How well has a health insured made the claim? The latest Iradai claim ratio of general, health insurance companies in India

The Indian (IRDAI) of the Insurance Regulatory and Development Authority recently published its annual report, which highlights the payment data of the claims of general and health insurance companies in the 2022-23 financial year. From the previous year, the regulator has begun to share only the claims (ICR) of the general and health insured, in its annual report instead of the rights settlement ratio, as in the previous year.

 

Health Insurance: To understand the difference between claim settlement ratio and the claim ratio organized

As a policyholder, it is important not to confuse these two terms. The claim settlement ratio insurance company shows the percentage of the number of claims to settle in a specific period. For example, 92% of the claim settlement ratio’s 92% of the properties are successfully removed in 92 aspected time, for each 100 claims filed.

However, the proportion of claims, however, refers to the percentage of the total claim paid in comparison to the total premium collected during the same period. For example, the claim ratio of 909% is in premium of Rs. 1, the insurance company spent Rs.

A gaze of IRDAI data on the claim ratio of insurance companies in 2024

Analyzing the IRDAI data on the claim rate of insurance companies in 223-6 in 223-8 shows a significant insight on how the insurer’s claims are handled. The ratio of the claiming claim provides a solution to the insured, especially in health insurance, how it manages its claims. The ratio of extremely low cost claims can indicate that the company is conservative in removal of claims. However.

According to the data regulatory data, net claims from general and health insurance holders reached Rs 76,160 crore in 2023-24 and approximately 18% increase in the previous year. Health insurance sector claims (ICR also decreased from 88.89% to 2022-23 to 88.15% in 2023-24.Read | Planning to buy health insurance? That terms you need to knowDuring the period of 223-4, about 83% of the total claims recorded by the insured have been dismissed and 5% of them have been denied and the remaining% March 1 was pending for settlement on March 1, 224.

During the period of 223-4, general and health insured have withdrawn 1.69 CRORE CRORE CRORE ACCOUNT COMMITTIONS AND RESPONSE Rs. The average amount per claim was Rs 31,086.

In terms of the number of claims, 72% claims were removed by TPA and 28% of the balance was removed by the home system, according to IRDAI data. In terms of the pattern of the claims of the claims, the total claims were removed by 39% by 66.16% of cashless mode and reimbursement mode. Insurance holders have resolved 1% of their claim through both cashless and replicas methods. In the case of cashless claims of the amount, 66.17% was removed by cashless mode, shared by the regulator.

The latest claims of general, health insurance companies in India

Health includes a personal accident.
NA indicates that the insurer’s business was not functioning in the corresponding financial year or in the respective department.
Re -classifying/reassuring in the previous year statistics, if anything, it was not considered by the insured.
# Financial Year 224-25 started business operations.
Source: Iradai Annual Report 2023-24

Purchase of Health Insurance? Understand the claim ratio

The balance should be increased in the Claim ratio (ICR) – not too much or very low. Extremely high ICR, such as 110%, indicates that the insurance company is paying more money than the premium received in the premium, which can indicate the company’s potential financial difficulties.

According to Rakesh Goyal, director of the Probus Insurance Broker, the ICR is considered reasonable between 80% to 100%, which indicates the balance between the premium and claims compiled. ICR less than 60% can indicate conservative underraining, while the ratio of less than 100% usually indicates profit.
50% or less ICR may be the sign that the insured operational is not beneficial, which pays Rs 50 per 100 rupees of premium, says Sebi-registered RIA Abhishek Kumar. “The proportion of claims (ICR) vote for the operational profit of the insurance company, and therefore it is useful metric to see when comparing policies. It shows how much money the insured is paying for each rupee collected as a premium. Either refusing its claim.

“The ideal ICR depends on many factors, but, in general, reflects efficient claim management and durable business methods, however, the extremely low proportion may suggest reluctance to erase insufficient coverage or legal claims,” ​​said Goyal.