Niva Bupa offers a range of health insurance plans catering to individuals, families, and senior citizens. Their plans often include features like cashless hospitalization at a wide network of hospitals (over 8,500), coverage for pre and post-hospitalization expenses, day-care procedures, and some plans even cover AYUSH treatments. Some policies offer benefits like a health check-up from day one, no capping on room rent, and a booster benefit that increases the sum insured for every claim-free year.
The company emphasizes a digital-first approach, offering a seamless experience for buying policies, tracking claims, and renewals through their app and website. They also claim a high claim settlement ratio, aiming for a smooth and quick process for policyholders.
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Latest claim settlement ratio of health and general insurers released by IRDAI in 2026: Acko, Aditya Birla, Galaxy lead; Shriram, IFFCO Tokio fall below 90%
When it comes to health and general insurance policies, policyholders expect prompt claim settlements from insurers in times of emergency. The real test of any insurance policy lies in how fairly and quickly claims are settled. To gauge an insurer’s efficiency, checking the claim settlement ratio is a reliable way. The Insurance Regulatory and Development Authority of India (IRDAI) releases a list of claim settlements by all health and general insurance companies every year.
According to the latest figures for FY 2024-25, the claim settlement ratio of various insurers has been revealed. Among private general insurers, Acko General Insurance took the lead with 99.98% of claims paid within 3 months, followed by Reliance General Insurance Co. Ltd. with a ratio of 99.32%. On the other hand, Kshema General Insurance Co. Ltd. had the lowest claim settlement ratio of 26.88% among private sector insurers.
Among public insurers, The Oriental Insurance Co. Ltd. settled 90.17% of its claims within 3 months. The New India Assurance Co. Ltd. and National Insurance Co. Ltd. had a claim settlement ratio of 91.75% and 91.79%, respectively.
In the standalone health insurance sector, Aditya Birla Health Insurance Co. Ltd., Galaxy Health Insurance Co. Ltd., Narayana Health Insurance Co. Ltd., and Niva Bupa Health Insurance Co. Ltd. each reported a 100% claim settlement ratio, with all claims settled within three months.
The claim settlement ratio refers to the percentage of claims that an insurer pays or settles out of the total number of claims it receives during a certain period. For instance, a health insurance company with a claim settlement ratio of 95% typically pays around 95 of every 100 claims it receives.
It’s essential for policyholders to check the claim settlement ratio of their insurer to ensure they are getting fair and prompt claim settlements. The IRDAI’s annual list of claim settlements provides a reliable source of information for policyholders to make informed decisions. By checking the claim settlement ratio, policyholders can gauge their insurer’s efficiency and make informed decisions about their insurance policies.
In conclusion, the claim settlement ratio is a crucial factor to consider when choosing a health or general insurance policy. Policyholders should check the claim settlement ratio of their insurer to ensure they are getting fair and prompt claim settlements. The IRDAI’s annual list of claim settlements provides a reliable source of information for policyholders to make informed decisions about their insurance policies.
Top Insurers With Maximum Grievances Revealed By Insurance Ombudsman: All You Need To Know
The Council of Insurance Ombudsman Annual Report 2023-24 has revealed a significant rise in complaints against health insurance companies in India. The report shows that the total number of complaints against health insurance companies increased by 21.7% in FY 2023-24, with 31,490 complaints, compared to 25,873 in FY 22-23. Private insurers accounted for the majority of complaints, with 26,064 grievances, while public sector insurers had 5,298 complaints.
Star Health & Allied Insurance topped the list with the highest number of complaints, with 13,308 grievances, of which 10,196 were related to claim repudiations. Other top insurers with high complaint numbers included CARE Health Insurance, Niva Bupa Health Insurance, National Insurance, and New India Assurance. The report also highlights that claim repudiation is the most common grievance, with the majority of complaints falling under this category.
The Insurance Regulatory and Development Authority of India (IRDAI) has responded to the rising dissatisfaction by mandating every insurer to appoint an Internal Ombudsman (IO) to review cases up to Rs 50 lakh that remain unresolved after 30 days or are rejected by insurers. However, experts argue that the independence of the IO is questionable since they report to the insurer’s top management, which may raise concerns about fairness and impartiality.
The report emphasizes the need for stronger accountability, transparency, and consumer protection in the health insurance sector. Policyholders are advised to look beyond premiums when buying health insurance and consider critical factors such as claim settlement ratio, repudiation rates, grievance redressal track record, and customer service quality. The IRDAI’s initiative to appoint an Internal Ombudsman is a step towards addressing the rising complaints, but its effectiveness and independence remain to be seen.
The Council for Insurance Ombudsmen (CIO) plays a crucial role in providing an alternative grievance redressal platform for policyholders. The CIO functions under the IRDA Act, 1999, and the Redressal of Public Grievances Rules, 1998, and is designed to provide a speedy and cost-effective mechanism to resolve disputes against insurance companies, intermediaries, or brokers. The report highlights the need for informed choices and stronger regulation to restore policyholder trust in the health insurance sector.
Policybazaar introduces a 100% claim settlement option for planned hospitalisations on select health insurance policies.
Policybazaar, a leading insurance marketplace, has introduced a 100% claim promise on planned hospitalizations for select health insurance policies. This initiative aims to provide a hassle-free and cashless experience for policyholders, ensuring zero deductions on eligible hospital bills. The benefit is available on specific plans from Bajaj Allianz, Niva Bupa, and Aditya Birla Health Insurance (ABHI).
To avail of this benefit, policyholders must complete certain pre-admission steps and meet policy conditions. These steps include informing the Third-Party Administrator (TPA) 48 hours before hospitalization and choosing a hospital from the insurer’s network. The network includes over 10,000 partner hospitals for Bajaj Allianz, over 2,100 hospitals for Niva Bupa, and a panel of hospitals for ABHI.
The policy-specific details vary across insurers. For Bajaj Allianz, the benefit is available for both new and ported policies with any sum insured, provided a consumables rider is added. For ABHI, the benefit is applicable only to new policies with a minimum sum insured of ₹10 lakh, and pre-admission intimation is required. For Niva Bupa, the benefit is available for both new and ported policies with a minimum sum insured of ₹10 lakh, and the customer must notify the claim team 48 hours prior.
Policybazaar has stated that this initiative will streamline documentation and coordination with hospitals, reducing delays and enhancing the cashless experience. However, claims will not be paid in cases of non-disclosure, waiting periods, or exclusions as per policy terms. The 100% claim promise does not apply to emergency hospitalizations, which will continue to be processed under standard policy terms.
According to Siddharth Singhal, Head of Health Insurance at Policybazaar, this initiative aims to alleviate financial worries during hospitalization, allowing policyholders to focus on their recovery. With this move, Policybazaar aims to provide a more customer-centric and hassle-free experience for its policyholders. The introduction of this benefit is expected to enhance the overall customer experience and increase trust in the insurance marketplace.
On October 8, 2025, insurance agents and associations are likely to raise the issue of Goods and Services Tax (GST) with the Insurance Regulatory and Development Authority of India (IRDAI) and the Finance Ministry.
The insurance industry in India is facing a significant issue related to the Goods and Services Tax (GST) and Input Tax Credit (ITC). Private insurers have reduced distributor payouts by 15-18% to offset the loss of ITC, following the GST exemption on life and health insurance premiums. This move is expected to have a significant impact on agents, brokerages, and individual advisors, particularly small and independent operators. The reduction in payouts will directly cut into their working capital, leading to reduced take-home income and morale, especially in smaller towns and rural markets.
The current GST framework, if left unadjusted, may set a precedent where insurers maintain profitability by squeezing distribution costs rather than improving efficiency. Industry associations and agents are likely to take up the issue with the Insurance Regulatory and Development Authority of India (IRDAI) and the Finance Ministry. The President of the General Insurance Agents Federation Integrated stated that the change will shrink access to insurance, which is against the Prime Minister’s vision of Insurance for All by 2047.
In contrast, Life Insurance Corporation (LIC) and other public sector insurers have decided to maintain existing commission structures, even as they pass the full GST relief to policyholders. LIC plans to offset the impact through higher policy sales and new product pricing. Public sector general insurers, including New India Assurance, Oriental Insurance, United India Insurance, and National Insurance, have also opted against cutting commissions, choosing instead to absorb the ITC loss.
Private insurers, on the other hand, are passing on the ITC burden to agents because their business models and cost structures leave little room to absorb additional expenses. The removal of ITC has raised operating costs by roughly 2-3% of premiums, and private companies must adhere to stricter IRDAI Expense of Management (EoM) caps. Absorbing this loss would directly dent profitability and risk regulatory breaches. Several private general and standalone health insurers, including Tata AIG, Aditya Birla Health Insurance, Niva Bupa, Care Health, and ICICI Lombard, have implemented revised commission structures, making payouts inclusive of 18% GST, which means distributors will bear the tax cost.
The latest claim settlement ratio of health and general insurance companies was released by IRDA in 2025. According to the data, Navi and Acko have taken the lead, while Star Health and Zuno have fallen below the 90% mark.
The rising medical inflation has made it challenging for individuals to bear medical expenses without a comprehensive health insurance policy. In India, the Insurance Regulatory and Development Authority (IRDAI) releases an annual list of claim settlements by health and general insurance companies. The claim settlement ratio, which refers to the percentage of claims paid or settled by an insurer, is a reliable way to assess an insurer’s efficiency.
According to the latest figures for 2023-2024, the general insurers paid out a total of 71,200,854 claims, with 81.13% of total claims paid within 3 months of claim intimation. Among private general insurers, Acko General Insurance and Navi General Insurance Ltd led with claim settlement ratios of 99.91% and 99.97%, respectively. Zuno General Insurance Co. Ltd had the lowest claim settlement ratio among private sector insurers, with 83.12% of claims paid within 3 months.
Among public insurers, The Oriental Insurance Co. Ltd had the lowest claim settlement ratio, with only 65.08% of claims paid within 3 months. United India Insurance Co. Ltd had the highest claim settlement ratio among public insurers, with 96.33% of claims paid within 3 months.
For stand-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 followed closely, with claim settlement ratios of 92.77% and 92.02%, respectively. Star Health and Allied Insurance Co. Ltd had the lowest claim settlement ratio among stand-alone health insurers, with 82.31% of claims paid within 3 months.
While checking the claim settlement ratio is necessary, it should not be the sole basis for finalizing a health or general insurance company. Other factors such as the sum insured, waiting period for various illnesses, and network of hospitals offered should also be considered.
The IRDAI data also reveals that during 2023-24, 16.3% of total claims were paid out between 3-6 months, indicating that some insurers may have delayed claim settlements. It is essential for policyholders to review the claim settlement ratio and other factors before selecting an insurer to ensure they receive adequate and prompt financial assistance in case of medical emergencies.
Overall, the claim settlement ratio is a crucial factor in assessing an insurer’s efficiency, and policyholders should carefully evaluate this metric along with other factors before making an informed decision. By doing so, they can ensure that they have a comprehensive health insurance policy that provides them with the necessary financial protection in case of medical emergencies.
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Non-life insurers record 2% premium growth in September, Bajaj Allianz General Insurance leads the way
The non-life insurance sector in India has reported a modest 1.94% year-on-year growth in gross direct premium to Rs 23,430 crore in September. This growth was driven primarily by an increase in standalone health insurance premiums. The largest general insurer, New India Assurance, saw a 3.5% rise in premiums, while ICICI Lombard General Insurance reported a 6.2% increase. Other state-owned insurers, such as United India Insurance and Oriental Insurance, also reported significant growth, with increases of 23.36% and 4.45%, respectively.
Private general insurers, including Bajaj Allianz General and HDFC Ergo, also reported varying degrees of growth, with Bajaj Allianz General seeing a 31.35% increase and HDFC Ergo experiencing a decline of 3.78%. Standalone health insurers, such as Niva Bupa Health Insurance and Star Health and Allied Insurance, reported growth of 1.45% and 3.36%, respectively.
The government’s recent clarification on Goods and Services Tax (GST) has also had an impact on the industry. Premiums for individual life and health insurance policies are now exempt from GST, making them more affordable for individuals and families. However, this exemption does not apply to group insurance policies, which are typically offered by employers to their employees. Reinsurance services, which insurers purchase to protect themselves, are also exempt from GST.
However, insurers will face a significant adjustment regarding Input Tax Credit (ITC). They will no longer be able to claim ITC for essential input services such as agent commissions, brokerage, and administrative services. This change may have a significant impact on the industry, as insurers will need to adjust their business models to account for the loss of ITC. Overall, the non-life insurance sector is experiencing moderate growth, driven primarily by increases in standalone health insurance premiums, and is adapting to changes in the tax landscape.
Rising Health Insurance Complaints in India: Key Data Insights
Complaints against health insurers in India are on the rise, indicating growing consumer awareness and the importance of effective grievance redressal mechanisms. According to Insurance Samadhan, a grievance platform, there was a 45% increase in complaints in Q2 2025 compared to the previous quarter, with 974 cases involving claims worth over ₹119 crore. The majority of these grievances (67.5%) related to health insurance, followed by life insurance (25.5%) and general insurance (6.9%). Endowment policies were the most commonly mis-sold products, often leaving policyholders with reduced returns or penalties.
The Council of Insurance Ombudsman (CIO) data for FY2023-24 provides further insight into the sector’s challenges. The ombudsman received the highest number of complaints against Star Health & Allied Insurance, with 13,308 cases, mostly regarding partial or complete claim rejection. Other insurers with high complaint volumes included CARE Health Insurance, Niva Bupa, and public sector insurers National Insurance and The New India Assurance. Star Health’s complaint volume was significantly higher than its peers, with 63 complaints per lakh policyholders.
Experts attribute the high complaint volume to mis-selling, driven by aggressive agent commissions and sales targets. Many consumers are sold unsuitable policies, which can lead to higher premiums or outright rejections due to pre-existing conditions. The data highlights the need for consumers to proactively evaluate their coverage and understand complaint mechanisms to ensure adequate protection. Additionally, the trend of Indians first experiencing insurance through employer-provided group health policies, and then purchasing retail policies triggered by claims or life events, emphasizes the importance of early adoption and careful policy selection.
The increasing complaints against health insurers in India underscore the need for improved grievance redressal mechanisms and consumer awareness. As the insurance sector continues to grow, it is essential for consumers to be aware of their rights and options for resolving disputes. By understanding the common issues and challenges in the sector, consumers can make informed decisions and ensure they have adequate protection. Ultimately, the rising complaints against health insurers in India highlight the need for a more transparent and consumer-centric approach to insurance sales and claims settlement.