The health insurance claim settlement ratio is a parameter that is used to measure the trustworthiness of the insurance company to settle the claim without any inconvenience. This ratio is regulated by the Insurance Regulatory and Development Authority of India (IRDAI).
By paying a premium for health insurance, we get financially covered for future medical emergencies as there is no need for paying a premium if your claim is not settled at the time you need it. This is why we should always check the claim settlement ratio of the insurer before getting health insurance, to know more you can visit https://www.turtlemint.com/health-insurance/articles/latest-medical-health-claim-settlement-ratio-india
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Reasons to check health insurance claim settlement ratio
Health insurance claim settlement ratio helps the insurer to decide the reliability of an insurance company of settling the claims. The higher the settlement ratio, the more the insured would be secured. These are the below-mentioned things you can evaluate by knowing the claim settlement ratio:
Reliability
Many insurance companies show great policy features, but some of them keep their promises of giving you financial support at the time you claim. So before purchasing any insurance policy blindly, you should check their health insurance claim settlement ratio, so that you will know the claim settlement history of the company, their number of unsettled claims, and claims that are kept on hold.
Comparison between two products
It helps you to differentiate between the two policies with the same functionality like if there are two policies from different insurance companies then to decide which one is better, you should go with the company which has a high settlement ratio. But you should also check whether the company is consistent or not, which means since how many years the company is persistent with their good settlement ratio.
The financial status of a company
An insurance company has a good health insurance claim settlement ratio shows that the functionality of the insurer is proper; the company is making a profit. The reputation of the company is good in the market because people are purchasing their policies, and it is financially stable.
Time frame
Only checking the claim acceptance ratio is not sufficient, the duration of redemption of money is also essential. It should not be more than 20 to 30 days. It shows that the insurer is so efficient in making their claims settled in the required time.
Types of Health insurance claims
Insured can avail their claim in two ways:
Cashless claims: Under this claim, the insurer settles down the bills directly with the hospital. But this facility is provided if the insured will do his medical treatments in the insurer’s network hospital. Cashless claims are also two types:
- Planned Hospitalization: Here, the insured is already aware of the hospitalization.
- Emergency Hospitalization: Emergency hospitalization comes when there is an occurrence of unexpected accidents or illness happens.
Reimbursement claims: In this claim process, the insured settles down the bill and asks the insurer to reimburse the money that he spends during his medical treatment. This facility can be availed in both network or non-network hospitals.
Conditions to avail health insurance claim:
- The claim must be filed within 30 days from the date of discharge.
- Relevant documents must be submitted.
- Authentic details must be filed.
Hence, before choosing a health insurance policy, you must check the health insurance claim settlement ratio so that you can have an idea about the financial history of the insurance company. You should also read the terms & conditions properly so that you’ll know that under which states your claim can get rejected in future, and are you flexible with that.
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