Why claim settlement ratio is important for buying health insurance
Why claim settlement ratio is important

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Why claim settlement ratio is important for buying health insurance

Max Bupa

13 October 2020

Customers understandably feel doubtful about whether or not an insurance provider will keep their side of the bargain in situations where their insurance is supposed to aid them. By spending on their health insurance premiums annually, customers want an assurance about whether their insurance provider will back them up during a crisis. One way to be assured about the likelihood that your insurance provider will settle your insurance claim is to lookat the insurance provider's annual claim settlement ratio. 


What is a Claim Settlement Ratio of Health Insurance?


CSR is known as the ‘claim settlement ratio.’ It is a ratio denoting the percentage of claims that are settled by an insurance company against the total percentage filed within a certain duration. As an example, let’s say a health insurance company has received around 100 claims in the last 3 months. Suppose the company has approved 70 of these 100 requests. Approval means the claims are settled. Hence, the claim settlement ratio is 70%. The remainder of the claims which have not been settled yet could be so for two reasons — they are either pending claims or they have been rejected as invalid claims by the insurance provider.

Most commonly there are two different claim ratios that you should know of before investing in health insurance. This includes the Claim Settlement Ratio and the Claim Incurred Ratio. In this article, we will be looking only at the significance of Claim Settlement. Here is why claim settlement ratio is important when it comes to health insurance. 


Importance of Claim Settlement Ratio: 


There are a slew of reasons why claim settlement ratio is important to consider when buying any type of insurance. However, its significance is not stressed enough. 


Here are some key reasons to look at the claim settlement ratio of health insurance plans – 


1. Helps You Contrast Policies


.No matter if you are looking for individual health insurance plans or family health insurance plans, you should compare different policies before buying a policy. Many customers use the claim settlement ratio as a way to distinguish and compare different policies.  One of the ways to get clarity about how likely an insurance provider is to back up one’s claims is to look at the claim settlement ratio for health insurance. Ideally, the customer desires that the provider is offering comprehensive protection with a high likelihood of settling health insurance plans claims. Hence, comparing the claim settlement ratio is vital for choosing a health insurance policy.


2. Allows Your Benefits to Matter


One of the biggest benefits of health insurance is when your policy offers a high claim settlement ratio. Tips to buying the best health insurance plan include looking for a comprehensive policy that offers benefits like home coverage, ambulance cover, cashless claims and other such inclusions. However, these benefits do not really mean much if the insurance provider is known to only settle about 50% of all claims coming in. Even if your insurance provider offers coverage against COVID-19, their claim settlement ratio should be high enough to secure you that your problems will be financially resolved by your insurance provider.


3. Value for Your Money


Ultimately, finding a good claim settlement ratio for health insurance is value for money. Every month, or year, you will be paying towards your health insurance policy. As long as your insurance provider's claim settlement ratio is over 90%, which is considered top of the industry standard, you can be assured that your money will not go to waste. As a policyholder, you can be reassured throughout your tenure of paying towards your policy rather than worrying about whether or not your claim will be settled.


How to Find an Insurance Provider with a Good Claim Settlement Ratio?


Now that we have established the importance of claim settlement ratio, here’s how you can discover policies with a good ratio. To discover the claim settlement ratios of a slew of insurance providers, you can take a look at the annual report provided by the IRDAI which summarises the performance of insurance companies in India for that year. The IRDAI refers to the Insurance and Regulatory Authority of India, and their annual reports allow you to discover where an insurance company stands when it comes to claim-settlement. The internet also enables you to seamlessly compare between different health insurance providers. The internet also enables you to seamlessly compare between different providers. If you are buying health insurance online, keep in mind that insurance providers are mandated to share their claims ratio on their official company website.




In summary, a high claim settlement ratio helps in picking the ideal health insurance policy, allows you to make the most of your insurance, and assures you of your premiums’ worth. Ensure you use this parameter among others to find the health insurance suited to your needs.


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