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How to Check Claim Settlement Ratio, Health Insurance Plan?


Wednesday, April 23, 2025
Why should claim settlement ratio be your top priority when choosing health insurance?

Given the medical inflation in India, securing a suitable health insurance policy is one of the smartest decisions you can make. While many people can advise you, very few would actually be willing to walk you through the process of choosing a suitable health insurance company. But, no worries you’ve come to the right place.

In this blog, we’ll discuss the importance of Claim Settlement Ratio(CSR) in helping you select the right insurer. Insurance companies with high CSR are generally considered to be reliable. The higher the CSR of your insurer, the higher the possibility of your claims getting approved and settled in the time of need. Let’s start by knowing in detail about CSR and gradually move to the other related aspects.
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What is the claim settlement ratio?

A Claim Settlement Ratio in health insurance is a key metric that shows the percentage of claims an insurer settles out of the total number of claims received in a policy year. For example, if an insurance company receives 100 claims in a year and settles 90 of them, the CSR would be 90%. Therefore, it is calculated using this formula:

CSR= (Total Claims Settled / Total Claims Received) x 100

An insurance company with a high claim settlement ratio in health insurance demonstrates a strong record of settling claims and ensuring you get the much needed financial help.

Why does claim settlement ratio matter?

Given below are some of the reasons why the claim settlement ratio of an insurance company matters:

Reliability

Securing a health insurance company has many benefits. It acts as a financial backup in case of medical emergencies. Purchasing a policy from a health insurance company with a high CSR creates assurance that you would get the required financial help whenever you need it.

Peace of mind.

The last thing you would want during a financial crisis is delayed claim processing and settlement. Buying health insurance from a company with good CSR ensures that your mental peace stays unharmed during an emergency and you receive the necessary funds required for your treatment or the treatment of your loved ones.

Value for money

The main reason for buying health insurance is to get financial protection against medical emergencies. You willingly pay the premiums every year just to ensure that when you raise a claim, it gets settled and you get the financial help you need. However if your chances of claim settlement are low, paying premiums may not seem worthwhile. Therefore, it can be beneficial to choose a company with a good CSR while buying a policy.

How to check the claim settlement ratio of a company? Here are several ways to check the health insurance claim settlement ratio of an insurer:

The Insurance Regulatory and Development Authority of India (IRDAI) publishes the claim settlement ratio of all health insurance companies in India in its annual report. You can check the CSR of your selected companies by downloading the latest report and comparing it to the CSR of different insurers.

Another way of checking the CSR of a health insurance company is by simply visiting the website and checking the ‘claims’ or ‘claim process section’. You can also get a fair understanding of their track record of settling claims by going through this data.

Reading previous customer reviews on platforms such as Google, forums and social media can also provide insight about the claim settlement process of an insurance company. This allows you to compare the reviews of the shortlisted companies and choose the right fit.

Wrapping it up!

A Claim Settlement Ratio is a crucial factor in selecting the right health insurance company. It helps determine the credibility of an insurance company. The higher the CSR, the greater the likelihood of your claim being settled. Before selecting your insurer, it’s always advisable to check the CSR by going to their official website or customer reviews on different forums. Additionally, you can reach out to the customer service department of the company to clarify further doubts regarding their settlement process.

Disclaimer: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.
This is sponsored feature article / news
Disclaimer :
The perspectives and beliefs presented in this sponsored content are solely those of the sponsor and do not reflect those of Medindia. Medindia holds no responsibility or liability for any direct, indirect, implied, punitive, incidental, special, or consequential damages that may result from the utilization of this material.


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