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What Is The Health Insurance Claim Settlement Ratio (CSR)?

Published On Oct 12, 2021 11:00 AM By InsuranceDekho

Health insurance plans are bought by the policyholders to get financial aid in times of medical emergencies. In this era of high inflation in the health sector, it is important for each and every individual to be secured under a comprehensive and affordable health insurance plan. Health insurance plans not only offer monetary compensation for medical treatments but also ensures quality treatment of the policyholders and their loved ones. Health insurance plans must be bought after carefully analyzing your requirements so that the plans are of great help at times of a medical emergency. Health insurance plans involve certain features like hospitalization costs, medication costs, room rents, ambulance charges, no claim bonus, tax saving perks, and much more.

There are several factors that can be considered while buying a health insurance plan like the sum assured, plan chosen, health insurer, claim settlement ratio, features, and a lot of other perks. Out of these claim settlement ratios determine the capability of a health insurance provider to effectively settle the claims of the policyholders without any hassles. The claim settlement ratio of the past 3 to 4 years can be compared for the potential health insurance providers before choosing to invest in a health insurance plan of a particular health insurance company.

What Is The Health Insurance Claim Settlement Ratio (CSR)?

About The Health Insurance Claim Settlement Ratio (CSR)?

A claim settlement ratio is an essential factor that is taken into consideration by the policyholders while looking for a suitable health insurance provider. It determines the credibility of a health insurance company and their ability to settle claims instantly at the time of a medical emergency. You can consider the health insurance firms with a claim settlement ratio higher than 80% and must compare the CSR’s of the past 5 years to make sure that the company has a good track record of settling claims on time.

Must Read: Tips To Ensure Smooth Claim Settlement Process

How To Calculate The Claim Settlement Ratio of An Insurer?

The formula to calculate the claim settlement ratio of a health insurance company is:

CSR of a company = Total number of claims settled / (total claims received + outstanding claims at the start of the policy year)

This formula calculates the ratio of claims settled by a health insurance company out of the total claims received in a policy year. The outstanding claims of the previous policy year are also included in the formula for calculating the CSR. This ratio greater than 80% is considered ideal for the policyholders and must be looked for by the policyholders. It is important to choose a health insurance provider wisely as it plays an essential role in settling the medical dues at the time of hospitalization due to a medical emergency.

Why To Compare The Claim Settlement Ratio of An Insurer?

Let us look at some of the key points that prove the importance of the claim settlement ratio of a health insurance provider:

  • The claim settlement ratio helps in determining the positive probability that your claim will be settled by the health insurer without any inconveniences. It helps in getting your claims settled smoothly and quickly.
  • You must consider the claim settlement ratios of a company for the past five years to make sure that their performance has been consistent over the past few years. This will help you in trusting their capability of settling the claims of the health insurance company.
  • You can use the data provided by the IRDAI on claim settlement ratio to determine the credibility of the health insurance company you are looking forward to buy your plan from. The data for the same can be obtained online over the internet.


A policyholder must always compare the claim settlement ratios of various insurers to look into their claim settling abilities. This can help the policyholders in achieving hassle-free and quick claims at the time of a medical emergency.

Also Read: TPA Vs In-House Claim Settlement Process

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.

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