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Claim Settlement Ratio 154409 views December 9, 2019
India is developing at a rapid rate. It has now become a business hub too. With a huge population and increase in spending capacity, India is an apple of every investor’s eyes. There is no surprise that foreign companies are joining hands with their Indian counterparts for a profitable venture. And the health insurance sector is not far behind.
New Health Insurance companies are entering a highly potent Indian market every year. This, in turn, has given rise to fierce competition. Every insurer is trying to lure the customers by aggressive marketing, by its plans and by its attractive schemes.
This scenario has made selecting the right Insurer and the right product immensely difficult. There are chances that a person might land up taking the wrong product from a non-reputed insurer.
Thus, one must consider a few factors before buying health insurance so that there won’t be any fraudulent contracts. Let’s discuss a few important factors by which you can gauge the performance of an insurer and have a look at the top ten health insurance companies in India.
Table of Contents
Factors to be Considered While Choosing a Health Insurer
There are many factors which has to be taken into consideration while finalizing the insurer. Accountability, year of presence in the market, network, trust etc. are some of the factors which people judge a company. However, these factors are superficial. One needs a standard method to use as a yardstick for gauging a company’s worth.
Incurred Claim Ratio
The incurred claim ratio is one of the standard methods to evaluate the performance and overall working manner of the company.
Incurred Claim Ratio (ICR) is the net amount of claim paid during a financial year against the amount of premium collected during the same period.
In simple words, the incurred claim is the expenses of medical procedures paid to all the customers during a year. While premium collected is the amount paid by customers for buying the Health Insurance. Thus the ratio of these two amounts is called the Incurred Claim Ratio. It is calculated annually.
If the Incurred Claim Ratio is more than 100%, it implies that the Insurer is paying more money as compared to the premium collected. These companies are in loss and chances are that they might leave the sector or change their product altogether.
And if the Incurred Claim Ratio is less than 50 %, it implies that the insurer is paying very less amount as compared to the premium collected. We can infer that these companies are profit-oriented and stringent in paying claims or has very strict for processing claims.
If the Incurred Claim Ratio is between 50% to 100%, it implies that the companies are paying claims, as well as earning a profit. These companies can be considered while buying health insurance.
Ideally one should look for insurers with Incurred Claim Ratio between 75% to 90%
The following table shows 10 Health Insurers in India with its Incurred Claim Ratio
| S.No. | Insurer | ICR (Incurred Claim Ratio) |
|---|---|---|
| 1 | Bajaj Allianz | 77.61% |
| 2 | Bharti Axa | 98.5% |
| 3 | Future Generali | 87.42% |
| 4 | ICICI Lombard | 68.26% |
| 5 | Reliance | 106.54% |
| 6 | SBI General | 52.93% |
| 7 | Tata AIG | 60.6% |
| 8 | Star Health | 61.76% |
| 9 | Care Health | 51.97 |
| 10 | Niva Bupa | 50.19% |
However, Incurred Claim Ratio does not provide the time required to settle a particular claim.
Health Insurance Claim Settlement Ratio
Claim settlement ratio (CSR) is the most accurate method to weigh a company’s standing in terms of claim settlement. It is the ratio of claims settled against the total number of claims admitted.
In other words, if there were 100 claims admitted by a particular company out of which 93 has been settled then the claim settlement ratio is 93%. It also implies that 7 claims have either been kept pending or have been repudiated.
More the Claim Settlement Ratio, the better is the insurer.
The following table shows 10 Health Insurance Claim Settlement Ratio Companies in India
| Insurer | CSR (Claim Settlement Ratio) |
|---|---|
| Bajaj Allianz Life Insurance Company | 93.95% |
| Bharti Axa Health Insurance | 77.78% |
| Iffco Tokio Health Insurance | 92.88% |
| Reliance Health Insurance | 75.76% |
| HDFC ERGO Health Insurance | 82.99% |
| National Insurance Company | 78.52% |
| Star Health Insurance | 79.34% |
| Care Health Insurance | 89.59% |
| Niva Bupa Health Insurance | 88.06% |
Conclusion: For Health Insurance Claim Settlement Ratio
A person takes health insurance so that he is protected from financial risk during health issues. And if an insurer repudiated his claim or delays in paying, then what is the use of buying health insurance in the first place.
Hence one should be very keen while selecting an insurer for buying health insurance. Incurred Claim Ratio and Claim Settlement Ratio act as a guide in the processes of our decision making. The above list of top 10 Claim Settlement Ratio Health Insurance Companies in India is your one-stop ready-reckoner.
Health insurance is a must, but it should be taken wisely and with care. A company which promises more benefits for peanuts must be discarded immediately. Whereas companies delaying claims or negotiating the claim amount must be avoided.
Your choice to buy health insurance depends solely on the promise that an insurer makes and his trustworthiness