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What helps you decide to buy a particular health insurance plan? Is it the features and benefits? The Sum Insured? The price? These are all good and important to consider when buying health insurance. However, do not forget a vital factor called health insurance claim settlement ratio (CSR) when sifting through the various policies.
The Claim Settlement Ratio of health insurance companies shows how well the company handles their customer claims. It's also an indication of whether you, as a customer, should. Thus, it is important to understand this concept, its benefits and its effect on health insurance's efficiency.
Reliance General Insurance employs a customer-centric approach and prioritises your healthcare needs, maintaining a record of 100% claim settlement*. Let us understand how it impacts your health insurance policies and gives you a better experience.
Health insurance claim settlement ratio is the number of claims settled versus the number of claims received. The ratio is usually denoted in a percentage form. The higher the percentage, the higher the insurer's reliability.
The Insurance Regulatory and Development Authority of India (IRDAI) monitors the medical insurance claim settlement ratio. They calculate the percentage of all private insurance providers annually and generate a report, which is published on their website.
Typically, an insurer with a claim settlement ratio of more than 85% is considered to be good, while a ratio higher than 90% is considered to be excellent. Reliance General Insurance offers a 100% claim settlement ratio*.
Incurred Claim Ratio (ICR) is the ratio of the total claim amount paid to the total premium amount received. Thus, unlike a high CSR, customers should look for a low ICR to choose the best health insurance company.
Similar to the claim settlement ratio, the incurred ratio is very often used to explain claim settlement in the insurance arena. However, the incurred ratio gives insight into the company.
Similar to the CSR reports, the IRDAI website also contains ICR reports for all private insurers.
The claim settlement ratio calculation is done using a simple formula and is used across multiple insurance products of various insurers, such as life insurance, car insurance, travel insurance, etc. It's a simple formula that gives you a picture of the insurance company's claim handling and settlement ability.
The claim settlement ratio formula is as follows:
Claim Settlement Ratio = Number of claims settled ÷ number of claims received x 100
Let us consider an example to understand how the formula works. Assume that a health insurance provider receives 300 claims in a year and settles 290 of them. According to the formula, the claim settlement ratio would be 96.66%.
However, for the next year, the 10 outstanding claims from the previous year will also be considered for calculating the health claim settlement ratio.
To know your Reliance General Health Insurance's settlement ratio, you need not calculate it every time. You can find it on our health insurance page or the IRDAI website.
Knowing the claim settlement ratio helps to make health insurance purchases easier and more efficient. As mentioned, it gives you an insight into the insurer's trustworthiness and efficiency while settling the claims. In addition, these are more reasons for the importance of claim ratio in health insurance:
It is an important factor when choosing a health insurance plan and helps you get the best insurer. The higher the claim settlement ratio, the higher is the chance to benefit from your insurance. Moreover, this ratio is calculated the same way for all insurance products across all insurance provider companies.
A higher CSR also means that the company employs a transparent and efficient claiming process. Transparency in the health insurance market is crucial, as there are higher stakes.
Claiming insurance benefits can be of the utmost importance in health insurance plans, as the claims help during critical medical emergencies. A high claim settlement ratio also implies higher accessibility to healthcare facilities and timely treatments, ensuring that the provider has a client-centric approach.
This is also an important metric to use while comparing multiple insurance providers for a common product. The best claim settlement in health insurance also implies a better financial state for the insurance companies, which eventually reduces financial risk, disputes, and claim settlement delays.
Any customer will want to know if their health insurance will give them value for their money. Our high health insurance claim ratio tells you that the premium you are paying will come to good use if a claim arises, which gives you a sense of relief and peace of mind.
Before buying any health insurance plan for yourself or your family, you must check the claim ratio.
The easiest way to do this is to visit the Reliance Health Insurance page. With Reliance General Insurance, you can enjoy a 100% claim settlement ratio*.
Alternatively, you can also check it on the IRDAI website. Here is how to:
Visit the official IRDAI website.
On the main menu tab, find the “Claims" section under the “Reports and Statistics" section.
Find the navigation menu on the left side of the screen and click on “Annual Reports".
Here, you can find the annual reports of health insurance claim settlement ratios from previous years.
Download the reports of the recent few years and look for their statistics on Reliance General Health Insurance.
Compare the settlement ratio of our various other health insurance products, such as Health Global Insurance and Health Infinity Insurance. Along with the ratio, compare the coverage benefits, too, and ensure that you select the plan that fits your needs.
Remember, the higher the claim ratio in health insurance, the higher the reliability and chances of receiving the claim when needed.
You can claim any of your Reliance General Health Insurance in two ways: cashless or reimbursement. Here are the two types of claims explained along with their claim processes to help you choose the right one while completing your health insurance claim settlement process:
This type of claim settlement process means getting the necessary treatment in any of the country's hospitals without needing to pay the bill upfront.
Once you file your cashless health insurance claim with us, you do not have to worry about getting your finances together to pay the bill, as we settle it directly with the hospital.
To claim your cashless insurance:
With our Cashless Anywhere policy, you can visit any hospital near you and start the necessary treatment procedure.
Use your Reliance Health Card at the hospital's TPA helpdesk. File your Cashless Claim with us within 24 hours of admission.
To register your claim, inform our health insurance claims team by calling (+91) 4890-3009, using the Reliance Self-i application or sending an email to rgicl.cashlesseverywhere@relianceada.com.
For planned treatments and hospitalisation, intimate our claims team as soon as the doctor prescribes it to avoid any delays. Alternatively, you can also complete this process with the help of the hospital's helpdesk or TPA. Simply submit the authorisation form, along with a copy of your health card.
The TPA or the helpdesk coordinates with our RCare Health team and sends all the necessary medical details and pre-authorisation forms.
Once the claim is verified, we settle all the bills directly with the hospital. You only need to leave the investigative reports and discharge summary with the hospital. Carry only copies of everything with you.
Please note that you will be required to pay for expenses not included in the policy, such as excluded expenses and deductibles, as per the policy terms.
This type of claim settlement process is ideal when your cashless claim request is denied or the hospital does not support cashless claims. You can file this claim after completing your treatment and submitting all the bills, reports, discharge summaries and other supporting documents.
Here is how you can file a Reimbursement Claim with us:
Undergo the same process of getting hospitalised and initiating the claim with us as you would for a Cashless Claim.
Once you inform us, you can complete the entire treatment and hospitalisation and pay the bill upfront.
While you are being discharged, collect all the treatment-related documents from the hospital. This includes bills, receipts, lap reports, other investigative reports, prescriptions, etc.
File a claim with us and submit scanned copies of all the documents required within 7 days of being discharged.
Once the claim is approved, we will reimburse the medical expenses to your registered bank account.
Policy Number
Contact details of the insured person (phone number, email ID, address, landmark, etc.)
Name of the insured person who is hospitalised
Relationship of the insured with the person who is hospitalised.
Name of the hospital
Illness/ailment details -(For health claims)
Accident details, including date, time and location of the accident - (For accident cases)
Commencement date of the symptom of ailment
Filled and duly signed Claim Form
Doctor's first prescription (with commencement date of the symptom of disease)
Treatment papers, such as prescriptions
Original medical bills and receipts
Investigative reports, such as X-ray scans
Original hospital discharge card
Copy of FIR (in case of accident)
Cancelled Cheque – CTS 2010 format.
If the insured's name is not printed on the cheque, provide a scanned copy of the 1st page of the passbook or bank statement.
Copy of ID proof of the patient patient & PAN card of the insured individual
Copy of your Reliance General Insurance's Health Card
Here is the detailed list of claims documents.
Read your health insurance policy documents thoroughly and understand your policy well. Be aware of its inclusions and exclusions, claim conditions and processes, deductibles, etc. This will help you know what is covered and what isn't.
To successfully claim your health insurance, we require your claim intimation within 24 hours of admission. So, inform us about your medical need or emergency as soon as you can to avoid rejection.
Ensure that all your medical bills, reports, prescriptions, or any other supporting documents are uploaded and complete. Missing or incorrect information is a common reason for claim rejection.
Always disclose any pre-existing conditions while buying any of our health insurance policies. Claiming your health insurance for expenses arising from treatment of such conditions will result in claim rejection.
You can file a claim for your health insurance policy with us in two ways (as mentioned). Follow the process diligently, including filling out the claim form correctly and submitting it within the specified timeframe for successful claim filing.
Claim rejections can happen for multiple reasons. If the rejection is due to a missing document or accidental wrong claim filing, it can be rectified through active communication with us. Thus, it is also important to understand the reasons for health insurance claim denial and act on them.
Also Read: How to Appeal Against A Denied Health Insurance Claim?
Health insurance is the most important investment in your secure future and the well-being of your loved ones. Due to increased awareness and growing healthcare costs, we offer various types of insurance policies that cater to the specific requirements of particular health conditions. For example, we offer Specially Abled Health Insurance, Critical Illness Insurance, Group Mediclaim Policy, etc.
However, to ensure that you secure the best insurance policy, it is vital to select the one with the highest claim settlement ratio. This helps you partner with the most reliable and trustworthy insurer and secure your future, like Reliance General Health Insurance.
With us, you can have peace of mind knowing that your policy will cover all your necessary medical needs.
Every health insurance policy has a different waiting period, which you must serve before receiving the policy benefits. For example, the initial waiting period is 30-60 days.
Whereas the waiting period to receive our coverage for pre-existing conditions ranges from 1 to 4 years. Thus, read your policy documents carefully before claiming your insurance.
IRDAI publishes a report on health insurance claim settlement ratios annually and uploads the updated report to its website.
According to the guidelines set by the IRDAI, insurers must settle health insurance claims within 30 days.
Disclaimer: *T&C apply. For more details on risk factors, terms conditions, brochure, and exclusions, please read the policy wording carefully before concluding a sale. Claim Settlement Ratio: This is the overall claim settlement ratio for FY 2023-24 without claim outstanding at the start of the financial year as per public disclosure of Reliance General Insurance Co. Ltd.
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