The claim settlement ratio of personal health insurance is the number of health claims settled to the number of health claims received by the insurance company. The health insurance claim settlement ratio depends on the number of claims settled by the insurance company compared to the number of claims received by the insurance company during a particular period.
The higher the claim settlement ratio, the higher the chance of getting the claim settled. But it is also important to check the claim amount paid by the insurance company against the claim amount made by their customers in the case of a group health insurance policy.
What’s on this page?
Claim Settlement Ratio = Claims settled/ Claims received
The top claim settlement health insurance company in India is the one with the highest claim settlement ratio. The highest claim settlement ratio can be found on the website of the insurance company by dividing the number of claims settled to the number of claims received.
It is always important to check the health insurance claim settlement ratio before taking the health insurance policy.
The higher the claim settlement ratio, higher would be the chance of your claim getting settled. The other thing to be taken into consideration is the consistent claim settlement ratio for the past 3 years. If a health insurance company is able to maintain a consistent health insurance ratio for the past 3 years, then it means that the company is good at settling the claims.
IRDA publishes an Incurred claim ratio which is the ratio of the claims settled to the claims received without any particular period. It means that the ICR ratio changes depending on how many claims are paid out and how much money is paid in premiums.
If the ICR value is between 50% to 100%, then it means that the company is making decent profits with a good product mix.
If the ICR value is more than 100%, it means that the company is incurring losses as the claims paid are more than the premiums collected, and the company would find it difficult to sustain in the long run. If the ICR value is less than 50%, it means that the company is making high profits in the market.
This could be possible because of the good product mix, high premiums, or rejecting a high number of claims.
Let us see the top 5 health insurance companies
with the highest claim settlement ratio
Aditya Birla Health Insurance
Aditya birla health insurance company limited (ABHICL), a part of Aditya Birla Capital Ltd. is a joint venture between the Aditya birla group and MMI Holdings of South Africa.
The company was incorporated in the year 2015 after obtaining a stand-alone health insurance license from the Insurance Regulatory and Development Authority of India.
Aditya Birla group holds 51% whereas MMI Holdings of South Africa holds 49% shares in the joint venture. ABHICL commenced its operations in the year 2016 and is engaged in the business of health insurance.
The incurred claim ratio of Aditya Birla health insurance for the years 2020–21 is 49.99%, which is less than the 50% mark, stating that the company is making decent profits with a good profit mix. The claim settlement ratio of Aditya Birla health insurance for FY19 stood at 72.80% and is considered as the good claim settlement ratio.
Niva Bupa Health Insurance
Niva Bupa health insurance is a joint venture between Fettle tone LLP (an affiliate of True North Fund VI LLP), leading private equity firm and the UK based health care services expert, Bupa Singapore Holdings Pvt Ltd. Niva Bupa health insurance is formerly known as Max Bupa health insurance company, where Max India Limited was a partner in the joint venture.
The incurred claim settlement ratio of Niva Bupa health insurance company is 56.09% which falls in the 50-100% range mark indicating that the company is making decent profits with a good health insurance product mix. The claim settlement ratio of Niva Bupa health insurance company for FY19 stood at 83.92% which is a good claim settlement ratio in the insurance market.
Care Health Insurance
Care health insurance (formerly known as Religare health insurance) is a subsidiary of Religare Enterprise. It got the license to operate as stand-alone health insurance in India in the year 2012 from the Insurance Regulatory and Development Authority of India.
Care health insurance is a specialized health insurer offering products in the retail and group health insurance segments in addition to the travel insurance segment.
The incurred claim settlement ratio of Care health insurance for the year 2020-21 is 55.15% which again falls in the 50%-100% mark making the company profitable with a good health insurance product mix. The claim settlement ratio of care health insurance for FY19 stood at 92.58% which is the highest among the health insurance companies in India for FY19.
Star Health Insurance
Star Health Insurance Company was a joint venture between ICICI Ventures, Sequoia Capital, and Oman Insurance, but later there were many changes in the shareholding of Star Health Insurance Company.
The company commenced its operations in the year 2006 after receiving a stand-alone health insurance license from the insurance regulator. Star Health and Allied Insurance Co., Ltd. is providing sterling services in the health, personal accident, and overseas travel insurance segments.
The incurred claim settlement ratio of Star Health Insurance is 94.44% for FY 21 which is less than 100%, which still means that there are profits for the company. The claim settlement ratio of star health insurance companies for FY19 is 78.15%, which is the second least among the stand-alone health insurance companies.
Manipal Cigna health insurance
Manipal Cigna health insurance is a joint venture between Ranjan Pai-led Manipal Education and Medical Group (MEMG) and Cigna corporation, which is the leading insurance company in America. The Manipal group is set to own 51% of the entity to become the majority shareholder of the company.
The claim settlement ratio of Manipal Cigna health insurance for FY19 is 84.93% which is the second highest claim settlement percentage among the stand-alone health insurance companies in India.