Having covered some of the health insurance claim ratios for Apollo Munich and Star Health insurance in 2014-15, here is IRDA claim settlement ratio of heath insurance in 2014-15 for some of the top companies.
Claim Settlement ratio of Max Bupa in 2014-15- 79.7%
Claims Rejected- 12.56%
Total claims settled- 88,584
Claim Settlement Ratio of Religare Health Insurance in 2014-15-87.23%
Claims rejected- 7.5%
Total claims settled-81,545
Claim Settlement Ratio of Royal Sundaram Health Insurance in 2014-15-87.93%
Claims rejected- 8.5%
Total claims settled-21,764
Claim Settlement Ratio of Cigna TTK Health Insurance in 2014-15-77.12%
Claims rejected- 19.4%
Total claims settled-711
Claim Settlement Ratio of Bajaj Allianz Health Insurance in 2014-15- 83.4%
Claims rejected- 18.8%
Total claims settled-1,43,516
Claim Settlement Ratio of ICICI Lombard Health Insurance in 2014-15- 95.2%
Claims rejected- 2.3%
Total claims settled-21,37,983
Claim Settlement Ratio of Oriental Health Insurance in 2014-15- 94.7%
Claims rejected- 0.1%
Total claims settled-6,92,720
Update- For latest 2015-16 IRDA data( till March31,2016) and premiums/features of health insurance companies, you must check our comparison tool
Claim Ratio Apollo Munich Health Insurance
Here is the IRDA Claim Ratio of Apollo Munich Health Insurance in 2014-15.
Total Claims Processed in 2014-15 – 133160
Total Claims Settled in 2014-15- 120,000
Apollo Munich remains one of the largest and best health insurers in the country.We’d definitely recommend Apollo Munich Health Insurance for your family floater policies.
You can see the summary of the 2015-16 IRDA data for Apollo Munich( till March 31,2016) using our health insurance comparison tool.
Star Health Insurance is one of the most popular health insurance brands in the country. Although it offers great variety of health insurance products, its claim settlement ratios for 2014-15 are not very impressive. Here is a brief summary:
Total Claims Processed-93833 ( Shows that it is one of the popular health insurance in the country)
Total claims Settled- 70328
IRDA Claim Settlement Ratio for 2014-15 ( till March 31, 2015)- 74.91%
Compared to other health insurance companies like Apollo Munich or Religare Health, this number is certainly lower. One should always prefer to be with an health insurer that is consistently settling above 85% of the claims.
so one should not only compare premiums but also compare data based performance of these health insurance companies.
Update- For latest 2015-16 IRDA data of insurers till March 31,2016, please get a quote below.
Here is some data on the claim settlement ratio of health insurance companies in India to get their health insurance rejection ratio in last quarter – Q4, 2013. I will be updating this with more insurer data.
Claim Settlement Ratio for Health Insurance Companies
|INSURER||Claims Reported||Rejected||Rejected Claims|
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The best health insurance policy for you is the one that meets your medical needs. In this article, we will see which factors you should consider before buying a health insurance policy.
With the increasing medical costs due to rising cost of medicines and procedures,living without a health insurance might be the biggest risk in your life. Many people are covered for their health costs by their employer but the cover is usually not sufficient to cover medical emergencies.
As medical insurance is relatively complex products with lots of “fine print”, it becomes very confusing for consumers to select the right term insurance plan. I have tried to capture some of the things that will help you buy the best health insurance plan, especially family floaters..
1. Do not go by price alone
Health insurance is not a simple product like term insurance where one can do a simple price comparison and decide to go ahead. As health insurance products come in various shapes and sizes, choosing the best health insurance plan for your needs is important. So if you decide to pick a health insurance purely on the basis of price, you might end up comparing apples to oranges. Just be aware of this problem!
2. Keep it simple.
Do not go for policies that are difficult to understand and have too many features or “ifs and buts”. Your basic objective to buy a health insurance is to cover large unexpected medical emergencies. No need to bother about regular medical bills.
3. Look for maximum entry age and renewal age
While government owned insurance companies like Oriental or United India Insurance allow a maximum entry age of 70-80 years, most private health insurance companies stop at 65.
4. Check maximum sum insured
Carefully look at maximum sum insured. Religare Health insures up to Rs.60 lakhs while companies like Apollo Munich and Star health provide highest sum assured (up to Rs.15 lakhs). Most of them insure up to Rs.10 lakhs.
5. Pre and Post Hospitalization expenses
Most companies cover 30 days of pre hospitalization expenses. Apollo Munich covers up to 60 days of pre hospitalization and 180 days of post hospitalization period.
6. Pre existing disease coverage
Most companies will cover existing illness after 4 years. Not much choice here!
7. Medical Checkup Requirement
It is always recommended that you get a medical checkup done so as to identify and declare any existing illnesses. Most companies make medical checkup mandatory for people with 45+ years of age. Oriental insurance looks to be most lenient as it required medical examination above 60 years.
8. Waiting period for claiming expenses
Many companies keep an initial waiting period before you can claim any expenses. Most companies have a 30 day waiting period ( Apollo Munich, Star health etc.) whereas Max Bupa has a 90 day waiting period! Government companies( Oriental etc.) have zero waiting period.
9. Examine expense Limits
Many insurers have sub limits on the medical expenses. For example Oriental insurance will restrict room rent to 1% of sum assured. Then some have limits on ambulance expenses, ICU expenses or some ask for a 20% payment contribution from your side. At the same time there are insurers like Apollo Munich, Reliance, Religare and ICICI Lombard( Complete Health Insurance) that work with no co payments or sub limits.
10. Study major exclusions
Most of the times, consumers are confused by the major exclusions in the policy. Sometimes it feels like exclusions are larger than what is included in the policy! Many insurers offer cheaper policies with tons of exclusions. Be careful about such policies as they are not going to give you the benefit you need at the time of hospitalization.
11. Know claim settlement ratio
Since claim settlement ratio can be a tricky metric to judge health insurance, it is nevertheless important not to pick insurers with below average claim settlement ratio. Oriental insurance scores with 90%+
12. Additional Benefits
Companies like Apollo Munich or Religare provide nice additional benefits like “no claim” or auto recharge / Restore benefit that can help you cover increased cost of medical expenses. Some also give day care treatments as well as maternity benefits. Carefully study these extras before taking the final call.
In subsequent posts, I will try to review some of health insurance products in the market which provide value for money.
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