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Knowledge Base Health Insurance Health Insurance- Claim Settlement Ratio
Friday, 23 December 2011 17:39

Health Insurance- Claim Settlement Ratio

Written by  Yashish Dahiya
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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:

 

Insurers

Claim Settlement Ratio (%)

Apollo Munich

76

Bajaj Allianz

84

Bharti AXA

65

Chola MS

62

Future Generali

79

HDFC ERGO

73

ICICI Lombard

65

IFFCO-Tokio

46

Max Bupa

65

Oriental Insurance

92

Reliance General

73

Royal Sundaram

93

Star Health

61

New India Assurance

89

United India Assurance

78

 

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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14 comments
  • Comment Link Vikas Saturday, 07 January 2012 00:23 posted by Vikas

    If ApolloMunich's claim ration is just 74%, then why a group of people suggest to take their policy to me?

    Any ideas. Why shouldn't I go for Royal Sundaram with highest %?

  • Comment Link Tajinder Monday, 21 May 2012 16:14 posted by Tajinder

    Dear ,
    In the above mentioned example , claim ratio is not the only factor to assess the company performance .
    Calim Ratio is simply no of claims settled/total no of claims. this is illustrates as 76/100 = 76% for apollo munich
    and 23/28 = 82% for others.
    So we also need to check how many claims that particular company gets , before assessing on claim ratio.

  • Comment Link vishal Monday, 17 September 2012 21:46 posted by vishal

    max bupa is number one

  • Comment Link pooja Saturday, 13 October 2012 15:56 posted by pooja

    max bupa services are excellent of all

  • Comment Link ROHIT Monday, 22 October 2012 00:56 posted by ROHIT

    ALL OF THEM ARE GUD

  • Comment Link Zaidi Friday, 09 November 2012 13:55 posted by Zaidi

    we cannot judge a company on the basis of claim settlement criteria...there are so many things which the company has to fulfill so that customers get satisfied...
    i am extremely satisfied with the policy bazaar.com services......but the thing we are getting the product of insurance company not policy bazaar.com...no doubt policy bazaar.com employees help us to the highest poiny so that we can choose the policy...but the imporatnt thing is to see the reviews of the company of whom we are getting the core products and benefits....

  • Comment Link zaidi Saturday, 10 November 2012 13:23 posted by zaidi

    max bupa is number one as well as the assistance given by policy bazaar.com it is out standing ...salute to the callers

  • Comment Link rohit Monday, 19 November 2012 18:43 posted by rohit

    policy bazar.com is a very helpful to find to know the camparative analysis.

  • Comment Link Ramesh Wednesday, 28 November 2012 11:42 posted by Ramesh

    I also understand that policy bazaar is a good source to get right information about the insurance.

    I am still confused to buy a new health insurance, which company should go to buy, i do not know the company services please suggest me how to choose the right and good company to buy the new health insurance policy.

  • Comment Link SHUBHAM Friday, 07 December 2012 12:57 posted by SHUBHAM

    FRIDAY,07 DECEMBER 2012 12:56 ICICI LOMBARD IS A VERY GOOD HEALTH INSURANCE WHICH GIVES U A VERY GOOD CLAIM SETTLEMENT

  • Comment Link Amit Goel Sunday, 30 December 2012 20:07 posted by Amit Goel

    After comparing all and detailed study, i am concluding currently Max Bupa and Apollo Munich are on top health insurance ....if u go with max benefit- i will suggest to choose Max Bupa (initial waiting period- 90 days only) and if you see the premium amount and healthy enough, can wait for 2 yrs minimum - than go with Apollo Munich (cover Ayurvedic, homeopathic treatment as well).

    Can check all details with policy bazar.....very good advisors..
    Thanks
    Amit Goel

  • Comment Link deepak Thursday, 28 February 2013 14:13 posted by deepak

    i am 42 years old diabetic man to whom should i take health insurance

  • Comment Link Karan Rawat Thursday, 28 February 2013 22:56 posted by Karan Rawat

    going by the claim ratio i am sure that ROYAL SUNDARAM will give a tough
    compition to other companies
    So,i will choose Royal Sundaram

  • Comment Link Yashish Dahiya Wednesday, 06 March 2013 12:34 posted by Yashish Dahiya

    Hi Deepak
    Any pre-existing illness is covered only after you have continuously renewing health or mediclaim policy for 2-4 years.
    Star Health Diabetes Safe is a dedicated health insurance plan for diabetic patients.

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