Understanding Health Insurance Claim Settlement: Key Insights from 2023-24
MAS Team | 28 March 2025
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Managing medical expenses without a robust health insurance policy can be difficult, especially when faced with high medical bills. Health insurance ensures financial support during medical emergencies, with policyholders paying regular premiums for this coverage. General insurance providers not only offer health insurance but also cover other aspects such as vehicle, home, and travel insurance.
Evaluating Your Insurer’s Claim Settlement Efficiency
A crucial factor in choosing a health or general insurer is its efficiency in settling claims. Delayed or denied claims can render insurance ineffective when needed the most. Therefore, assessing the claim settlement ratio—particularly for claims processed within three months—can provide valuable insights into an insurer’s reliability.
The Insurance Regulatory and Development Authority of India (IRDAI) annually publishes data on claim settlements by health and general insurers, with the most recent report covering the fiscal year 2023-24.
Understanding the Claim Settlement Ratio
The claim settlement ratio represents the percentage of claims an insurer settles compared to the total claims received in a given period. For example, an insurer with a 93% settlement ratio successfully processes 93 out of every 100 claims submitted.
For stand-alone health insurers, the reported data focuses solely on health insurance claims, while for general insurers, it encompasses claims from health, motor, travel, and other general insurance segments.
Claim Settlement Performance: 2023-24 Overview
Below is a summary of the claim settlement performance of various insurers, highlighting the percentage of claims settled within three months:
Public Sector Insurers:
- United India Insurance Co. Ltd. – 96.33%
- The New India Assurance Co. Ltd. – 92.70%
- National Insurance Co. Ltd. – 91.18%
- The Oriental Insurance Co. Ltd. – 65.08%
Private Sector Insurers:
- Navi General Insurance Ltd. – 99.97%
- Acko General Insurance Ltd. – 99.91%
- Reliance General Insurance Co. Ltd. – 99.57%
- Universal Sompo General Insurance Co. Ltd. – 98.11%
- SBI General Insurance Co. Ltd. – 97.05%
- ICICI Lombard General Insurance Co. Ltd. – 97.16%
- Tata AIG General Insurance Co. Ltd. – 95.43%
- Zuno General Insurance Co. Ltd. (formerly Edelweiss General Insurance) – 83.12% (lowest among private insurers)
Stand-alone Health Insurers:
- Aditya Birla Health Insurance Co. Ltd. – 92.97%
- Care Health Insurance Ltd. – 92.77%
- Niva Bupa Health Insurance Co. Ltd. – 92.02%
- Star Health and Allied Insurance Co. Ltd. – 82.31% (lowest among stand-alone health insurers but with the highest volume of claims settled within three months)
Key Takeaways
- Top Performers: Acko General Insurance (99.91%) and Navi General Insurance (99.97%) led among private general insurers in settling claims within three months.
- Lowest Settlements: Zuno General Insurance had the lowest claim settlement ratio (83.12%) among private insurers, while The Oriental Insurance Co. Ltd. had the lowest ratio (65.08%) among public insurers.
- High Volume Settlements: Star Health and Allied Insurance settled the highest number of claims (16,80,171) within three months, followed by Aditya Birla Health Insurance (12,24,376 claims).
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Overall Performance: General insurers, both public and private, settled 81.13% of total claims within three months, with an additional 16.3% settled between three to six months.
While the claim settlement ratio is an essential factor, it should not be the sole criterion for selecting an insurer. Other critical factors include:
- Sum insured: Ensure it aligns with potential healthcare costs.
- Waiting period: Understand the waiting periods for pre-existing conditions and specific treatments.
- Hospital network: A broad network ensures accessibility to quality healthcare facilities.
Assessing an insurer’s claim settlement efficiency helps in making informed choices when selecting a policy. Regularly reviewing IRDAI reports can aid policyholders in choosing insurers with prompt and fair claim settlements, ensuring financial security in times of need.
Dear Investor,
In case of any grievance / complaint :
In case of any grievance / complaint :
- Please contact Compliance Officer Shraddha Mhatre at [email protected] and Phone No. - 91-22-35131664.
- You may also approach CEO Debashis Basu at email- id [email protected] and Phone No. - 91-22-35131664.
