Why it is Important to Check the Claim Settlement Ratio of Health Insurance Companies?

One of the most expensive things in India is healthcare, and it is only rising each year. if you are diagnosed with a serious or rare illness, you must have a good bank balance to get the right treatment. The other option you have is that of having a health insurance policy. When you buy a health insurance policy, you can avail of the benefits and get coverage for hospital bills. Purchasing the right health insurance policy is the most prudent thing one can do.

While we plan to buy a health insurance policy, we must not be in any kind of hurry. This will only lead to buying a health insurance policy that is not apt for you. And since there are so many health insurance companies and policies in the market that it can be very challenging for the policy buyers to choose one.

If you are a policy buyer who is looking forward to buying a health insurance policy, you must check the health insurance claim settlement ratio of the company. This will help you to understand whether you will get your claims settled or not.

Understanding Claim Settlement Ratio

The Claim Settlement Ratio, also known as CSR is the ratio that provides information on the number of claims of the policyholders that have been settled by the insurance companies. The number of claims is divided by the total claims received, and then the CSR is found. For example, if an insurance company receives 10 claims, and settles seven, then the CSR would be 70%. The more the CSR is of an insurance company, the more you are likely to claim your sum insured.

Significance of CSR

The reason why we opt for a health insurance policy is to get financial support in a situation when we are not well and need the right treatment. And when we need the money, we must be able to claim it. This is why you should take a look at the Claim Settlement Ratio of a company that you intend to buy the health insurance policy. It will give you a clear picture of the claim settlement. By checking the CSR, you will be able to understand the willingness of the insurance provider of giving you the funds when the need arises.

Claim Settlement process in health insurance

If you are a policyholder, you have all the rights to claim your sum insured. However, you need to follow a certain process for that. Let us take a look at the Claim Settlement process.

Step 1: Claim intimation

If it is a planned treatment, you can inform the insurance provider or TPA 48 to 72 hours before hospitalization via a call or an email. You need to do this as per the insurer’s guidelines. If it is an emergency, you must inform the insurance provider within 24 hours of hospitalization.

Step 2: Documents approval

You would be required to show your health card along with Identity proof at the hospital. Then the documents will be verified at the hospital and then they will submit the pre-authorization form to the TPA or the insurance company.

Step 3: Claim settlement

At this stage, the claim will be approved by the insurance company, provided everything is in order. Once the treatment is over, the medical bills will be settled by the insurance company directly with the hospital.

Now that you know the importance of the Claim Settlement Ratio and why you should check it before buying a health insurance policy from an insurance provider, you must take a look at it before taking the final call. You can visit the IIFL website to find the Claim Settlement Ratio of several insurance companies in India.

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