In today’s world, having a solid health insurance policy is crucial to bear the burden of medical expenses. General insurance companies also offer health insurance coverage, among other types of insurance. However, it’s essential to evaluate the effectiveness of your health or general insurer in settling claims on time. One way to do this is by checking the claim settlement ratio, which refers to the proportion of claims paid out of the total number of claims received. According to the Insurance Regulatory and Development Authority of India (IRDAI), the claim settlement ratio is a significant indicator of an insurer’s credibility. For instance, a health insurer with a claim settlement ratio of 93% means it typically pays around 93 out of every 100 claims it receives.
IRDAI releases a list of claim settlements done by all health and general insurers every year. In 2023-2024, over 71,200,854 claims were paid out, with 81.13% of these paid within 3 months of claim intimation. Among private general insurers, Acko General Insurance led the pack with a claim settlement ratio of 99.91%, while Navi General Insurance Ltd. was close behind with 99.97%. Public sector insurers like National Insurance Co. Ltd. and The New India Assurance Co. Ltd. also performed well, with settlement ratios of 91.18% and 92.70%, respectively.
Amongstand-alone health insurers, Aditya Birla Health Insurance Company had the highest claim settlement ratio within 3 months at 92.97%. Care Health Insurance and Niva Bupa Health Insurance also performed well, with settlement ratios of 92.77% and 92.02%, respectively. On the other hand, Star Health and Allied Insurance Co. Ltd. had the lowest claim settlement ratio within 3 months, but it paid out the most claims (16,80,171) in less than 3 months. Overall, it’s essential to evaluate an insurer’s claim settlement ratio, as well as other factors such as sum insured, waiting period, and network of hospitals, before finalizing a health insurance policy.