Things you should know about claim settlement ratio in health insurance

by Ester Adams

Do you have a family that consists of your spouse, children, and parents? If so, you often need to take at least the elderly members for health checkups or doctor’s consultation, right? We realize this or not, we end up spending a lot of money on such consultations. Also, this is an unavoidable circumstance. However, you can save your money by taking a smart step, which is buying a health insurance policy.

When you purchase a health insurance policy, you do not have to worry about an emergency medical situation. You can simply head to a network hospital and get your treatment. Make sure you inform the health insurance company about it so that they can settle the medical bills with the hospital. As a matter of fact, taking a cashless health insurance policy will make things even easier for you. You can skip standing in the long queues in the hospital for paying bills. This is all taken care of by the insurance provider. And if the treatment is planned, you can update the insurance company beforehand. 

Nevertheless, before you finalize on one particular health insurance provider, you must check the claims settlement ratio of the company. Knowing the right information about the claims settlement ratio of an insurance company is important since this will determine the chances of claiming the sum insured. Before we discuss it further, let us discuss what it is precisely.

What is Claims Settlement Ratio?

Claims Settlement Ratio, also often called CSR, is the ratio of the claims that have been settled to claims that have been made with an insurance provider. This is basically a metric that helps in rating the insurance companies in the country. This is one of the main parameters for the customers while opting for an insurance company.

This is calculated as the year starts. The claims settlement ratios of the insurance companies that are registered with IRDA are published by the Insurance Regulatory and Development Authority of India (IRDAI) on yearly basis.

Importance of health insurance claims settlement ratio

As you start looking for health insurance policies, you will come across several insurance companies providing the product. Therefore, the competition in the market for health insurance policies is fierce. Do all the insurance providers come up with the same kind of features and keep the promise? Well, the answer is no. This is why checking the claim settlement ratio in health insurance is so important. This will give you an idea of the kind of response you are going to get from the insurance company when you claim the sum insured.

Reasons for rejections of insurance claims

As you are showing your interest in buying a health insurance policy, you need to know that insurance companies cannot reject claims of their policyholders without citing a valid reason. In most cases, it is the policyholders who make the mistakes while purchasing the health insurance policy. This finally leads to the rejection of their claims. Here are some reasons based on which the insurance companies reject the claims of their customers.

  • Incorrect details filled by the policyholder: While filling the health insurance policy forms, you must enter all the details correctly without making even a single mistake. Do not rely upon the insurance agent for this, and instead fill the form yourself.
  • Not disclosing the pre-existing health issues: You must not hide any of your pre-existing health conditions from the insurance company. You should also disclose information about the health history of your family while purchasing as well as renewing your health insurance policy.
  • Missing out on following the claim process properly: Each of the insurance companies follows some guidelines in terms of the claims settlement process. You must follow the process without fail.

If you want to know more about the claims settlement ratio in heal insurance, you can visit the website of the IIFL.

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