Public sector giant New India Assurance has emerged as the top performer in health insurance claims settlement for the financial year ending March 31, 2023, according to the General Insurance Claim Insights 2023-2024 report by the Insurance Brokers Association of India (IBAI). The insurer achieved a remarkable claims paid ratio of 95.04% in terms of the number of claims and 98.74% in terms of the claim amount, cementing its reputation as a trusted player in the health insurance space. Over the year, the company processed an impressive 90.56 lakh health insurance claims.
Key Rankings in Health Insurance Claims Settlement
1. Aditya Birla Health Insurance
- Claims Paid Ratio (Number of Claims): 94.52% for 8.60 lakh claims.
- Claims Paid Ratio (Amount of Claims): 71.56%, significantly lower than its high volume of claims settled.
2. Bajaj Allianz General Insurance
- Claims Paid Ratio (Number of Claims): 90.29% for 9.56 lakh claims.
3. Oriental Insurance
- Claims Paid Ratio (Amount of Claims): 97.35%, placing it second in this category.
- Claims Paid Ratio (Number of Claims): 87.97%, reflecting its solid performance among public sector insurers.
4. Star Health and Allied Insurance
- Claims Paid Ratio (Number of Claims): 75.10% for 19.55 lakh claims.
- Claims Paid Ratio (Amount of Claims): 54.61%, highlighting a lower performance in monetary terms despite processing a high volume of claims.
Expert Opinions: Beyond Claims Ratios
While the claims settlement ratio is a key indicator of an insurer’s efficiency, industry experts urge consumers to consider additional factors before purchasing health insurance policies.
- Narendra Kumar Bharindwal, Director and Vice-President of IBAI, highlighted a crucial trend: “Insurance companies tend to process smaller claims quickly to boost their settlement ratios, often delaying larger claims. This can skew rankings, making it essential to evaluate performance across both volume and amount metrics.”
- Nisha Sanghavi, Director of Promore Fintech, emphasized a broader perspective when evaluating health insurance products:
“Consumers should assess policy features like pre- and post-hospitalization coverage, no-claim bonuses, exclusions, incurred claims ratios, financial stability, and solvency ratios. Having an advisor or agent is also invaluable for navigating the claims process effectively.”
Implications for Policyholders
The report underscores the importance of understanding an insurer’s claims paid ratio, both in terms of the number and amount of claims settled, as these metrics reflect the efficiency and reliability of the provider. For example, while New India Assurance leads in both categories, Star Health’s significant disparity between its claims count and amount ratios points to potential delays in high-value claim settlements.
Conclusion
The IBAI report offers critical insights for both consumers and industry stakeholders, emphasizing the need for a balanced evaluation of health insurance providers. As the health insurance market grows, policyholders must look beyond settlement ratios and focus on product features, financial stability, and advisory support to make informed decisions.
