Top Health Insurance Companies in 2024: Based On Claim Settlement Ratio

Getting the right health insurance plan for yourself and your loved ones is crucial, however, it can be daunting given the number of companies and their respective plans that are floating in the market. Bear in mind that there are certain aspects like a company’s claim settlement ratio (CSR), solvency ratio, plan features, add-ons provided and waiting period are some of the factors coupled with your specific medical needs to consider while deciding to buy a plan for you and your family. This article will cover the details of what is claim settlement ratio or CSR, the top 5 health insurance plans available in the market based on the company’s claim settlement ratio, and the process of settling claims.

What is Claim Settlement Ratio or CSR?

The claim settlement ratio for health insurance is a clear-cut sign of confidence in the insurance industry. It is the ratio between the total number of claims settled to the total number of claims raised in one year. The higher the ratio, the more claims have been approved by the insurance company. A lower claim settlement ratio indicates that a higher number of claims have been rejected by the insurance company than they have been accepted. 

Since the main goal of taking health insurance for a customer is to get financial stability and support in time of need, it is important to buy your health insurance plan from a reliable company. 

Top 5 Health Insurance Companies in India Based on Claim Settlement Ratio

Any health insurance company that has a claim settlement ratio of 85% and above is considered reliable and good to buy your health insurance plan from. The claim settlement ratio of a company keeps changing every quarter, hence it is important to make sure you keep yourself updated on the changes made as per the Insurance Regulatory and Development Authority of India (IRDAI). 

The current top 5 companies in India based on their claim settlement ratios are listed below in descending order:

1. Reliance General Insurance Co. Ltd.

Reliance General Insurance Company Limited operates as an an integral part of the Reliance Anil Dhirubhai Ambani Group. Founded in the year 2000, the company is entirely owned by Reliance Capital and is recognised as one of India's leading general insurance companies. Reliance General Insurance has covered over 300 Crore lives and provides more than 100 insurance products in the retail and commercial insurance sector including health, motor, life, travel, and other insurance. [2]

 Here are the key metrics of Reliance General Insurance Company Limited

*The solvency ratio is a financial indicator measuring a company's ability to meet its long-term debt obligations and signifies its financial stability. Any company having a solvency ratio >1.5 is considered to be good to buy insurance from.

*Life covered here refers to the number of people insured.

2. HDFC ERGO General Insurance Co. Ltd.

Headquartered in Mumbai, Maharashtra, HDFC ERGO General Insurance Company Limited was founded in the year 2002 and has served over 1.5 crore customers. The company offers a variety of general insurance products from health, motor, travel, and personal accident insurance in the retail insurance sector and customised products like property, liability, and marine insurance in the corporate insurance sector. Formally known as Apollo Munich Health Insurance, HDFC ERGO is a joint venture between HDFC and ERGO International AG. [1] 

Key Metrics of HDFC ERGO Health Insurance

2. ICICI Lombard General Insurance Co. Ltd.

Founded in the year 2001, ICICI Lombard General Insurance Company is a joint venture between Fairfax Financial Holdings Limited and ICICI Bank. The company has covered more than 2.17 crore lives till now and offers a wide range of medical insurance policies. ICICI Lombard also offers insurance products like liability, engineering, health, auto, motor, crop, fire, and personal injury. 

Key Metrics of ICICI Lombard General Insurance Co. Ltd

4. Kotak Mahindra General Insurance Co. Ltd

Founded in the year 2015 Kotak Mahindra General Insurance is completely owned by Kotak Mahindra Bank Ltd. The company offers a wide range of insurance like health, motor, commercial and home insurance. Kotak Mahindra General Insurance is known for its focus on quality and innovation in the general insurance category and boasts a good claim settlement ratio of 97.61%

Here are the key metrics for Kotak Mahindra General Insurance:

5. Liberty General Insurance Co. Ltd.

Launched in the year 2013, Liberty General Insurance Limited is a joint venture between Liberty Citystate holdings PTE Limited, Enam Securities, and DP Jindal Group. The company offers a wide range of insurance solutions which include health and personal accident insurance, employee compensation insurance, car and two-wheeler insurance, commercial insurance, fire and engineering insurance, marine insurance, and other miscellaneous insurance services in India.

Things to Know About Claim Settlement

Oftentimes the reason for claim rejection that also leads to a decrease in a company’s claim settlement ratio is not following the proper process mentioned in your policy document. Before you apply to settle your claim remember to

1. With the recent announcement of Cashless Anywhere you can now avail of health insurance from any hospital of your choice and claim with your insurer. While cashless everywhere means you can go to any hospital, certain hospitals will be listed as excluded or blacklisted hospitals. Make sure you check the list of these hospitals and do not get admitted to one of them.
2. In case of planned hospitalisation, It is important to inform your insurer at least 48 hours in advance before being admitted. This will ensure that you get your claim and don’t have to face rejections.
3. In case of emergency hospitalisation, make sure to inform your insurer within 48 hours of hospitalisation. In some cases, your insurer might ask you to inform them within 24 hours of hospitalisation also. If you fail to do so, your claim most likely will get rejected.

FAQs

Q1. What is thе Claim Sеttlеmеnt Ratio (CSR) for health insurancе companies,  and why is it important in 2023?

A. Thе CSR is thе ratio of claims successfully sеttlеd to thе total claims rеcеivеd by an insurancе company.

Q2. Which health insurancе companies have thе highеst claim sеttlеmеnt ratios in 2023?

A. Currently, the company which has the highest claim settlement ratio is Reliance General Insurance Co. Ltd.

Q3. What is thе idеal CSR pеrcеntagе I should look for when choosing a health insurancе company?

A. Any company with more than 85% as CSR is good to get your health insurance from.

Q4. What arе some factors that can lеad to a health insurancе claim bеing dеniеd,  еvеn with a high CSR from thе company?

A. Claims can bе dеniеd for various reasons, including non-disclosurе of prе-еxisting conditions, not adhеring to thе company's claim filing procеss, incomplеtе or inaccuratе information on thе claim form, and fraud or not informing the insurer about your hospitalisation in time.

References

1. https://www.insurancedekho.com/health-insurance/hdfc-ergo 
2. https://www.insurancedekho.com/health-insurance/reliance-general