• IRDA Incurred Claim Ratio of Health Insurers in India

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    The IRDA, or Insurance Regulatory and Development Authority publishes the Incurred Claims Ratio for health insurance companies in India. Incurred Claim Ratio is basically the overall value of every claim a company has paid divided by the total sum of premium collected during the same period. Incurred Claims Ratios are calculated on an annual basis, and the ratios for 2014-15 and 2013-14 have been listed below for the sake of comparison.

    Incurred Claim Ratio = Net Claims Incurred / Net Earned Premium

    Incurred Claim Ratio of Health Insurance Companies - A Comparison:

    Insurer Net Earned Premium (in lacs) Net Claims Incurred (in lacs) Incurred Claims Ratio (%)
    2013-14 2014-15 2013-14 2014-15 2013-14 2014-15
    PUBLIC SECTOR HEALTH INSURERS
    National United Oriental New India 259,216 207,502 284,120 162,988 332,965 299,246 200,410 368,785 270,331 273,098 275,179 185,417 366,344 356,057 234,517 364,302 104.29 114.26 96.85 115.23 110.2 118.98 117.02 98.78
    PRIVATE SECTOR HEALTH INSURERS
    Bajaj Allianz 65,513 69,512 56,733 51,152 86.60 73.59
    Bharti AXA 16,453 19,117 14,201 18,636 86.32 97.48
    Cholamandalam 21,002 19,635 12,960 10,295 61.71 52.43
    Future Generali 14,401 14,192 12,218 11,345 84.85 79.94
    HDFC Ergo 40,606 58,145 37,725 32,843 92.91 56.48
    ICICI Lombard 114,832 106,110 106,816 92,720 93.02 87.38
    IFFCO – TOKIO 19,741 29,989 17,209 27,714 87.17 92.41
    Liberty Videocon 41 3,747 36 3,843 88.29 102.56
    L&T 4404 3,502 3,992 1,819 90.64 51.93
    Magma HDI 0 66 0 61 0 92.67
    Raheja QBE 2 35 1 41 96.45 116.54
    Reliance 37,663 44,927 36,827 48,291 97.78 107.49
    Royal Sundaram 20,603 22,577 11,761 11,942 57.09 52.89
    SBI 912 24,252 443 19,492 48.63 80.37
    Shriram 143 214 129 152 90 70.91
    TATA AIG 17,906 35,591 15,449 24,892 86.28 69.94
    Universal Sompo 6481 9,955 7060 10,176 108.95 102.22
    PRIVATE SECTOR STANDALONE HEALTH INSURERS
    Apollo Munich 54,340 65,588 35,644 41,343 65.59 63.03
    Cigna TTK 1 667 1 429 59.68 64.33
    Max Bupa 23,766 31,524 14,040 17,388 59.07 55.16
    Religare 8,164 15,372 6,525 9,397 79.92 61.13
    Star Health 67,540 101,793 45,395 65,106 67.21 63.96
    Incurred-Claim-Ratio-IRDA-Data

    What do Incurred Claim Ratios Mean?

    Incurred Claims Ratio shows the ability of a company to make payments towards claims. If the ICR of a company is more than 100%, it indicates that the amount of money given away by the company as claim is more than the amount of money collected by the company as premium. In such cases, the company will find it hard to sustain itself, and as a result, will either resort to rejecting some borderline claims, raise the price to better manage claims, or change their product altogether.

    If the ICR of a company is between 50% and 100%, it indicates that the company has collected more money as premium than it has given away as claims. In such cases, the company makes profits and means that the company has not only produced a quality product, but has also succeeded in selling it to customers and helping them understand where claims must be made and where they shouldn’t.

    If the claim is less than 50%, it means that the company is either hardly giving out claims or is making relatively large profits. However, the fact that the company is generating considerable profits is not necessarily a good thing as all health insurance companies should offer products that actually pay out claims within the correct limits. In case claims are low, then customers who purchase such products realise over a period of time that the health insurance policy is costly and/or the number of exclusions in the policy are way too many, and thus shift to a better or more efficient product. Hence, the perfect value of ICR ranges between 75% and 90%.

    Things to Consider :

    While ICR is a fine yardstick with which the performance of a company can be measured, it does not tell the whole story. Following are the points to consider with regards to the ICR of a company.

    • Time taken for settlement of claims: While ICR is calculated by comparing the claims settled by a company against the collected premiums, the time taken for the settlement of claims in not considered. Hence, the insurer may have recorded a ratio between 90% and 95%, but the claim settlement process may still take as long as four to six months, making it a rather hassling experience for the individual. So basically, the customers will have to wait patiently for the settlement of claims while the insurer delays it while maintaining a healthy ratio at the same time.
    • Low earnings: Insurers who operate start-ups may not have earned a substantial amount of money through premiums initially in its first few years of operations, thus making the claims experienced relatively high. As a result, the ICR of the company will be more than 100% which means that the insurer is incurring losses due to the fact that the claim incidence in the initial years may have been significantly higher.

    Difference between Incurred Claim Ratio and Claim Settlement Ratio?

    Incurred Claim Ratios are often confused or mistaken for the same as Claim Settlement Ratios. A claim settlement ratio is basically the ratio of settled claims to the total claims filed in a particular accounting period. Hence, in case the claim settlement ratio of a company stands at 90%, it means that 90 claims out of the 100 filed have been settled. The remaining 10% are either pending or rejected by the insurance company.

    Conclusion:

    For instance, say Company A has an incurred claim ratio of 90% and Company B’s ICR is 95%, most customers will likely opt for Company B as their ratio is higher. However, Company A must also be given some consideration as Incurred Claim Ratio is not the factor based on which the reputation of an insurance provider is measured. The reason for this is that the time taken to settle claims is not mentioned in the ICR. Company B may have a higher ratio of 95%, but the time taken for the settlement of claims can be relatively high (six months or above). On the other hand, Company A has a lower ratio in comparison with Company B, but the time taken for the settlement of claims can be only a month or two, making it easier for a customer to settle his / her claims at a quicker rate than it would with Company B.

    Moreover, there may be other factors such as network hospital coverage, specific plan benefits such as premium rates and coverage that must also be considered when choosing a company as an insurance provider. The key to choosing the right health insurance provider is to compare the ratios and pay attention to the other important factors.

    GST rate of 18% applicable for all financial services effective July 1, 2017.

    Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

    Incurred Claim Ratio of Health Insurance Reviews

  • Page 1 of 3 1 2 3
    • Cigna TTK Health Insurance
      "Good protection for family with good medical cover"
      0.5 5.0/5 "Blown Away!"
      I have chosen CIGNA TTK is because of their claim settlement ratio is around 94% its really good, they are providing good cash less facility and also they got tie up with 200 hospitals . I took the insurance for my family, my premium amount around Rs.22k with the medical cover of 4.50 lakhs its good. I would be receiving my policy copy very soon from them.
      Was this review helpful? 0
      , pune
      Reviewed on Oct 30, 2017
    • review Health Insurance
      "Good health insruance"
      0.5 5.0/5 "Blown Away!"
      Every person had to take Bharathi axa because it is very much helpful. I am holding this insurance for about 3.5 years. I normally pay the premium through online. Claim settlement went very well when I was hospitalized total expenses incurred was 40k and I had to pay only 2 k from my end and the rest was borne by Bharthi Axa
      Was this review helpful? 0
      , bangalore
      Reviewed on Aug 10, 2017
    • review Health Insurance
      "Good health insruance"
      0.5 5.0/5 "Blown Away!"
      Every person had to take Bharathi axa because it is very much helpful. I am holding this insurance for about 3.5 years. I normally pay the premium through online. Claim settlement went very well when I was hospitalized total expenses incurred was 40k and I had to pay only 2 k from my end and the rest was borne by Bharthi Axa
      Was this review helpful? 0
      , bangalore
      Reviewed on Aug 10, 2017
    • ICICI Lombard Health Insurance
      "Service is excellent"
      0.5 5.0/5 "Blown Away!"
      ICICI LOMBARD HEATH INSURANCE is really good, I have asked my friends and colleagues and opted for the same. Feedback is good coverage is good claim ratio is fine, they have good number of hospitals outside the cities and that is the highlight there. Service and the facilities are really good.
      Was this review helpful? 0
      , ranchi
      Reviewed on Aug 08, 2017
    • ICICI Lombard Health Insurance
      "Satisfactory "
      0.5 4.0/5 "Great!"
      I do have health insurance policy with the ICICI Lombard general insurance company and am with them from the last eight years of time. Service aspects are good one with the ICICI lombard general insurance company, also the coverage value is a satisfactory one and the claim ratio too. I have got around 50% of cost of treatment as claim settlement.
      Was this review helpful? 1
      , mumbai
      Reviewed on Jun 22, 2017
    • HDFC Ergo Health Insurance
      "Trust"
      0.5 4.0/5 "Great!"
      With the HDFC ERGO , I do hold a health insurance policy and the coverage value is around lakh Rupees , which covers myself and my spouse. I do not have any claim expereince them till now. They are ranked 3rd with respect to claim settlement ratio.
      Was this review helpful? 1
      , mumbai
      Reviewed on May 16, 2017
    • Star Health Health Insurance
      "Mal trade practice by Starhealth"
      0.5 0.5/5 "Unacceptable"
      Commits 95% claim settlement but inspite of all documents submission they just cleared 50% of claim amount. Gives lame excuses for rejections. They are cheaters. Beware of. Apathetic customer service response. Even escalation doesn't work.
      Was this review helpful? 1
      , pune
      Reviewed on Mar 20, 2017
    • New India Health Insurance
      "Good to go"
      0.5 5.0/5 "Blown Away!"
      I do have personally taken a health insurance policy from New India assurance company and the claim settlement got happens in couple of hours. I got around 100% of cost of the treatment as reimbursement for most of the time. Cashless treatment facilities are also available with them, also they have provided the coverage for full family.
      Was this review helpful? 0
      , mumbai
      Reviewed on Mar 16, 2017
    • Star Health Health Insurance
      "Protect your health"
      0.5 3.5/5 "Pretty good"
      Star health insurance is the good health insurance for every family , all plans available for certain age criteria. Strong cashless hospital s tied up with every location in india, claim settlement is very easily and faster then others, I fully trusted with them. I always recommended to my family friend s.
      Was this review helpful? 0
      , nasik
      Reviewed on Jan 28, 2017
    • New India Health Insurance
      "Simply the best"
      0.5 3.0/5 "Satisfactory"
      NEW India health insurance. I am working in that company for 2.5 years and I did not go for claim settlement till date. It is the simply the best my employer takes care of it and they make the payment on my behalf . I have got the ID card and other health documents too
      Was this review helpful? 0
      , hyderabad
      Reviewed on Dec 22, 2016
    • review Health Insurance
      "Good service"
      0.5 5.0/5 "Blown Away!"
      Bharathi Axa medical insurance is really good. They are providing very good and quick response. The claim disbursement and the claim settlement amount is really good. Reimbursement is of two types one is manual and the other one is cash less. In case if the hospital comes under the list we can produce the I card and get the cash less . In case if the list of hospitals does not come under the cover then we had to produce the medical bills and the get the claim.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Nov 04, 2016
    • Star Health Health Insurance
      "Good ,fast response and reliable"
      0.5 5.0/5 "Blown Away!"
      I bought this Star health insurance policy before 5 months it provides most of the benefits, its better than any other medi claim policy in the market. It covers most of things and the market rate is much cheaper than any other products. They have their own claim settlement ratio.
      Was this review helpful? 1
      , bangalore
      Reviewed on Sep 03, 2016
    • HDFC Ergo Health Insurance
      "Can be streamlined"
      0.5 4.0/5 "Great!"
      The service provided was very good in the Insurance category.The claim settlement was good.They can streamline the process for providing better service.They have clearly mentioned about the waiting period and the offers related to the health Insurance with HDFC ERGO
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jun 07, 2016
    • HDFC Ergo Health Insurance
      "Great !!!"
      0.5 5.0/5 "Blown Away!"
      HDFC ergo has given the five lakhs medical coverage for the monthly premium of Rs.423. Cashless treatment is available. I got my claim settlement within three days which was done before the promised days. The required only the original bills no any other documents in fact i was admitted in the nursing home only. After 2 years they cover the pre existing diseases also.
      Was this review helpful? 1
      , mumbai
      Reviewed on Mar 30, 2016
    • ICICI Lombard Health Insurance
      "Great service..."
      0.5 5.0/5 "Blown Away!"
      It was wonderful claim experience as they settled the claim within 15 days. Hassle free claim settlement from the ICICI Lombard. They gave hundred percent of settlement. They normally does not cover cancer but not sure about other uncovered diseases on the health insurance.
      Was this review helpful? 0
      , mumbai
      Reviewed on Feb 11, 2016
    • Religare Health Insurance
      "Fantastic"
      0.5 5.0/5 "Blown Away!"
      I am having the health insurance policy with the Religare insurance company and am having it from the last two years of time. Premium was around 11000 Rupees for my full family. Medical coverage value is around 2 lakh Rupees and I dint faced any claims. The claim ratio is very good with them.
      Was this review helpful? 0
      , vadodara
      Reviewed on Jan 09, 2016
    • Cigna TTK Health Insurance
      "Fabulous"
      0.5 5.0/5 "Blown Away!"
      I have the health insurance policy with the Cigna TTK . They have done up with the follow back and I have not faced any claims. Successful claim ratio is good with them and they are having many networking hospitals
      Was this review helpful? 0
      , mangalore
      Reviewed on Jan 09, 2016
    • Max Bupa Health Insurance
      "Good"
      0.5 4.0/5 "Great!"
      I am having the health insurance policy with the Max bupa insurance company. The claim settlement time is good while compare with others. Services are good with them and the customer service representative have clear knowledge about the products. Thirty thousand Rupees is the premium and the floater is around 25 lakh Rupees and each one will have coverage of 6 lakh Rupees.
      Was this review helpful? 0
      , chennai
      Reviewed on Jan 08, 2016
    • National Insurance Health Insurance
      "Claim was not 100%..."
      0.5 4.0/5 "Great!"
      For a couple of times I applied for claim settlement where National Insurance is straight forward. Settlement was not hundred percent and not happy with that. They deducted some amount for claim and that might be their policy. They paid around 80% out of the actual amount on health insurance.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Jan 08, 2016
    • Apollo Munich Health Insurance
      "wide range of network hospitals..."
      0.5 5.0/5 "Blown Away!"
      I have seen that Apollo Munich is great in claim settlement ratio and also they have wide range of network hospitals for health insurance. We also can get cashless treatments in the network hospitals. Medical coverage is three lakhs. I just joined with Apollo Munich.
      Was this review helpful? 0
      , raipur
      Reviewed on Dec 31, 2015
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