Health problems come uninvited. Even if you are the fittest person in your circle, you don’t need to never have to visit a doctor. And these days if a health issue needs hospitalization, it will also require quite a lot of money. This is why purchasing a health insurance policy is one of the most prudent things you can do. As soon as you get financially independent, you must buy a health insurance policy that suits your needs. Nevertheless,while buying a health insurance policy, you must check the health insurance claim settlement ratio of the particular health insurance company that you are interested in. Well, let us find out the factors to understand the claim settlement ratio in health insurance.
Calculating the Claim Settlement Ratio
You can very easily calculate the health insurance Claim Settlement Ratio. You just need to use a simple formula for this, which is mentioned herein below:
Claim Settlement Ratio (CSR) = (Total claims settled)/(Total claims received+Outstanding claims at the starting of the year)
A few of the health insurance companies that are known for their excellent Claim Settlement Ratio are Care Health Insurance, IFFCO Tokio Health Insurance, Oriental Insurance, Magma HDI Health Insurance, etc. Since these companies have higher Claim Settlement Ratios, they are trusted by the policy buyers.
You must judge the Claim Settlement Ratio of a health insurance company by its consistency. You can check the records forthe last 5 years. If it has been maintaining a high Claim Settlement Ratio for the past five years, it means the company has been settling claims consistently. This means you can choose it without a doubt.
Annual report by IBAI
The Claim Settlement Ratio of each of the public as well as private insurance companies is published each year by the Insurance Brokers Association of India (IBAI) in its General Insurance Claim Insights Handbook for Policyholders. You can find the report of your preferred health insurance companies on the official website of IBAI. Before you finalize or even shortlist health insurance to purchase a health insurance policy from it, you must go through the list once.
Number of claims received by an insurance company
Last but not the least;you should also check the number of claims received by the insurance companies during a fiscal year. Doing this will give you an idea of the size of the insurance company.
Documents you would need for health insurance Claim Settlement
For a successful claim settlement of your health insurance policy, you would need to submit the following documents.
- Original investigation reports
- Pharmacy bills along with the prescription
- FIR or post-mortem report if need be
- Original hospital bills and a valid photo ID proof
- Original bills, receipts, and discharge report
- Final hospital discharge summary
- Treating doctor’s report, and original consultation notes
- Test reports along with attending doctor’s or surgeon’s report
- Indoor case papers and duly-filled claim form
- Nature of operation performed and surgeon’s bill and receipt
Claim Settlement Ratio of health insurance companies
Mentioned here are some of the insurance companies in India with their Claim Settlement Ratio.
Aditya Birla Health Insurance:The Claim Settlement Ratio of the company is 94% and the Incurred Claim Ratio is 49.08%.
Bajaj Allianz Health Insurance:The Claim Settlement Ratio of this particular company is 98% and the Incurred Claim Ratio is 81.96%.
Care Health Insurance:Earlier known as Religare Health Insurance, the Claim Settlement Ratio of the company is 95% and the Incurred Claim Ratio is 55%.
Cholamandalam Health Insurance:The Claim Settlement Ratio of Cholamandalam Health Insurance is 95% and the Incurred Claim Ratio is 40%.
If you want to know more about the Claim Settlement Ratios of some more health insurance companies, you can take a look at the IIFL website.