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Best Health Insurance Companies in Terms of Claim Settlement

India thrives for new ventures, international tie-ups and partnerships entering into its great and growing markets. Even in the field of health insurance, insurance companies apply aggressive marketing strategies and do their best to bring in customers with their unique plans and offer lucrative schemes to enroll as many customers as possible. The onset of a medical emergency and ever-growing health issues, diseases, and pandemics have made it a crucial and mandatory option to buy a medical insurance policy. This has become an integral part of everyone’s portfolio of essential finances. A good health insurance policy will safeguard someone’s savings and will be their support system in times of financial adversity.

Keeping this in mind, there are several health insurance companies with comprehensive benefits and health insurance coverage offering some of the best health insurance policies. In such a scenario, it is very difficult for a layman to find the appropriate insurer and the appropriate product as per his individual needs.

Everyone needs to take a few relevant points into consideration before opting for the right plan and right company for covering their health. But before digging into it, let us tell you how to select a good health insurance policy.

Here you go!

What is a Good Health Insurance Plan?

A health insurance policy is an agreement between the health insurance company and the insured, in which the insurer pays for the medical expenses incurred by the insured. The health insurance company provides a cashless treatment for any medical contingency like injuries or illnesses covered under the policy at one of the network hospitals or reimbursement for the medical expenses that the insured is eligible for. Buying a health insurance policy is also eligible for tax deductions on the amount of premium paid towards the health insurance company under Section 80D of the Indian Income Tax Act, 1961. 

Grounds of Benefits to be Considered While Opting for Health Insurance

The best health insurance policy will provide for a range of benefits:

  • The insured can use funds to recuperate or survive better after the illness
  • Critical medical services that may be provided to the insured at the time of his hospitalization
  • A good policy may also compensate for daily living expenses, so that the insured does not suffer financially during the time when he is unable to earn.
  • A good insurance plan may also include advanced treatments and diagnosis, which the traditional policies have discarded or not considered.
  • Transportation expenses, ambulance charges, OPD expenses, pre and post hospitalization expenses, medication, surgeries, pregnancies are a few examples that a good plan may cover. 

Other benefits provided by a reliable health insurance company are:

  • Lower premium charged
  • Minimum limits and sub-limits on the features of their coverage plan
  • Wide coverage offered on illnesses
  • A low waiting period for pre-existing diseases
  • Additional value-added benefits
  • Accountability
  • Wide network of hospitals 

Well, two more things that work as a yardstick to gauge about the performance of a particular insurance company include:

  • Incurred Claims Ratio (ICR)
  • Claim Settlement Ratio (CSR)

What is an Incurred Claims Ratio or ICR?

Incurred Claims Ratio stands for the total number of health insurance claims paid by the insurance company against the net premiums accumulated or earned for a specific financial year.

The formula would be: Incurred Claims Ratio = (Claims paid/Premiums paid) * 100 

In simple words, Incurred Claims Ratio is the annual calculated ratio of two very important amounts:

Expenses provided by a health insurance company towards payment of medical procedures

Payment received from the customers as a premium to the health insurance company

Features of Incurred Claims Ratio:

  • The ratio is always expressed in the form of % (percentage)
  • It only takes claims paid and premium earned into consideration and has nothing to do with the number of policies or nature of the claim and other factors
  • Time taken to settle the claim is inconsequential while calculating the Incurred Claims Ratio

Simple Interpretation of ICR to be Considered

  • Any medical insurance company with an Incurred Claims Ratio of more than 100% is at a loss. This means it is paying more claims than it is receiving a premium. These companies may dissolve soon due to their loss-making tendency.
  • Medical insurance companies with an Incurred Claims Ratio of less than 50% means that they are totally profit-oriented. They are more concerned about earning premium rather than paying out claims. These are stringent companies that should be avoided.
  • Insurance companies with an Incurred Claims Ratio between 50% - 100 are balanced companies that are paying equal relevance to both, the incoming profit and outgoing expense. Ideally an insured must lookout for a health insurance company with an Incurred Claims Ration between 75% - 90% to get the maximum benefits.

Besides the ICR, other factors that the insured should look at are:

  • Time taken for settlement of claims as there could be cases that remain pending for 5 months to a year. This could be quite a hassle for the insured party as they would want their claims to be processed swiftly and conveniently. So, this underlying factor should surely be investigated.
  • Low initial earnings of an insurance company, meaning that although they are paying their claims but they may not have enough income, so eventually the people investing in such companies suffer.

ICR of Health Insurance Companies in India

Let’s have a look at Incurred Claim Ratio (2017-18) of general health insurers and standalone medical insurance companies in India:

Name of the Health Insurance Company

Premiums Earned

Claims Settled

Incurred Claims Ratio

ACKO Health

Insurance

0.08 Crore

0.05 Crore

65.02 %

Bajaj Allianz Health Insurance

1331.06 Crore

1033.47 Crore

77.61 %

Bharti Axa Health Insurance

99.79 Crore

98.29 Crore

98.50 %

Cholamandalam Health Insurance

339.16 Crore

135.53 Crore

39.96 %

Edelweiss Health Insurance

0

0 Crore

70.01 %

Future Generali Health Insurance

256.26 Crore

224.03 Crore

87.42 %

Go Digit Health Insurance

1.76 Crore

1.05 Crore

60 %

HDFC Ergo Health Insurance

805.11 Crore

423.30 Crore

52.58 %

IFFCO Tokio Health Insurance

499.08 Crore

452.62 Crore

90.69 %

Kotak Mahindra Health Insurance

15.10 Crore

7.28 Crore

48.21 %

Navi Health Insurance

16.87 Crore

1.33 Crore

7.89 %

Liberty Health Insurance

101.25 Crore

75.51 Crore

74.58 %

Raheja QBE Health Insurance

0.13 Crore

0.02 Crore

18.19 %

Royal Sundaram Health Insurance

251.76 Crore

154.60 Crore

61.41 %

Reliance Health Insurance

671.16 Crore

715.08 Crore

106.54 %

Shriram Health Insurance

2.27 Crore

1.15 Crore

50.38 %

Universal SOMPO 

Health Insurance

133.06 Crore

138.60 Crore

104.17 %

Standalone Health Insurance Companies

Aditya Birla Health Insurance

151.98 Crore

135.35 Crore

89.05 %

Cigna TTK Health Insurance

266.14 Crore

123.20 Crore

46.29 %

HDFC Ergo General Health Insurance

1264.34 Crore

789.88 Crore

62.47 %

Care Health Insurance (formerly known as Religare Health Insurance)

679.67 Crore

353.21 Crore

51.97 %

Max Bupa Health Insurance

575.85 Crore

289.02 Crore

50.19 %

SBI Health Insurance

806.21 Crore

426.76 Crore

52.93 %

Star Health Insurance

2739.60 Crore

1692.02 Crore

61.76 %

Disclaimer: Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer. 

What is a Claims Settlement Ratio or CSR?

Claims Settlement Ratio is also one of the most accurate and important methods to calculate and weigh the capability and standing of any health insurance company. It is the ratio of claims admitted by the insured against the number of claims that have been settled.

For example – a company received 1000 claims and it could settle only 900 out of those, so the Claim Settlement Ratio of that health insurance company would be 90%. It is best for any company to have a higher claim settlement ratio to have better goodwill and ranking in the field of health insurance.

Features:

  • Any person will take health insurance for the necessity of financial support when he needs it the most, which is during their medical issues which are quite a burden on the finances. So, the CSR is a way to discover which company can solve the main issue at their best.
  • A company may promise innumerable benefits and lucrative offers, which can bring in the layman but eventually have a low CSR. This would mean that they would not receive their claimed amount. Such companies or policies should be immediately discarded. CSR helps the insured to withdraw from such options and not fall for any trap.
  • CSR helps to maintain and provide necessary information about the history of each health insurance company.
  • If an insured is stuck between opting for two companies with almost the same benefits, then the final nail in the coffin should be the Claims Settlement Ration. They should surely go for the company which offers a high CSR.

For a customer who is not an expert, understanding which company is beneficial for them when choosing their medical insurance provider can be quite difficult. For this we must understand the following ratios:

Claim Settlement Ratio

The higher the health insurance Claim Settlement Ratio of a Health Insurance Company, the better is its reputation and goodwill. This high CSR simply implies that it is clearing the majority of its claims and speaks volumes about the policies of the company.

Formula is – Claims Settled/Total Claims Registered

The Health Insurance Claim Settlement Ratio is calculated on the following formula: Claims Settled/ (Claims Reported + outstanding claims at the beginning of the financial year – outstanding financial year-end claims) 

Claim Repudiation or Claim Rejection Ratio

This is the ratio of the total number of claims rejected or repudiated by the insurance company against the number of claims received in a specific financial year. There could be a number of reasons for the rejection of these claims. For example, false claims by the insured, time-line not adhered to or the untimely intimation and acknowledgment of the claim, or it could just be rejected for the simple reason that there is no coverage under the policy bought by the insured. Avoiding Claim Repudiation is one good reason for every person to go through the details, terms and conditions of their policy thoroughly.

Formula is – Claims Rejected/Total Claims 

Claim Pending Ratio

Many claims are left under the ‘Pending’ status due to some issues regarding the documentation from the insured or the doctor’s side. For example: a pending doctor’s certificate could push the case to the claims pending department. It normally takes some time by the insurer to calculate and validate all the expenses incurred while the insured was hospitalised due to a covered risk.

Formula is – Claims Outstanding/Total Claims

Claim Settlement Ratio (CSR) of Health Insurance Companies in India 

Let’s have a look at the health insurance Claim Settlement Ratio of various private and stand-alone medical insurance companies in India:

Name of the Insurance Company

As per Public

Disclosure - Claims Settlement Ratio

Effective Ratio

Aditya Birla Health Insurance

94 %

97 %

Bajaj Allianz Life Insurance Company

93.95 %

93.95 %

Bharti Axa Life Insurance

77.78 %

77.78 %

HDFC ERGO Health

 

92 %

92 %

Iffco Tokio General Insurance Company

92.88 %

92.88 %

Manipal Cigna Health Insurance

91 %

91 %

Max Bupa

96 %

96 %

National Insurance Company Limited

78.52%

78.52%

Reliance General Insurance Company

75.76%

75.76%

Religare Health Insurance Company

93%

99%

Royal Sundaram Health Insurance

 N/A

 N/A

Star Health Insurance

90%

95%

Disclaimer: Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer. 

Difference between Incurred Claims Ratio and Claim Settlement Ratio

It is highly confusing for a common man to comprehend the difference between these ratios and both are quite suitable for being the deciding factors in what would be the best health insurance company in relation to claim settlement. Claim Settlement Ratio of health insurance companies (CSR) is quite popular for measuring the capacity for settlement as well as actual settlement of claims by any company, whereas Incurred Claims Ratio (ICR) is utilised to understand the financial capacity of the insurer. They slightly differ from each other in following terms:

Incurred Claims Ratio

Claim Settlement Ratio

This is applicable for General Insurance Companies

This is calculated for Life Insurance Companies but is an important factor in analysing the popularity of a

Health Insurance Company

To calculate this ration, monetary values

are considered of claims paid against premiums received

To calculate this ratio, absolute values of total

number of claims processed against the number of claims received


Top Health Insurance Companies in Terms of Claim Settlement 

Looking at the above data, let us decide which is the best health insurance company in claim settlement, considering the both ICR and CSR:

Health Insurance

Company

Number of Issues

Policies

ICR – Incurred Claims

Ratio

CSR – Claim

Settlement Ratio

Bajaj Allianz

516178

77.61 %

93.95 %

Bharti AXA

20853

98.50 %

77.78 %

HDFC Ergo Health

809364

62.47 %

84.08 %

HDFC ERGO

654375

52.58 %

82.99 %

IFFCO Tokio

164998

90.69 %

92.88 %

Max Bupa

309909

50.19 %

88.06 %

National Insurance

1807861

115.55 %

78.52 %

Religare

437555

51.97 %

89.59 %

Reliance General

82134

106.54 %

75.76 %

Star Health

3089558

61.76 %

79.34 %

 Disclaimer: Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

Bajaj Allianz Health Insurance Company Limited 

Among all the private health insurance companies, Bajaj Allianz offers the highest ICR Incurred Claim Ratio of 77.61%. Along with the high Claim Settlement Ratio, this health insurance company (CSR), maintains a record of having the quickest cashless claim settlement of one hour and by settling many other claims. There is an in-house claim settlement department along with a 24*7 call assistance facility, which makes it quite feasible for the insured to contact the company in case of an emergency and to process the claim. The company is fully committed to providing the best service for processing a claim which is well within time and the fastest way to get the financial burden off one’s shoulders.

Features and Benefits:

  • Pre- and post-hospitalisation, ambulance charges and day-care procedures charges
  • Maternity expenses incurred during childbirth, abortion or other related issues, and vaccination for the new-born baby for 90 days
  • Organ donor benefit, bariatric surgery cover, convalescence benefit and daily cash benefit of Rs. 500
  • Hospitalisation expense cover for Ayurvedic or homeopathic treatment
  • Free health check-ups after every three years

Bharti Axa General Insurance Company Limited

Bharti AXA General Insurance offers health insurance with an extensive sum insured, which can go up to Rs 1 crore. It has a 24*7 committed claim settlement team that settles the claims swiftly and conveniently. It has an impressive rate of ICR of 98.50% through which it has garnered a lot of goodwill and customer trust.

Features and Benefits:

  • Anyone between the ages of 91 days old and 65 years old can purchase this policy
  • No claim discount during renewal
  • Critical illnesses covered
  • Recuperation benefit provided
  • Pre and post-hospitalisation coverage
  • Covers Ayush treatment
  • Incorporates domiciliary hospitalisation and day care

 

HDFC Ergo Health Insurance (Formerly known as Apollo Munich Health Insurance)

Apollo Munich health insurance, now popularly known as HDFC ERGO Health Insurance Company, boasts of getting claims worth Rs 5775 cores settled in one financial year with 10000 plus cashless hospitals all over India and with an 89% of its claims settlement ratio. It offers a sum insured from 3 – 50 lakhs, with the new restore benefit, multiplier benefit and discount at renewal. This policy also provides the Ayush cover and a 60 and 90 days of pre and post hospitalisation services. Maternity, critical illnesses are also covered under this policy. It further has the advantage of an attractive 62.47%, ICR which is good enough for the policyholders.

Features and Benefits:

  • Pre-hospitalisation of 30 days and post hospitalisation of 90 days included along with 140 days of day care procedures when in-patient hospitalisation is less than 24 hours
  • Domiciliary treatment and emergency ambulance cover, a good number of network hospitals, are some of its well-known benefits
  • Accrued and portability benefits
  • No Claim Bonus available, critical illness covered, and tax benefits can be availed.

HDFC Ergo General Insurance Company Limited

The company’s ICR is 52.58 %, which also flaunts to authorise a cashless claim in 22 minutes. The insurer has the potential to settles the claims well in time offering cashless services at 9000+ network hospitals countrywide, including indemnity and fixed benefit plans for the insured. It boasts of catering to 1 crore plus customers and providing a series of healthcare facilities.

HDFC Ergo offers various plans like an indemnity-based health plan, a top-up health insurance plan and a lump sum benefit plan. Some of the unique benefits such as no medical test till age 45, instalment benefit of the sum insured rebound and many more.

Features and Benefits: 

  • Cashless hospitalisation and sum insured rebound available
  • Tax benefits up to Rs. 75000
  • Instant claim settlement and fitness discount
  • Cashless home health care, instant policy issuance, no room rent restriction and long term policy discount available
  • 24*7 customer support

Iffco Tokio Health Insurance Company Limited

Iffco Tokio General Health Insurance company offers an Incurred Claim Ratio of 90.69%, which makes it one of the best health insurance in claim settlement companies in the country. With 5000 plus network hospitals, it normally provides its assistance in cashless hospitalisation. The best facility provided by this company is the unlimited family coverage with an in-house claim settlement department to cater to the needs of the insured.

Features and Benefits:

  • Coverage for hospitalisation expenses including in-patient expenses, pre and post-hospitalisation expenses etc.
  • Health check-up up to 1% of the sum insured in every 4 claim-free years
  • Cashless hospitalization facility at more than 5000 network hospitals
  • Coverage for alternative treatments, ambulance charges, critical illness benefit and many more

Max Bupa Health Insurance Company Limited

It is an amalgamation between Max India Limited and BUPA which is a UK based health service company. It claims to have settled more than 1140 crore value of settlements along with a cashless claim under 30 minutes. The current ICR is 88.06% which is quite impressive and is now a super bond in the field of health insurance claim settlement ratio companies for the last two years. It flaunts of cashless OPDs and paperless reimbursements involving no third-party agents instead of indulging indirect claims settlement procedure.

Features and Benefits:

  • Offers enhanced sum insured, covered hospitalization expenses, lifetime renewal benefit, the long-term policy period, pre and post hospitalization charges and day care
  • Domiciliary treatment, emergency ambulance cover, donor expenses, worldwide emergency coverage, restoration benefit are some of its well-known benefits
  • Medical check-up, critical illness expert opinion, voluntary co-payment, waiver of senior citizen mandatory co-payment and tax benefits are also provided under this plan
  • Free look period of 15 days in which a policyholder can cancel the plan by listing a valid reason after which the premium will be refunded
  • Additional discounts like a family discount, long term discount, no claims bonus, healthy rewards can be availed with this policy

National Insurance Company Limited 

It provides a high sum insured policy which indemnifies the expenses within 24 hours and manages 140 plus day care procedures in cashless and reimbursement during the policy period. It is one of the oldest insurance companies with over 2000 offices all over the country which are run by 15000 plus professionals. It is one of the most trusted brands and claims fast and convenient claim settlement procedures as well. The National Insurance is a pioneer in the field of health insurance framework with the Incurred Claim Ratio (ICR) of 115.55%.

Features and Benefits:

  • Policy coverage can be availed for the age between 3 months - 65 years
  • Covers both individual and family as per the requirement
  • Cashless facility and a lifelong renewal option
  • Tax benefits

Religare Health Insurance Company Limited

Religare Health Insurance maintains a decent ICR and CSR and is a renowned health insurance organisation. The standalone company provides access to cashless claims in over 5420 network hospitals and has a decent claim settlement procedure and record. They are swift in processing the claims and are quite reliable in their approach towards their customers. With over 700000 claims in one financial year, Religare has made a mark for itself in providing one of the most reliable health insurance services in the country.

Features and Benefits:

  • Individual & family floater cover
  • In-patient, pre, post-hospitalisation and day-care expense cover
  • Domiciliary hospitalization, ambulance cover, daily hospital allowance, organ donor cover, Ayurveda, homeopathy, sidha and Unani and second opinion is also covered
  • Tax benefit also provided

Reliance General Insurance Company Limited

With an ICR of 106.54 %, Reliance General Insurance is a big name in the health insurance business, that offers a wide range of health insurance. It is an association with 4000+ network hospitals and takes care of speedy claim settlements both cashless and reimbursements. 

Features and Benefits:

  • Add-on cover for Critical Illnesses, tax benefits and In-house settlement of claims
  • Domiciliary hospitalization cover
  • Pre-medical screening not required for people less than 45 years of age

Star Health Insurance Company Limited

Star Health offers customer-friendly and a hassle-free claim process, which makes sure all settlement is processed professionally well within the time. The insurer thrives on its courtesy, speed, convenience, attention and efficiency maintaining a high standard of customer service. It owns an in-house team for processing the claim settlement process properly, which reduces the burden of third party settlement to make it quickly. It holds one of the largest network hospitals that assist in cashless settlements with no hassle. The company has managed to settle more than 5 lac claims out of which 90% of the claims were settled within two hours. The ICR of Star Health is 61.76%.

Benefits and Features:

  • Coverage between 60-75 years
  • No medical screening
  • Pre-existing illness covered
  • Medical consultation covered
  • Enhanced sum insured up to Rs 25 lakhs
  • Lifelong renewals and discounts
  • Hospitalization coverage, emergency ambulance cover, day care procedures, hassle-free claim settlement, cashless hospitalization also provided
  • Tax benefits 

Mistakes to Avoid while Deciding a Health Insurance Company

Do not Rely 100% on the Employer’s Cover

Many people simply rely on the health insurance cover that is provided by the company they work for. But one should remember that this cover is over once the job is. Also, it is an individual cover not protecting the family and it could also be limited in many ways. It is always suggested to buy a comprehensive policy as per individual needs extending these insurance benefits to the family as well with a holistic policy rather than relying only on the employer’s insurance cover. 

Not Reading the Fine Print Carefully

Many of us avoid reading the long terms and conditions of any given policy or agreement and look for the I accept or I agree tab. This section carries crucial information that can be used later, details such as the category and room rent of a hospital, in case you need to be hospitalized, waiting period of any pre-existing disease, before and after hospitalisation charges etc. Otherwise, a subsequent refusal to settle your claim due to any of the above reasons may come as a rude shock. 

Premium is Not the Only Factor

A layman would not comprehend the importance of the many crucial factors based on which a health insurance company can be judged. Most people will just consider the amount of premium they have to pay and if it is within their financial capacity to make such payments. But one needs to realise, this is not the only factor to be considered. Also, a low premium means a low coverage and lack of benefits, which otherwise can be gained by investing a little more into a sound policy, which gives maximum benefits.

Not Disclosing Personal or Accurate Medical History

No matter how hard one tries, the medical department will surely find out the correct medical details of any person. It would be unwise and unhelpful to hide vital health-related details from the insurer while applying for a policy. If any false claim has been made and if revealed later, the insured may have to suffer from a rejection of claim whenever required.

Depending on the Basic cover

Other factors like ambulance charges, OPD charges and other costs such as critical and high-end medical expenses also need to be considered while purchasing a health plan. These along with the basic cover are required to gain the maximum benefits of insurance for the family or the individual. Consider the insurer that puts equal importance to them as well. 

Buying Medical Insurance Only for Tax Savings

Investing in a health insurance policy definitely provides tax relief and benefits under Section 80D of the Indian Income Tax Act. Although, it cannot be ignored but this should not be the only reason to apply for a Mediclaim policy. One must consider unforeseen diseases and medical emergencies that may cause a huge financial drain. An extensive health insurance coverage in this regard comes to your rescue without a doubt.

Investing More than Required

There are times when either the insured has surplus funds, or he/she is highly worried about the future medical needs and goes for the highest sum insured, and thus the highest premium and also applies for many additional riders with the policy. Doing this will also be a financial burden as he is occupied with a huge amount to be paid as a premium.

Not Comparing Multiple Plans/Providers Available in the Market 

There are several health insurance giants in the market, and one must very carefully scrutinize each one of them as per his individual and family needs to opt for the best policy. Many just follow the family rule or depend on hearsay but this is not recommended. A proper analysis and fact research on every available policy within one’s budget is a must.

Thinking that Insurance is Only for the Aged People 

It is not true that only old people are susceptible or vulnerable to illnesses and medical emergencies. We should all be well prepared to face any medical challenge and also protect ourselves and our families to deal with any medical emergency. Financially such emergencies can burden an individual along with their family, so it is strongly recommended to invest in a sound insurance health policy.

Frequently Asked Questions

  • Q1. How is the Incurred Claim Ratio published and updated?

    Ans. The IRDA – Insurance Regulatory and Development Authority of India published the report of the Incurred Claim Ratio of all the existing health insurance companies in the country at the end of each financial year which contains information about the total amount of claims processed against cumulative premiums earned by each company.

  • Q2.What are the types of claim settlements and are they both considered while calculating Claim Settlement Ratio?

    Ans. There are two types of Claim settlements regarding health insurance cashless claims and reimbursement claims. In case of cashless claims, if the insured visits any hospital in the network hospitals as given in the policy then he does not have to pay anything there, instead it is directly paid by the insurer. In case of reimbursement claims, if the insured goes to any other hospital that is outside of the network of hospitals provided in the policy list, in that case, the insured has to pay the medical expenses from his pocket, which are later reimbursed to him by the insurer.

    Yes, both kinds of claims are taken into consideration while calculating the claim settlement ratio.

  • Q3. What are the documents required for making a health insurance claim settlement?

    Ans. The documents required at the time of claiming a health insurance claim settlement are:

    • Initial and primary investigation reports
    • Medical bills along with the issued prescription by the medical practitioner
    • In case of accident or death of the insured then an FIR needs to be issued or in case of death a post-mortem report
    • Original receipts and bills
    • Discharge report duly stamped and signed
    • Valid photo ID proof and address proof of the insured
    • Doctor’s treatment report, and consultation prescriptions
    • Final discharge file
    • A claim form that is properly filled and other relevant documents regarding the case.
    • Doctor or surgeon report along with all the test reports 
    • Details of any operation that was performed along with the receipt and the bill of the surgeon.
  • Q4. What are the common reasons for which the claim settlement report can be rejected by the insurer?

    Ans. A claim can be rejected for the following reasons:

    • If the insured, makes a fraudulent claim
    • In case the claim is made on a specified exclusion mentioned in the policy
    • In case the policy stands expired
    • If the treatment is not mentioned in the terms and conditions in the list of the policy bought by the insured
    • In case a treatment is done for pre-existing disease and the policy is still under the time frame of the waiting period.
  • Q5. How many health insurance claims can an insured make in one year?

    Ans. The insured can make any number of claims provided the value of the total claims does not exceed the total sum insured as per the insurance policy.

  • Q6. How can the insured inform the health insurance company in case he is hospitalised?

    Ans. If the insured is hospitalised, he can inform the insurance company by sending an email or calling at their specified numbers. If there is any delay in the information, there could be a rejecting of the claim. So, the insured should surely inform the insurer the very first thing after being hospitalised.

  • Q7. How can I make a cashless claim only?

    Ans: An insured need to follow these steps to only make a cashless payment:

    • To get admitted in only one of the network hospitals as specified in the list of the policy
    • As soon as hospitalisation is done, he should intimate the insurance company about the details of his hospitalisation
    • The complete documentation process needs to be duly filled and diligently followed
    • The insured should fill the claim settlement form accurately providing all the necessary proof
    • If the above is approved by the insurer the bills pertaining to the insured’s illness and hospitalisation is well taken care of by the health insurance company and the insured does not have to pay anything
  • Q8. How much time does it normally take to process a claim?

    Ans. The time span varies from 7 days to a month. In case of a few pending cases, the waiting time could go up to 6 months depending on the proper filing of the claim process.

  • Q9. Why is the Claim Settlement Ratio important before purchasing any new health insurance policy?

    Ans. A claim is the main reason why a layman would pay a premium and buy a health insurance policy. If we compare a number of insurance health insurance companies, we can take CSR as an important parameter to judge the top company as it assures great value in products that are products, shows the efficiency of the company, thrives on the reliability and the goodwill of the insurer and also hints at the sound financial health of the company.

  • Q10. What are the basic things that one must avoid while buying a health insurance policy?

    Ans. Many young people feel they do not need any health insurance and they are living in the misconception that their jobs and businesses are enough to pay for their medical bills. Let us take a reality check here and remember that life is uncertain, and a pandemic, accident or any unwanted illness may show up any time. We need to be prepared to stay off the burden of financially tackling the same and invest in a sound health insurance policy to combat the treatment expenses. Thus, we need to be very particular about a few things while buying a good health insurance policy.

Written By: Paisawiki - Updated: 22 September 2020

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Best Dental Insurance Plans in India

Best Dental Insurance Plans in India

Best Dental Insurance Plans in India One of the scariest aspects of everyday life is going to see a dentist. A simple toothache can turn a happy day into a painful experience. And we can’t ignore the expenses associated that can’t assume to be...