How the claim settlement ratio helps in buying health insurance

Table of Contents

While we make our wealth, invest in many ventures and plans that will grow the amount of money we are putting into it, we often do not think enough about our health. Well, apart from taking care of your health, there are genetic illnesses, that you may get at any point of time in your life. With the risk and discomfort from these illnesses, also comes the need of paying a lot of money to get the best possible treatments. And getting adequate medical treatment is a thing, for which we may end up paying a lot of money, that we could never even imagine. To avoid such circumstances in life, buying a health insurance policy is a prudent idea.

Now when we talk about health insurance, we need to know that there are several health insurance policies available in the market. Therefore, it can become a bit confusing for some people to choose the best one of the lot. Well, one of the most important things that you must check while choosing a health insurance policy is the claim settlement ratio of the insurance company. This will give you a clear idea of the coverage that you can claim. The health insurance claim settlement ratio says a lot about the insurance company. So, let us first understand what it is.

What is the health insurance claim settlement ratio?

The health insurance claim settlement ratio (CSR) is basically the ratio of claims settled of the policyholders who made the claims with an insurance company. You can call it a common metric that helps in rating the insurance companies. CSR helps in making it one of the main parameters for the policy seekers to choose an insurance company.

At the beginning of each year, the Insurance Regulatory and Development Authority of India (IRDAI) calculates and published the most recent claim settlement ratios of the IRDA registered insurance companies.

Why is the health insurance claim settlement ratio important?

The numbers of health insurance companies in the market are more than we can even imagine. Therefore, the competition among them is fierce. However, not all of them can be trusted. Since you are putting your money into them, you would certainly want to claim your coverage when it is needed. This is when the claim settlement ratio of an insurance company matters. This is significant for both the insured as well as insurer. The higher the percentage of the claim settlement ratio is. The more the chances are there for you to claim your coverage.

What are the reasons for the rejection of claims?

It is high time for the policyholders to understand that an insurer cannot reject your claims without a proper and valid reason. And if your claim is being rejected by the insurance company, it means you might have made mistakes. Some of the common reasons for such rejections include:

Entering incorrect details

While buying a health insurance policy, you will get a form that you have to fill up very carefully. You need to make sure that each detail you are entering is correct. Therefore, do not depend on the insurance agent to do it; instead, you should fill-up the form.

Not disclosing important information like pre-existing health conditions

While you are sharing details with the insurance company, you must be transparent and disclose all the pre-existing health conditions. You also should inform them about the health history of your family. If you have missed it out while buying the policy, you can update the insurer while renewing your health insurance policy.

Not following the precise process of claims

You must know the guidelines for the claim settlement process of the insurance company from which you have bought your policy. You also need to follow the precise process.

Now that you know why the claim settlement ratio is important, ensure you check the CSR of your preferred insurance company.