Claim Settlement Ratio for Health Insurance in India 2013-2014 IRDA Claims Settlement Ratio for Health Insurance or Mediclaim is the total no. of health claims approved by the insurance company divided by the total no. of claims filed by customers. Claims Settlement Ratio (CSR) shown here is different from Incurred Claims Ratio (ICR) published by the IRDA, which is just the ratio of total claim amount to total premium collected. ICR does not tell us what % of claims are approved or rejected. So in our view, CSR is a much better indicator for customers trying to decide which health insurance to buy, because it is the ratio of claims approved to total claims made.
We have computed CSR for Medical Insurance company-wise and you can see which companies approve more health claims than others.
Before you proceed to evaluate CSR, an important word of caution : Unlike CSR for Life Insurance, Claims Settlement Ratio for Health Insurance is indicative and the caveats need to be understood clearly. Death claim can be made only after a clear event (you are either dead or alive) but a Health Claim need not be as clear an event as Death. This is because when a health insurance claim is made, there is a probability that the claim reason (illness, expense incurred, etc.) may not even be covered by the health insurance product in the first place. And that could mean a VALID rejection of the claim. When you go through the Claims Settlement Ratio for Health Insurance, understand that a company with slightly higher or lower ratio is probably not very different from another which has almost the same CSR, say + / – 5%. However, very high or very low CSR will mean positive or negative implications respectively in product inclusions and exclusions, as well as the transparency with which the company sells health insurance products to its customers. Very high is great, very low is poor and best avoided. Hope this is understood. WHICH ARE THE BEST CLAIMS SETTLEMENT RATIO OF HEALTH INSURANCE COMPANIES IN INDIA 2013-2014? There are 24 companies which offer Health Insurance in India. So if you have been confused till now,
it is not surprising. The good thing is that you are researching before you buy – Claim Settlement Ratio for Health Insurance is something you should surely know before you go ahead with your choice of company and product. A higher claim settlement ratio for medical insurance means there is a higher probability of your claim getting passed.
SUMMARY Don’t choose a company just because of high Claims Settlement Ratio for Health Insurance. Do check the size of their operations, i.e. how many claims they have settled – Bigger is better since they will be able to offer better services. Anything above 80% is a decent CSR, but some good companies have high pending cases which brings down the CSR%. Therefore you should look at the CSR% only for claims where the decision has been made, i.e. approved or rejected. That will be much a better indicator. And you can see that comparison . Use this list to create the list of companies that you should start with. Then move on to check the product features and price.
[Source: https://www.mintwise.com/blog/claim-settlement-ratio-for-health-insurance-india-2014/]