Top-rated health insurance companies go a long way to help you cover your medical expenses and reduce the possibility of serious illness. It is therefore important to buy a health insurance product from an insurer that has the highest customer satisfaction rate and one that fulfils all your medical needs.

To find an insurance company with the highest customer satisfaction, you must consider these two things: Incurred Claim Ratio and Claim Settlement Ratio.

Incurred Claim Ratio (ICR)

Incurred Claim Ratio is the ratio of the accurate claim settled by the insurance company to the net premiums received in any given year. In other words, ICR is the proportion of claims that are paid out against the total amount of premiums collected by the health insurers. ICR indicates ability of insurers to pay the claim.

Say, for example, if a health insurance company approved a total claim of Rs. 80 crore in 2019 against the premiums collected amounting to Rs. 100 crore, then the ICR of the company would be 80% in 2019.

If the ICR of a health or general insurance company is very low, it shows that the claim settlement process of the company is not good. However, experts are of the view that market presence of an insurer may be doubtful in case of very high ICR. It is therefore recommended to choose an insurance provider that has a moderate ICR i.e. between 75% and 90%.

Every year, Insurance Regulatory and Development Authority of India (IRDAI) publish a report that contains many details of insurers, including Incurred Claim Ratio. So, you check ICR on the IRDAI website.

Claim Settlement Ratio (CSR)

Claim Settlement Ratio is the proportion of claims settled by an insurer against the total number of claims received by the same insurer.

Say, for example, the CSR of an insurance provider will be 92% if the company settles the claims amount to Rs 92 crore against Rs 100 crore (the total amount of claims received). It means the company rejects only 8% of claims of customers. Higher the CSR means higher the chances of your claims getting settled. High Claim Settlement Ratio indicates that the claim settlement process of the Health Insurance Company is robust.

Thus, on the basis of ICR and CSR, you can choose a health insurance company that has the highest customer satisfaction.

Below is a table that shows ICR and CSR of Health Insurance Companies as per FY 2019-2020.

Health Insurance Companies

Claim Settlement Ratio Incurred Claim Ratio
HDFC ERGO General Insurance 86.52% 77.20%
National Health Insurance 83.78% 105.98%
Oriental Insurance 93.96% 102.34%
New India General Insurance 92.68% 91.43%
United India Insurance 78.03% 101.46%
TATA AIG General Insurance 76.04% 77.46%%
Reliance General Insurance 76.43% 83.65%
SBI General Insurance 66.08% 71.12%
MAX Bupa Health Insurance 89.46% 53.51%
Star Health Insurance 78.62% 65.91%
Aditya Birla Health Insurance 70.81% 40.08%
IFFCO Tokio General Insurance 96.33% 88.61%
Care Health Insurance 95.47% 59.13%
Magma HDI Health Insurance 95.17% 84.35%
Bajaj Allianz General Insurance 92.24% 70.74%
Navi General Insurance 86.98% 65.52%
Manipal Cigna Health Insurance 85.72% 61.64%
Edelweiss General Insurance 85.57% 114.70%
Future Generali General Insurance 82.96% 59.66%

Source IRDAI and IBAI’s General Insurance Claim Insights Handbook – 5th Edition.

To know the complete list of health insurance companies with ICR, click here, and visit the page number 201. To check CSR, visit the official website of the insurance company.

Bottom Line

Since you know the CSR and ICR of health insurance companies, choose has the Highest Claim Settlement Ratio and Incurred Claim Ratio between 75% and 90%.