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Best Health Insurance Companies in Claim Settlement

When medical expenses are incurred on treatments during an emergency, the health insurance claim settlement process comes into force. If the health insurance policy secures the costs of treatments and medications, the health insurance company is required to pay for the expenses.

There are ample amount of health insurance companies in India, among which the companies that settle the most number of claims swiftly are considered to be the better ones. To gauge an insurer’s claim settlement procedure, one should have a glance at several factors such as a company’s goodwill and background, number of customers, and insured incurred claim ratios, particularly.

However, before going to judge an insurer based on such ratios, you should have their understanding first.

What is a Claim Settlement Ratio?

The Claim Settlement Ratio is the proportion of the number of claims that were settled or approved by the insurance provider in a financial year against the total number of claims received by the health insurance company. For instance, if a company owns a claim settlement ratio of 90%, it denotes that the insurance provider has settled 90 claims out of 100 received. The remaining 10% are either pending or rejected by the insurance company.

What is an Incurred Claim Ratio?

The Incurred Claim Ratio signifies the amount of claims paid off by an insurance company against the amount of premium received in a financial year. It denotes the ability of insurance companies to make payments towards claims.

If the ICR of a firm is more than 100%, it means that the amount of money it has paid off to its policyholders against their claims is more than the money collected through the premium, which means the firm may find it hard to survive for long. If the ICR is between 50% and 100%, it shows that the firm has gathered more money through premiums than it has given away for claim settlement, which indicates that the company is in profit and has managed to launch a great product.

Lastly, if the ICR of a company is less than 50%, it could mean that the firm may not be giving claims easily. Therefore, the best ICR is considered to be between 75% and 90%.

Claim Settlement Ratio of Health Insurance Companies

Insurer No. of Policies Issued* Incurred Claims Ratio (ICR)* Claim Settlement Ratio (CSR)* 
Bajaj Allianz 516178 77.61% 93.95%
Iffco Tokio 164998 90.69% 92.88%
Care 437555 51.97% 89.59%
Max Bupa 309909 50.19% 88.06%
Apollo Munich 809364 62.47% 84.08%
HDFC ERGO 654375 52.58% 82.99%
Star Health 3089558 61.76% 79.34%
National Insurance 1807861 115.55% 78.52%
Bharti AXA 20853 98.50% 77.78%
Reliance General 82134 106.54% 75.76%

*Data from IRDAI annual report 2017-2018 

1. BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LIMITED

Bajaj Allianz, with an Incurred Claim Ratio (ICR) of 77.61% and a high Claim Settlement Ratio (CSR), holds the record for quickest claim settlement by settling several of its claims within a turnaround time of just a single hour. The organization has an in-house claim settlement group and has overhauled more than 2.9 lac claims in the financial year 2017-18 itself. The company’s commitment towards the claim settlement can be understood by the fact that there is a facility of 24*7 call assistance for settlement of claims. 

2. IFFCO TOKIO GENERAL INSURANCE COMPANY LIMITED

Iffco Tokio General Health Insurance offers an array of general insurance items, and health insurance is one of them. The organization has 4000+ network hospitals all over the country and aids in the simple settlement of cashless health claims. The company’s potential to repay the claims is fair enough, which can be understood by its Incurred Claim Ratio (ICR) of 90.69%.

3. Care Health Insurance

Care Health Insurance formerly Religare Health Insurance, a standalone health insurance firm, owns several progressive health insurance plans, and a decent claim settlement record. They are tied up with 5420+ network hospitals in India and committed to settling the claims rapidly. What makes the company more dependable is its impressive Incurred Claim Ratio (ICR) of 51.97%, which assures customers about the firm’s financial stability.   

4. MAX BUPA HEALTH INSURANCE COMPANY LIMITED

Max Bupa Health Insurance Company Limited is a joint venture between Indian-based firm Max India Limited and UK-based health care service organization Bupa. Since its establishment, the organization has insured more than 26 lac individuals and boasts of settling claims of around Rs 1141 crore. There is a cashless claim pre-authorisation in under 30 minutes. The current claim settlement ratio (CSR) of the company is approximately 88.06%, with an Incurred Claim Ratio of 50.19%, which together led the firm to be tagged with 'Superbrand' for consecutive two years. 

5. APOLLO MUNICH HEALTH INSURANCE COMPANY LIMITED 

Apollo Munich health insurance firm boasts of getting 89% of its claims settled without delay since its establishment. Until September 2018, it boasts of settling claims of around 6059 crores. The organization is an esteemed standalone health insurance company, that additionally offers the absolute and the best medical coverage plans. It has a wide network of 5000+ network hospitals. The Incurred Claim Ratio (ICR) of the company is 62.47%, which is attractive enough to attract policyholders. 

6. HDFC ERGO GENERAL INSURANCE COMPANY LIMITED 

HDFC ERGO provides a wide range of health insurance policies, which include both indemnity and fixed-benefit plans. The organization owns a huge chain of 9000+ cashless hospitals and health care facilities which tries to achieve easy cashless claim settlements for gaining great settlement records. The cashless claims get pre-authorized within approximately 22 minutes. The Incurred Claim Ratio (ICR) of the firm is 52.58%, which assures the potential of the company to settle the claims easily.       

7. STAR HEALTH INSURANCE COMPANY LIMITED

Star Health owns a special team for implementing the claim settlement process properly, which lessens the hurdles in dealing with third parties and makes the claims get settled quickly. The firm holds one of the largest numbers of network hospitals at over 9100+ hospitals that assist in cashless settlements with ease. As per the latest report, the company has managed to settle more than 5 lac claims in the last financial year, out of which 90% of the claims were settled within two hours. The incurred claims ratio of Star Health is 61.76%.

8. NATIONAL INSURANCE COMPANY LIMITED

National Insurance is a pioneer in the health insurance industry with the Incurred Claim Ratio (ICR) of 115.55%, in the public sector. It is one of the oldest insurance-providing firms with 1998 offices across the nation that are run by 14000+ insurance professionals. These astonishing numbers make the company hold the most trusted bunch of clients and speedy claim settlement records too.

9. BHARTI AXA GENERAL INSURANCE COMPANY LIMITED

Bharti AXA General Insurance offers health insurance plans with the sum insured going up to Rs.1 crore. The policy also has a 24*7 committed claim settlement helpline which assists in settling the claims rapidly and easily. This dedicated support has led the Incurred Claim Ratio (ICR) of the firm to an impressive rate of 98.50%.

10. RELIANCE GENERAL INSURANCE COMPANY LIMITED

Reliance General Insurance is another big name in the health insurance industry, that offers a wide array of general insurance items. Till the health insurance category is concerned, Reliance is there in association with 4000+ network hospitals and encourages speedy cashless claim settlement. With the Incurred Claim Ratio (ICR) of 106.54%, the firm holds the valuable goodwill to attract and retain the policyholders.    

These are top health insurance organizations in terms of claim settlement procedures. In this way, you can pick one of the best insurance firms based on incurred claim settlement records to guarantee a fast and simple settlement of your health insurance claims. 

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