Claim Settlement Ratio in Health Insurance

Claim settlement ratio or CSR in a health insurance policy is the ratio of the settled claims to the claims made with an insurer. It is the common metric used to rate an insurance company, which is also one of the key considerations for policyholders to choose an insurer.

The CSR is calculated at the beginning of every year by India's Insurance Regulatory and Development Authority (IRDAI). In addition, the organisation publishes the up-to-date health insurance claim settlement ratios of the registered insurance companies annually.

Simply put, for example, if the health insurance company A settles 100% of the claims raised by its policyholders during a year, its CSR will be 100%. However, if company B settles around 80% of the claims raised by its policyholders and rejects 20% of the same, its CSR will be 80%.

IRDAI uses a definite formula to calculate the CSR of a registered insurance company in the country. According to the formula,

CSR = Total no. of claims settled/Total no. of claims received X 100

The result is represented in percentage. For example, if the CSR of an insurance company is 80%, this means that for every 100 claims raised by its policyholders, 80 claims are settled by the company and paid out.

It should also be noted that the CSR is not just calculated for the life insurance policies but every kind of insurance offered by an insurance company.

In a life or health insurance policy, the vitality of the insurance lies in the assurance that during an unfortunate event like medical emergencies, they or their beneficiaries will be able to raise a claim for getting the insurance coverage. If the claim is settled by the insurer and paid out on time, the sum assured will help the beneficiaries manage their financial requirements.

Having said that, there are a few factors under which the insurer might not settle a claim. This could be due to incorrect information by the policyholder while filling out the application forms, or hiding medical histories while availing the life or health insurance policy, and so on. Other reasons may also include the incompetence, poor practices and low reliability of the insurance company.

Ultimately, medical insurance for families in India can only be as reliable as the company that provides the same. Therefore, the CSR or the Claim Settlement Ratio in Health Insurance will help you make an accurate judgement regarding the potential insurers.

While looking for a health insurance policy for yourself or your family, you need to go through the CSRs of the potential insurance companies to make an informed choice. It can also help you in several other ways:

• If the CSR of an insurer is 80% and above, the insurance company will assure that you can fully trust them, and they will settle and pay out the claim made by your beneficiaries in your absence.

• Your family members will not have to worry about hustling day and night to get their claims settled with a good CSR.

• It will provide your family with a kind of financial security in your absence.

• If you can compare health insurance CSR of different companies, look for some of the best ones that offer not only a higher CSR but also reputed services. You will be relieved that your premium payments are safe with them.

• Having said that, you should be able to check the Health Insurance Claim Settlement Ratios of the past couple of years to choose the best insurer. A good and steady CSR will portray the company's credibility, and therefore, should be an influential factor in selecting a medical insurance plan for your family or yourself.

• So, now that you are aware of the relevance of CSR in health insurance plans, here are a few more tips to make your purchase better and safer:

• A Bigger CSR isn’t Equivalent to a Better Company Always: This is because a new company, which is also a small one, may have received just a small number of claims in a particular year. Hence, they will have a higher CSR. Such an insurer might not be able to handle large claims or customers. Hence, it would help if you didn’t choose them simply because they have paid out all the claims in the past year.

• Look into every parameter, such as the Solvency Ratio, customer reviews, after-sales service, trustworthiness, etc., and choose a company that has been consistent in settling its claims in the past.

• Do Consider the Overall Rating of the Insurer:** The CSR will not be the only thing to consider while choosing a health insurance company. It would help if you also learned more about their insurance pricing, product features, benefits, and so on before choosing one.

-Consider Claim Settlement Ratio as One of the Factors: Finally, do go through the CSR of the insurers as presented by the IRDAI before signing a policy deal with one of them. Once you can compare health insurance companies based on their past CSRs, you will be able to pick the right one for yourself.

Tata AIG offers the Medicare line of health insurance plans that offer individual, family floater and senior citizen plans, along with a Medicare Plus super top-up health plan. With a veritable history of providing dependable service and the brand value of the TATA name, we offer you comprehensive health insurance plans. Our health insurance benefits include:

• A Claim Settlement Ratio of 94.43% for FY 2020-21

• A wide network of more than 7200 cashless hospitals

• In-built Covid-19 coverage

• Considerable No Claim Bonus for claim-free years

• 24x7 assistance with our team of dedicated experts that justifies our motto “With You Always”

• 5%-10% discounts on the premium of 2-year and 3-year policies

In short, before choosing a health insurance company, you need to consider their claim settlement ratio in health insurance along with other important parameters. This will help you to understand the financial stability of the company and its authenticity better.