Visakhapatnam: Public sector insurer New India Assurance had the highest health insurance claims paid ratio of 95.04% in terms of the number of claims, and 98.74% in terms of the amount of claims, for the year ending March 31, 2023, according to the General Insurance Claim Insights 2023-2024 report by the Insurance Brokers Association of India (IBAI). New India Assurance processed a total of 90.56 lakh health insurance claims.
Following New India Assurance, Aditya Birla Health paid 94.52% of the 8.60 lakh claims it received. However, in terms of the amount of claims settled, its ranking fell to 71.56%, a significant drop compared to its claims count.
In third place for the number of claims was Bajaj Allianz General, with a claims settlement ratio of 90.29% for 9.56 lakh claims. Oriental Insurance, a state-owned insurer, ranked second in terms of the amount of claims paid, with a ratio of 97.35%, and had a relatively strong claims paid ratio of 87.97% in terms of the number of claims.
In contrast, Star Health and Allied Insurance scored lower, with a claims paid ratio of 75.10% in terms of the number of claims, and 54.61% in the amount of claims settled. Star Health processed 19.55 lakh claims during the year.
A higher claims paid ratio indicates better performance for an insurer. The claims paid ratio based on the number of claims refers to the percentage of claims paid out from the total number of claims available for processing during the year.
Narendra Kumar Bharindwal, Director and Vice-President of IBAI, explained: “We noticed that insurance companies tend to pay claims of smaller amounts quickly to boost their claim settlement ratio. However, they often delay payments for larger amounts, which can cause their ranking to look impressive in the number of claims settled but much lower when it comes to the actual amount paid.”
Nisha Sanghavi, Director of Promore Fintech, added, “When purchasing a health insurance policy, people should not only focus on the claims settlement ratio but also consider product features like pre- and post-hospitalization coverage, no-claim bonuses, and what is or isn’t covered. It's also important to review the insurer’s incurred claims ratio, financial stability, and solvency ratio. Additionally, in health insurance, having an advisor or agent can be crucial for assisting with claim servicing.”
