Claim Settlement Ratio 171 views October 29, 2020

Claim Settlement Ratio – HDFC ERGO

As diseases, stress and medical costs are increasing, healthcare has become an expensive proposition. But there are health insurance companies ready to pay for your health care expenses on your behalf. But you should also know the claim settlement ratio of the health insurance company. And, in this post, we will discuss the claim settlement ratio of HDFC ERGO Health Insurance. So read and know about it!

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What is the Claim Settlement Ratio of HDFC ERGO and Why is it Important?

As per the annual report data of the Insurance Regulatory and Development Authority of India (IRDAI), HDFC ERGO claim settlement ratio for the year 2018-19 is 62.00%. And the claim settlement ratio is calculated by dividing the number of claims settled by the total claims received. For instance, if the insurer receives 10 claims and settles only 7 out of it, the claim settlement ratio (CSR) would be 70%.

The ratio helps you estimate the likelihood of your claim being settled in case there is any need in the future.

HDFC ERGO Health Insurance (Except Domestic, Overseas, and Personal Accident) Annual Data 2018-19

Do you know how many health insurance policies HDFC ERGO has sold in 2018-19? If not, check out this table below:-

Number of policies Number of covered personsGross Direct Premium Amount (in INR)
1066395 9605125423

Solvency Ratio of HDFC ERGO

The solvency ratio helps you find the insurance company’s financial status. And you can check the solvency ratio for HDFC ERGO in IRDAI annual report. Check out the table below and know the Solvency Ratio of HDFC ERGO for the financial year 2017-18.

DateQuarterly Solvency Ratio
30.06.2018 2.10
30.09.20182.03
31.12.20181.92
31.03.20191.75

How Many HDFC ERGO Claims Got Settled in FY 2018-19?

According to the IRDAI annual report data, HDFC ERGO has paid 18,66,809 claims in the year 2018-19. For more information, check out this table below:-

Pending Claims at the Beginning of the YearClaims Intimated or Booked

Total Claims Paid Claims Repudiated

Claims ClosedPending Claims at the End of the Year
52,18620,12,05118,66,80916,98660,1561,20,286

Note:- As per the number of claims paid during the year 2018-19, the claim settlement ratio of HDFC ERGO is estimated to be 62.00%

HDFC ERGO Claim Settlement Process

Your health insurance claim settlements are not a stressful experience at HDFC ERGO General Insurance Company Ltd. Check out the below pointers and know how to raise insurance claims. The entire process is simpler and faster.

  1. Provide complete information
  2. Read the policy wording carefully to know exclusions, limits, sub-limits, etc.
  3. Disclose any pre-existing medical conditions

Claims can be made under a cashless arrangement or via reimbursement. The insurer or the Third Party Administrator (TPA) must be informed of the cashless request, and only the insurance company needs to be informed if you want to proceed with reimbursement.

In the case of an emergency, you should intimate the insurer within 24 hours of hospitalization if the procedure is planned. After that, complete the relevant paperwork and formalities in 3 to 4 days in advance. That is why the insurers insist on a 48 hour-advance intimation for a speedy pre-authorization process. So keep your health card ready and handy in this type of situation.

Remember that HDFC ERGO cashless facility works only in the network hospitals (the hospitals which are on the pre-approved list) Ensure the pre-authorization form or the cashless request form is complete and correct and signed by the attending doctor.

You need to provide the OPD consultation papers for planned hospitalization. Get all bills, prescriptions, consultation receipts, medical reports, admission letters from the treating doctor, stamped hospital bills and receipts, etc. Settle all these expenses if the process is not cashless and get the receipts from the hospital. Do note that even for a cashless claim, there might be some expenses that might not get covered under the policy which you need to pay by yourself. You need to settle those hospital bills if the treatment is available at a non-network hospital, the customer has to pay for the whole treatment. After discharge, you can submit all the documentation and required reports to the insurer. Then, the insurer will check all the necessary documents and approve it if they find it reasonable.

Make sure you furnish complete and correct information in the claim settlement form and submit it within the given time frame as stipulated in the policy document. And all original hospital bills and receipts should be duly stamped and signed by the hospital. Also, take care of the below-mentioned things –

  1. Make timely payment of premiums so that the policy does not lapse
  2. Give bank mandate for reimbursement, if necessary
  3. Maintain your medical record, including copies of the old insurance (if any)
  4. Keep the insurer updated on relevant developments

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