opted by you at the time of purchasing the policyholder. The insurer is liable to pay the entire amount of the claim after considering all the voluntary or compulsory sub-limits, deductibles, etc. As per this process, you have to pay for the treatment at the hospital and get it reimbursed later on from the insurance provider subject to the amount of the claim. If you get treatment at a hospital outside the network of the insurer, you set foot in a Reimbursement Claim Settlement Procedure. You will need to pay only in case of co-payments or a sub-limit clause that you have chosen during the plan purchase. The insurer directly pays to the hospital subject to the amount of the claim. As per the Cashless Claim Settlement Procedure, you need not pay anything to the hospital for the treatment and medical services. When you get medical treatment at a network hospital with your health insurance, then you can attain a cashless claim. (Source: IBAI’s General Insurance Claim Insights Handbook - 5th Edition.) You can choose an insurer as per their best health insurance claim settlement ratio in the FY 2019-2020. Top 10 Health Insurance Companies Claim Settlement Ratio in India Health insurance claim settlement ratio which you should look into before buying health insurance. It is because the main motive of buying an insurance plan is to avail claims during the time of medical emergency. CSR is considered one of the significant factors in selecting an insurance company when purchasing a health insurance policy. What is the Claim Settlement Ratio?Ĭlaim Settlement Ratio refers to the proportion of claims paid out of the total number of claims received by an insurance company during a financial year. Hence, the Claim Settlement Ratio or CSR of an insurance company reflects its reliability, which in turn, helps the policy buyers in decision making when planning to buy a new health insurance policy. Aspects like these make an insurance company more trustworthy amongst its customers. For instance, Niva Bupa tries to settle health insurance claims within 30 minutes of receiving them. There are several insurance companies that guarantee claim settlement within a stipulated period of time, provided it is a non-fraudulent one. If the company is unable to settle the claims, then the whole purpose of purchasing insurance gets wasted. Claim Settlement Ratio of Health InsuranceĬlaim Settlement Ratio in health insurance is one of the most vital factors to be considered while choosing a health insurance company as it tells you about the claim settling ability of the insurance provider. In short, a policyholder can ask the health insurance provider to offer cashless service as well as can submit a claim settlement form to seek reimbursement. With this, the policyholder can either receive a cashless treatment or can get reimbursement for availed treatment or health services. Health insurance claim settlement is a procedure where a policyholder makes a request to his or her insurer in order to avail of the medical services listed under the health plan.