Health Insurance Claim Settlement Ratio 95.2% FY 19-20 | Care Health  Insurance

A clear sign of confidence in the insurance industry is the health insurance claim settlement ratio. The ratio of claims paid in a fiscal year to claims submitted by insurance holders is known as the claim settlement ratio. If the claim settlement was completed within three months of filing for claim settlement or not is what counts most in determining a favourable claim settlement ratio. *

The pandemic’s most important lesson for us is that insurance can help us avoid serious financial hardship. The significance of the best mediclaim policy at this time cannot be overstated, given the rising costs of healthcare and those related to critical illnesses. A comprehensive policy may be able to reduce a lot of the stress associated with unanticipated medical emergencies. 

These policies pay your bills as soon as the insurance provider is alerted and cover daycare treatments, hospitalisation, medical care at home (domiciliary charges), ambulance costs, etc. 

To your knowledge, some insurance companies offer a direct claim settlement process, while others use TPAs (Third Party Administrators) to help with the process. 

What is the meaning of the claim settlement ratio (CSR)? 

You should research a supplier of health insurance’s dependability before buying a policy. The claim support provided by a corporation can be determined by looking at the claim settlement ratio. It effectively shows how many claims were settled by a corporation relative to all claims filed. High CSR is a sign of a company’s strong claim-settling capacity. *

Total claims resolved minus total claims filed is multiplied by 100 to compute CSR. 

For instance, a CSR of 95% means that an insurer has resolved 95 of the 100 claims that policyholders have submitted. 

Claim Settlement Ratio in Health Insurance: Its Significance 

The reliability indicator for a corporation provides information on its financial stability and ability to pay claims.

A look at how consistently insurers resolve claims is a useful statistic for health insurance comparison for measuring the performance of a rival.

What does a ratio of incurred claims mean? 

In addition to the CSR, the IRDAI also makes available the health insurance firms’ Incurred Claim Ratios. #

The amount spent by the insurer to resolve claims is revealed by the incurred claim ratio. In essence, it compares the money mediclaim vs health insurance companies make from new business premiums to the costs associated with claims. *

The formula for calculating the incurred claim ratio is (total amount paid in claims / total amount of premiums received) multiplied by 100. 

For instance, an insurance provider’s incurred claim ratio will be 64.7% if it has paid out Rs. 55 crores to settle claims and received Rs. 85 crores from premiums. 

A ratio of less than 50% indicates that the company has strict underwriting and claim processing standards, which result in many claims being denied. A low ratio could also indicate that policyholders are paying much more in premiums than they are receiving in benefits. 

It’s crucial to remember that a company’s performance is not necessarily reflected by the Incurred Ratio.

Checking the claim settlement ratio of a health insurance company is an essential step before purchasing a policy. It helps you understand the company’s reliability and efficiency in settling claims. By analysing the claim settlement ratio, you can get an idea of how likely it is that the insurance company will settle your claim in case of a medical emergency. Furthermore, it is advisable to compare the claim settlement ratio of different insurance companies to make an informed decision. In summary, a high claim settlement ratio is an indicator of a good insurance company, and potential policyholders should consider it when buying health insurance. *

* Standard T&C Apply

# Visit the official website of IRDAI for further details.

Insurance is the subject matter of solicitation. For more details on benefits, exclusions, limitations, terms, and conditions, please read the sales brochure/policy wording carefully before concluding a sale.

By Rehan

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