8/28/2015

HealthInsuranceClaimsThingsYouShouldLookBeforeBuyingHealthInsurance

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HealthInsuranceClaimsThingsYouShouldLookBeforeBuyingHealthInsurance

HealthInsuranceClaimsThingsYouShouldLookBeforeBuyingHealthIn
surance
WrittenbyPolicyBazaar

Views:5417

Published:02June2015

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There has always been a doubt in customers mind about whether private company will keep its side
of the bargain i.e. it will settle the claim or not. A customer spends premium annually which will
cover his medical expenses but theres always concern in his mind about the claim settlement.
There are three vital claim ratios that one must understand:
Claim settlement ratio
Claim repudiation ratio
Claim pending ratio
Claim Settlement ratio tells us about the claim solving ability of the insurer. If claims are intimated
and the insurer solves those, claim settlement ratio would be good. Higher claim settlement ratio
implies that majority of claims are getting solved. Example An insurer has 60% claim settlement
ratio which means that insurer settles 60 out of 100 claims.
Health insurance settlement ratio has been calculated as:Total claims settled/ (total claimsclaims
rejected) %
Claim repudiation ratiotells us about the percentage of the claims rejected by the insurer.
Example Claim repudiation of 20% means 20 cases out of 100 are rejected.
Claims repudiation ratio= (Claims rejected/total claims) %
The reasons for rejection could be false claims, untimely intimation, coverage not covered under
the policy etc.
Claims pending ratiotells us about the outstanding claims that have not been settled either way
neither accepted nor rejected.
Example Claims pending ratio of 40% would mean 40 claims out of 100 are yet to be solved.
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HealthInsuranceClaimsThingsYouShouldLookBeforeBuyingHealthInsurance

Claims pending ratio= (Claims outstanding/total claims) %

Health insurance claims could remain outstanding as a result of unfurnished information like
doctors certificate. The insurer takes time to validate the expenses incurred during hospitalization.

Howdoesclaimsratiodatahelpme?
Claims data let you understand the history of insurer claims handling process. It should also be
noted that new insurers typically would have lower settlement ratio. That is because claims filed so
early could probably mean that it could be a fake. Yet claims data does enlighten us in making
analysis of companies which have been operating for same period. Even though genuine claims are
rarely rejected, knowing about claims does help you arrive at the final decision. If you think that
two insurer products have more or less same benefits, knowing that one insurer has 90% claim
settlement could clinch the deal.
Policybazaar view:
Health insurance claims are mostly accepted. Thats because of insurers service of network
hospitals where cashless facility is available. In case of non network hospitals also, as long as
treatment is within coverage and stipulated requirements has been fulfilled, claims will be
accepted. It must be understood that no insurer rejects genuine claim.
The claim settlement data for quarter ended Dec 31, 2010 of the insurers is given below:

LEAVE A

Insurers

% Claims Settled

Apollo Munich

93%

BAJAJ Allianz

81%

bharti AXA

66%

Cholamandalam MS

59%

Future Generali

66%

HDFC ERGO

75%

ICICI lombard

92%

Iffcotokio

61%

Max Bupa

54%

Oriental Insurance

88%

Reliance General

61%

Royal Sundaram

91%

Star Health

63%

FEEDBACKThe New India Assurance

United India Insurance

71%
86%

REQUEST A

CALL BACK

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HealthInsuranceClaimsThingsYouShouldLookBeforeBuyingHealthInsurance

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