Health insurance is pretty important today. With medical treatments getting more expensive and rising numbers of lifestyle diseases or health emergencies, a comprehensive health coverage plan is non-negotiable. Here comes the 'Claim Settlement Ratio (CSR)' - the decisive factor. What's CSR? Let's read on to understand the meaning of CSR, how it influences your insurance-buying decision, and the top insurance providers with decent CSR.
What is the Definition of Claim Settlement Ratio?
The Claim Settlement Ratio or CSR is the percentage of claims approved and paid out by an insurance provider out of the total number of claims filed during a financial year.
CSR figures help you get a hang of how well an insurance company settles claims. A higher CSR means the company is more likely to pay when you need help in a hassle-free way.
Let's suppose an insurer has a CSR of 97%. It shows that the company has settled 97 out of every 100 claims made, and you may consider it.
Why CSR Matters?
Many health insurance buyers choose an insurance company based on the extent of coverage (the wider, the better) and the lowest premium (the lower, the better). However, this idea may not always serve the purpose if the insurer does not handle claims efficiently. Therefore, checking how well an insurer processes and settles claims is important. Here is why CSR matters:
- A company with a higher CSR is likely to be more dependable in the long term. It also means faster and smoother claim settlements.
- It often reduces the chances of your claim being rejected, provided all your documents are in place.
- Companies with high CSR are generally more customer-friendly and process-driven.
Top 10 Health Insurance Companies by Claim Settlement Ratio
Refer to the table below for the best health insurance service providers with a good CSR:
|
Health Insurance Company |
CSR |
Overview |
Pros |
|
Care Health Insurance (Formerly Religare) |
100% |
It offers various plans with excellent claim settlement performance. |
Fast approvals Large hospital network Easy online tracking |
|
Niva Bupa Health Insurance (Formerly Max Bupa) |
100% |
It provides family and individual plans with a quick claim process. |
Lifetime renewal Cashless hospitals |
|
ManipalCigna Health Insurance |
99.96% |
It offers new-age plans with wellness and critical illness benefits. |
Smooth claim process Wellness rewards |
|
Star Health and Allied Insurance |
99.21% |
It is India’s first health-only insurer with a strong network. |
High claim approval Special disease coverage plans Seamless support |
|
Aditya Birla Health Insurance |
99.01% |
It focuses on wellness and care for chronic conditions. |
Wellness rewards Fitness benefits. |
|
SBI General Insurance |
98.62% |
Supported by SBI, it provides wide coverage at affordable rates. |
Trusted name Big reach Large customer base. |
|
ICICI Lombard Health Insurance |
98.53% |
It is one of the leading general insurers with a solid claim history. |
Wide coverage Reliable brand. |
|
HDFC ERGO Health Insurance |
98.59% |
It is known for its reliable claim process and wide plan options. |
Quick service 24/7 support Many partner hospitals |
|
Go Digit Health Insurance |
96.83% |
It is a newer player with good digital claim experience and fair settlement. |
Simple processes Tech-driven service. |
|
TATA AIG Health Insurance |
95.46% |
It is a trusted brand with a variety of plans. |
Satisfied customers Well-designed policies |
Tips to Ensure Smooth Claim Settlement
Choosing a company with a high CSR is a wise move for hassle-free claim settlement. However, you need to be equally careful when filing a claim. Here are some tips to help you follow the right process:
- Disclose all relevant details without fail. Always be honest about your medical history and current health status. Be accurate.
- Make sure to clear all your doubts related to the policy term. Understand what is covered and what is not. Ignoring this may land you in rough waters at the time of need.
- Keep medical bills, doctor’s prescriptions, and hospital documents safely and handy.
- It is also always a good idea to go for cashless treatment at network hospitals whenever possible.
- Inform the insurance company as soon as hospitalisation occurs or is planned.
- Always pay your premiums on time to ensure continuous coverage. It will also help you avoid claim rejection due to a lapsed policy.
The Bottom Line
The CSR is one of the most critical parameters when selecting a health insurance provider. A high CSR suggests the insurance company is trustworthy, responsive, and efficient at handling claims. However, you should also consider other factors when zeroing in on an insurer. It includes coverage benefits, premium amount, hospital network, customer reviews, and claim processing speed.
By choosing a health insurance provider with a consistently high CSR and aligning it with your health needs, you can safeguard yourself and your family from the financial burden of unforeseen medical expenses.
FAQs
1. How much claim settlement number is a good score?
A CSR above 95% is considered excellent in the health insurance industry.
2. Does a high CSR mean all my claims will be approved?
Not necessarily. Claims are subject to policy terms and conditions. However, a high CSR indicates the insurer has a track record of settling most claims.
3. How can I check an insurer's CSR?
You can check the CSR of insurance service providers in the annual IRDAI report. Alternatively, you may visit the official website of the insurance company or a trusted insurance broker like Policybazaar.
4. Is CSR the only factor to consider when buying health insurance?
No. Other factors like premiums, coverage benefits, waiting periods, and network hospitals are equally important.
5. Can a claim be rejected even if the CSR is high?
Yes, if the claim does not meet policy guidelines or there is misrepresentation of facts, it is likely to be rejected.
