You need health cover regardless of what you take two at a time - pills or stairs.
You need health cover regardless of what you take two at a time - pills or stairs.
  • IRDA Incurred Claim Ratio of Health Insurers in India

    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

    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.

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