The Claim Settlement Ratio (CSR) is a critical metric that measures an insurance company's success in processing and settling health insurance claims. According to reports from Mint, CSR represents the percentage of claims an insurance company successfully settles out of total claims received in a financial year. For example, if an insurance company received 100 claims but settled only 82, its CSR would be 82%. A higher CSR indicates better claim processing efficiency and reliability.
New India Assurance leads the rankings with an average CSR of 98.91% from FY 2022-25, demonstrating exceptional claim settlement performance. As reported by Mint, Digit Health Insurance follows closely with 98.66%, while Bajaj General Insurance ranks third at 96.78%. HDFC ERGO and Acko Health Insurance tie at 96.71% and 96.50% respectively. SBI General Insurance rounds out the top seven with 96.14%, while Aditya Birla Health Insurance completes the list at 95.81%.
Policyholders can switch health insurers through the portability facility mandated by the Insurance Regulatory and Development Authority of India (Irdai). According to Mint reports, portability allows you to transfer your accrued waiting period credits to a new insurer, including the waiting period already served for pre-existing conditions. To initiate portability, apply to your new insurer at least 45 days before your renewal date and submit a portability form, existing policy details, and claim history. The new insurer will evaluate your application and may accept, reject, or offer modified terms, with the sum assured under the ported policy capped at your current coverage without attracting fresh waiting periods.
According to Mint reports, non-disclosure of pre-existing diseases is a major cause of claim rejections, as honest declaration of conditions like diabetes, hypertension, and high blood pressure is essential. Waiting periods that must be completed before coverage begins also result in denied claims. Treatments not covered under policy such as dental care, cosmetic surgery, and therapies require specific policy additions through riders. Policy lapse due to missed premiums makes claims invalid, while incorrect documentation and treatment at non-networked hospitals can lead to rejection.
