Claim Settlement Ratio V/S Incurred Claim Ratio- Know the Difference
Updated On Dec 09, 2021
Table of Contents
Health insurance is imperative if you want to live a stress-free life and avoid financial hassle at the time of need. It provides access to adequate healthcare without the need to gather funds immediately. However, it is important to know the proper terms related to health insurance to make the best choices and not miss out on useful benefits. Claim settlement ratio and incurred claim ratio are two such pertinent terms.
What is the Claim Settlement Ratio?
The claim settlement ratio for a particular health insurance policy is the ratio between the number of claims made against the policy and the number of claims that it has settled. The higher the claim settlement ratio, the more reliable the company is, when it comes to settling the claims you might make against it. The factors taken into the ratio are not over a specific time period. However, this measure is usually officially published for life insurances. In the case of health insurance policies, one is more likely to get the numbers for the overall insurance company. Moreover, the lack of a fixed time period can hamper understanding of what really are the chances of getting one’s claim settled at the hour of need. The claim settlement ratio for a particular health insurance policy is usually provided at the official website of the insurance company.
Must Read: HDFC Ergo Health Insurance Plans for Individuals
What is the Incurred Claim Ratio?
The formula for determining the incurred claim ratio is the total amount that has been paid out in the claim by the total premium amount that has been collected. It is calculated over a single financial year. This too, indicates how likely an insurance company is to settle a claim. The more the ratio, the more likely it is because it indicates that more money has been spent in settling claims than what has been taken from policyholders. However, if this is more than 100%, it probably means that the health insurance company is not getting good profits, and might just be in a precarious financial situation. A high incurred claim ratio also indicates that the policyholders might be charging high amounts for premium, which might not be required. To find the incurred ratio of a particular health insurance policy, one can look at the figures that are officially published by the Insurance Regulatory and Development Authority of India (IRDAI).
Claim Settlement Ratio V/S Incurred Claim Ratio: The Differences
The difference between these important terms is crucial knowledge in determining which health insurance policy is more suited to the policyholder.
| Field | Claim Settlement Ratio | Incurred Claim Ratio |
| Formula | Between the total claims settled and the total number of them that have been made. | Between the total claims paid out to the total premium amount incurred. |
| Determining Level |
The more the ratio, the more chances of the claim being settled. |
The higher the ratio, the more claims are settled. However, more than 100% might indicate losses. |
| Calculation Period | No specific period | Over the course of a financial year |
| Reliability | Less reliable | More reliable |
Endnotes
Choosing the right health insurance can seem to be a daunting task since it is a substantial investment whose returns are equally as important. Nevertheless, it is measures such as the claim settlement ratio and the incurred claim ratio that helps determine a good health insurance choice. However, knowing the difference between them is important to know the insurance policies better.
Also Read: Benefits of Universal Sompo Health Insurance Plans for Family
Disclaimer: This article is issued in the general public interest and meant for general information purposes only. Readers are advised not to rely on the contents of the article as conclusive in nature and should research further or consult an expert in this regard.
