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The Importance of a Health Insurance Claim Ratio

Buying a new health insurance policy to suit your needs can be tedious as there are many options. Read more to know about the health insurance claim settlement ratio 2020-21.

  • 2,993 Views | Updated on: Jun 07, 2024

Buying a new health insurance policy to suit your needs can be a tedious task as there are many options. And, if you are a first-time insurance buyer, you may get confused. To avoid such a situation, you should take your time to assess your requirements and consider factors like the age of the family members, family’s medical history, budget, etc., before you start looking for a policy.

After knowing your exact needs, you can compare the different plans available in the market and choose the one that suits your needs and offers maximum benefits. Just as it is important to choose the right plan, it is critical to select the right insurance company.

One of the best ways to determine the best insurance company is to look at their claim settlement ratio of the past few years. It is better to buy health insurance plan from a company with a good claim settlement record as you must be able to avail the policy benefits during an emergency without any hassles.

What is the claim settlement ratio?

A claim settlement ratio indicates the number of claims successfully settled by an insurance company against the number of claim applicants received in a specific period. A company with a high claim settlement ratio defines its ability to settle claims during an emergency instantly. Generally, most reputed insurance companies like Kotak Life Insurance have a high claim settlement ratio.

The formula for calculating the claim settlement ratio

CSR = Total claims settled / total claims received + outstanding claims at the start of the year

Most health insurance companies use the above formula to calculate their claim settlement ratio in a year. While comparing the best health insurance companies to purchase a plan, it is better to look for an insurer with a claim settlement ratio of over 80%.

Importance of claim settlement ratio of a health insurance company in India

Remember, the primary objective of buying a health insurance policy is to get financial compensation during a medical emergency in the family. And, if a company has a high claim settlement ratio, you can be confident that the insurer will process your claim on time and settle the bills without any hassles.

When you compare the different insurance companies, it is better to look at the company’s claim settlement ratio for the past five years. This will give you a fair idea of the insurer’s consistency in settling the claims. It will also help make an informed decision when it comes to choosing the right insurance company.

Generally, most insurance companies have their CSR data on their website. However, if you don’t find the same on the insurer’s website, you can check the IRDAI (Insurance Regulatory Development Authority of India) website. IRDA is the regulatory body that oversees the insurance operations in India, and it periodically publishes the CSR of all insurance companies on its website for public reference.

Final Word

Now that you know what the claim settlement ratio is and its importance, make sure that you do your due diligence and compare the insurance companies’ CSR before choosing the right one.

- A Consumer Education Initiative series by Kotak Life

Amit Raje
Written By :
Amit Raje

Amit Raje is an experienced marketer who has worked in various Fintechs and leading Financial companies in India. With focused experience in Digital, Amit has pioneered multiple digital commerce in India. Now, close to two decades later, he is the vice president and head of the D2C business department. He masters the skill of strategic management, also being certified in it from IIMA. He has challenged his challenges and contributed his efforts in this journey of digital transformation.

Amit Raje
Reviewed By :
Prasad Pimple

Prasad Pimple has a decade-long experience in the Life insurance sector and as EVP, Kotak Life heads Digital Business. He is responsible for developing user friendly product journeys, creating consumer awareness and helping consumers in identifying need for life insurance solutions. He has 20+ years of experience in creating and building business verticals across Insurance, Telecom and Banking sectors

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