GIPSA, PPN and Empanelment in Health Insurance - Explained
GIPSA, PPN in GIPSA, Points to remember before opting GIPSA services, hospitals, empanelment
October 5, 2022
Table of contents
An insurance claim settlement ratio is the ratio between the number of claims settled to the number of claims made in a financial year by an insurance company. Life insurers and health insurers have separate claim settlement ratio. Buyers, including HRs and founders prefer an insurance company with higher claim settlement ration.
The Claim Settlement Ratio (CSR) is calculated as follows
Claim settlement ratio = Number of claims settled/Number of claims made*100
For example, let us assume an insurance company has a CSR of 80%. This means that for every 100 claims received by the insurance company, 80 claims are settled and 20 claims are not. Unsettled claims are the claims that are in process.
The higher the percentage of CSR, the better the insurer. This applies to both health insurance and term insurance policies. Moreover, a claim settlement ratio is one of the authentic factors to look for regarding an insurance company to understand how efficiently claims are processed.
Every year, the IRDAI (Insurance Regulatory and Development Authority of India) publishes a report which mentions the claim settlement details of all the 24 life insurance companies and 30 health insurance companies in India. The report includes all the details regarding the number of claims made by customers, the number of claims that were settled by the insurers, and the number of claims that were rejected during the financial year of an insurance company.
Claim Settlement Ratio in an insurance company is an important factor to consider when choosing health insurance or a life insurance plan. It tells about the claim settling ability of your insurance provider. If your insurer is unable to settle the claims, then the purpose behind buying insurance goes useless. Hence, the CSR of an insurance company shows its reliability, which helps the customers in deciding the insurance company for policy purchase.
There should be consistency in the claim settlement ratio of an insurance company. Hence, while choosing an insurance company for an insurance plan, check for the claim ratio of the past 5 years. Choose the plan if the company has been consistent in settling claims throughout. This shows the capability of the insurance company to settle the claims.
While checking the claim ratio, we get to know the number of claims received by the insurer in a financial year. This gives us an estimate of how big and old the insurance company is.
Here is the IRDA claim settlement ratio (2019-20) of health insurance companies in India
Claim settlement ratio of public sector general insurers
Claim settlement ratio of large private sector general insurers
Claim settlement ratio of small private sector general insurers
Claim settlement ratio of standalone health insurers
In life insurers, LIC has the highest claim settlement ration of 98% and in health insurance IFFCO Tokio General Insurance has 96%.