Claim settlement ratio or CSR is the percentage of claims an insurance company settles in a given year out of the total claims received. Typically, the claim settlement ratio serves as a reliable indicator of credibility. In fact, the industry believes that the higher the CSR, the more reliable the insurance provider is. This is why most individuals make it a point to check the CSR of their choice of insurance providers. Let’s take a look at some of the best claim settlement health insurance companies in India.
Take a look at the table below to gain an insight into the best claim settlement ratio in the health insurance list:
|Insurer||Policies||Amount in Crores (In Rs)||Amount in Crores (In Rs)||Percentage of Total Claims||Amount in Crores (In Rs)|
|Navi Health Insurance||68,137||98%*|
Insurance providers offer cashless claims and reimbursement claims.
Given below are the documents required to make a health insurance claim:
Claim Settlement Ratio = (Total claims settled in a year/ Total claims received in a year) X 100
For instance, an insurance company, say XYZ, settled 9,000 claims out of 10,000 claims for 2020-2021. Based on the formula XYZ’s CSR will be,
= (9,000/10,000) x 100
The claim settlement ratio of insurance providers comes in handy in more than one way. These are among the top benefits:
The claim settlement ratio serves as an indicator of the insurer’s credibility. In other words, it indicates that the insurance provider is capable of paying the sum assured to the policyholder or his/her nominee. Typically, an insurance provider with a consistently high CSR is more likely to meet their commitment, and pay a sum assured as and when a claim is raised.
Insurance providers with the most claim settlement track records are most likely to follow a transparent claim process. In such an arrangement, it is expected that the claim process will be hassle-free. As a result, the policyholder or his/her family will be able to access the sum assured without going through any rigorous formalities.
Here are the details:
A high claim settlement ratio is significant because it indicates that the claim settling ability of the insurance provider is high.
For example, a Claim settlement ratio of 96% indicates that the insurer has settled 96 claims out of 100.
An investor needs to be aware of the following ratios before investing in a health insurance policy:
Given below are the factors affecting the claim settlement ratio:
The claim settlement ratio should never be the sole factor when it comes to selecting a particular health insurance provider.
Individuals should also keep these points in mind when glancing through the best claim settlement ratio in the health insurance list to select an insurer:
Given below are the top reasons for claim rejection for health insurance policies:
Given below are the ways to avoid health insurance claim rejection:
The disadvantages of the claim settlement ratio are as follows:
The policy-holder can study reviews of insurance policies before zeroing in on one.
While looking for the best claim settlement insurance company, keep these pointers in mind to select a suitable policy plan:
First, one should identify whether an individual insurance policy or a family floater policy plan is more suited in his/her case. Accordingly, one should proceed to find out whether he/she will be well off with a general insurance policy or a health insurance plan.
To make the most of an insurance policy, it is always best to choose a policy plan with extensive coverage. Individuals should always look for an insurance policy that extends a high sum insured/assured and offers multiple features that benefit them in case of a financial emergency.
For example, in case of a medical emergency, having a health insurance policy that comes with a short waiting period and follows a quick claim settlement process will allow the policyholder to avail of the best quality treatment.
Individuals can make sure that their insurance policy does not burn a hole in their pocket by comparing the premium and sum insured of the leading health insurance policies online.
They can easily compare quotes online by simply entering relevant personal and policy requirement related details and selecting a plan that matches their investment intent and requirement perfectly. Also, with the help of an online insurance premium calculator, they can easily plan their finances and streamline financial obligations easily.
An insurance policy that accompanies a quick claim settlement process is ideal when it comes to availing of such a plan. These policies allow the insured to avail of cashless treatment from the best network hospitals or get promptly reimbursed for their medical bills.
For example, Navi Health Insurance helps insured individuals to get their claims settled in 20 minutes and receive cashless treatment from more than 10,000 network hospitals. This allows the policyholder to avail the best of medical assistance at the earliest and without straining available savings.
It is important to check the TPAs and network hospitals under the third-party administrators to ensure a hassle-free claim process when availing of a health insurance policy. Also, checking the network hospital coverage in advance will help individuals analyse whether they can get quality treatment from leading hospitals located nearby in case of emergency.
Individuals must make it a point to check out the exclusions of an insurance policy before availing it. Typically, leading insurance providers follow a standardised list of exclusions set by the IRADI and third-party regulators.
Regardless, many insurance providers go above and beyond those exclusions and include additional ones to the existing list. Not having a proper idea about those exclusions can jeopardise insureds’ chances of settling a claim.
Subsequently, they should check details about exclusions related to pre-existing conditions and other related limitations on coverage to gain a better idea about the policy and its extent of coverage.
The following features and offerings make Navi a viable insurance provider in more than one way:
Download the Navi app today and sign up for a comprehensive health insurance plan to protect yourself and your family from life’s uncertainties.
Selecting an insurance provider by looking at just the best claim settlement list may not be a smart move. However, supplementing the same by scrutinising the features, terms of claims, offerings, and limitations could prove an effective way of selecting an insurance provider.
Ans: The policy-holder needs to inform the insurance company at least 3 days before planned hospitalization, in case of cashless claims. For medical emergencies, policyholders need to inform the insurer within 24 hours of hospitalization. The insured person needs to raise a reimbursement claim within 7-15 days of getting discharged from the hospital. Please check the time-frames of the insurance policy minutely as it might vary from one insurer to another.
Ans: Usually, the claim settlement period varies among companies mostly because of the process they follow. Regardless, Navi allows cashless claim settlement in as fast as 20 minutes.
Ans: It is advisable to raise a claim at the earliest for prompt settlement. However, the time frame varies for critical illness, disability and death claim.
Ans: Yes, the claim settlement ratio of an insurance company keeps changing every year, with the change in its total number of claims received and the actual number of claims settled.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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