Health Insurance- Claim Settlement Ratio

Health Insurance- Claim Settlement Ratio

There are many health insurance plans in the market. Most of the health plans are very comprehensive with many benefits including no sub limits on room rent, maternity benefits, lifelong renewal etc. There are very few things which sets them apart. The basic premise of health insurance is to provide financial assistance in times of need. It could be cashless or reimbursement  and as smooth as possible. However there has been regular complaints about the delay in services on the part of TPA or health insurer.

Therefore before randomly choosing a health insurance plan, one should always check the claims data. The claims data will apprise you of total number of claims, how many claims have been settled and rejected. Some claims remain outstanding as well.

The health settlement ratio determines the % of claims solved by the insurer. For instance- claim settlement of 80% implies that out of total of 100 claims, 80 claims have been accepted by the insurer. The rest 20 claims have been denied or remain outstanding.

Health insurance claim settlement has been calculated as the following formula-

Health insurance claim settlement ratio = claims settled/ (total claims-claims rejected)%

The health insurance claim settlement ratio of the insurers for the Quarter 2,  2011 is given below:

Along with health settlement ratio, you should keep in consideration number of claims outstanding and claims rejected. If your claim is always stuck in paperwork, it would not make much sense. Hence try to find out the time taken by the insurer to solve the claim as well.

For 2011-12 claim settlement figures, check out -

http://knowledge.policybazaar.com/health-insurance/item/1122-health-insurance-incurred-claim-ratios-for-2011-12.html

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