2. After the budget, is it good idea to look at raising it to 6 & 2+2 plus CI for both ?
3. Any advise on whether to choose a product covering all 5 members or maintain separate as 3 + 2 (parents) ?
4. Continuity with the same insurer (as for employer) advised or better to look for alternate?
Kedar, we do not know how much of health insurance cover you already have with your organization. But knowing that most offer up to Rs. 10 lakhs max, you should go in for a higher cover especially to cover for critical illnesses if you don’t already have a CI cover.
Since the budget is just a few days away, suggest you wait for it if you are not in a tearing hurry. We anticipate some changes in tax incentives around health insurance and that may give birth to some innovative new products in this space.
Kedar, we do not know how much of health insurance cover you already have with your organization. But knowing that most offer upto Rs. 10 lakhs max, you should go in for a higher cover.
Since the budget is just a few days away, suggest you wait for it if you are not in a tearing hurry. We anticipate some changes in tax incentives around health insurance and that may give birth to some innovative new products.
I see one listed as ” I want to buy Health Insurance , but with so many options I am confused”. I hope it will help in decision making. I am basically looking at Family floater option , myself(41), wife(41), kid(12) & my dependant parents ( 72y , 60y). Not sure if a good company with good product covering all 5 simultaneously is there or better to split as one for 3 of us & one for parents separately ?
I read on some channels that new govt may have some decisions regarding HI ; any opinion ? is it good to wait till budget ?
I have HDFC Ergo cover through current employer , however would like to go for additional cover outside of current employer arrangement. Is it good idea to stick to same Insurer in such case or better to scout another like ICICI/Bajaj/National ?
I see one listed as ” I want to buy Health Insurance , but with so many options I am confused”. I hope it will help in decision making. I am basically looking at Family floater option , myself(41), wife(41), kid(12) & my dependant parents ( 72y , 60y). Not sure if a good company with good product covering all 5 simultaneously is there or better to split as one for 3 of us & one for parents separately ?
I read on some channels that new govt may have some decisions regarding HI ; any opinion ? is it good to wait till budget ?
I have HDFC Ergo cover through current employer , however would like to go for additional cover outside of current employer arrangement. Is it good idea to stick to same Insurer in such case or better to scout another like ICICI/Bajaj/National ?
Which one in particular are you referring to, Kedar?
Which one in particular are you referring to, Kedar?
Hello, can you please repost the original article under the Health Insurance section ? I am unable to locate it on the site. it will greatly help as I am planning for a family floater health insurance purchase asap.
Hello, can you please repost the original article under the Health Insurance section ? I am unable to locate it on the site. it will greatly help as I am planning for a family floater health insurance purchase asap.
Because their ICR is low? No. They may be managing their portfolio smartly acquiring a younger customer base resulting in lower Claims.
Stay put.
Because their ICR is low? No. They may be managing their portfolio smartly acquiring a younger customer base resulting in lower Claims.
Stay put.
I have Apollo Munich insurance. Should I switch ?
I have Apollo Munich insurance. Should I switch ?
Thanks, Jacob. We will be including Claim Settlement Ratio for Health Insurance shortly.
Thanks, Jacob. We will be including Claim Settlement Ratio for Health Insurance shortly.
Was looking for interpretation of this information and finally got it here. Thanks to MintWise team. Please also write on claim settlement ratio for health insurance.
Was looking for interpretation of this information and finally got it here. Thanks to MintWise team. Please also write on claim settlement ratio for health insurance.