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  • Insurance Which companies are better at settling health claims?

    Which companies are better at settling health claims?

    Read on to know which are the insurers with the highest number of networked hospitals for cashless claim settlement.
    Nishant Patnaik Sep 16, 2024

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    Tata AIG, The New India Assurance and HDFC Ergo are the top three general insurers in terms of settling health claims, shows the draft red herring of Niva Bupa Health Insurance.

    Tata AIG achieved a 100% claim settlement ratio in FY 2024. This means that every claim filed with Tata AIG in FY 2024 was settled.

    Not so far behind was the New India Assurance with a claim settlement ratio of 99.90%.

    HDFC Ergo occupied the third spot with a claim settlement ratio of 97.94% in FY 2024.

    Claim Settlement Ratio is calculated by dividing the total number of claims settled during the year by total number of claims outstanding at start of the period plus claims reported during the year less claims outstanding at end of the period. The ratio provides insight into the efficiency of claim processing and customer satisfaction.

    Further, Aditya Birla Health and Bajaj Allainz  were the next two with claim settlement ratio of 95.61% and 95.12%, respectively in FY 2024.

    Among others in the top 11 list in terms of claim settlement ratio were Care Health, Niva Bupa, National Insurance, Manipal Cigna, ICICI Lombard and Star Health .

    Let us look at the table to know more:

    Insurers

    FY 2024

    Tata AIG

    100%

    The New India Assurance

    99.90%

    HDFC Ergo

    97.94%

    Aditya Birla 95.61%

    Bajaj Allianz

    95.12%

    Care Health

    92.61%

    Niva Bupa

    91.93%

    National Insurance

    90.22%

    Manipal Cigna

    88.54%

    ICICI Lombard

    86.58%

    Star Health

    86.49%

     

    Another key parameter that determines the performance of health insurers is tie up with network hospitals for facilitating cashless claim settlement.

    The data shows that Star Health led the pack with over 14,000 tie ups for cashless settlement.

    Three health insurers - Niva Bupa, Aditya Birla and Tata AIG shared the second spot with over 10,000 tie ups across the country.

    HDFC Ergo came in third with over 9900 tie ups for cashless facility in FY 2024.

    Let us look at the table to gain more insights:

    Insurers

    FY 2024

    Star Health

    14000+

    Niva Bupa

    10000+

    Aditya Birla

    10000+

    Tata AIG

    10000+

    HDFC Ergo

    9900+

    Manipal Cigna

    8500+

    Care Health

    7800+

    ICICI Lombard

    7500+

    Bajaj Allianz

    7000+

    The New India Assurance

    3600+

    National Insurance

    3200+

     

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    Need a clarification or more information on an issue?
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    4 Comments
    ARUN · 3 months ago `
    From my experience, it is not the Insurance Company , but, TPA which is critical in settling the claim. Medi Assist (TPA) is worst in its claim settlement.
    Medi Assist Health Insurance TPA Pvt. Ltd · 3 months ago
    Hi Arun,

    Sorry for any inconvenience you’ve experienced with us. It is our top priority to quickly resolve any trouble for our members.
    Send over the claim ID/MAID of the patient to us at info@mediassist.in.
    We'll forward this to the right team and get back to you soon.
    Thanks for your patience.

    Best,
    Team Medi Assist
    Reply
    Medi Assist Health Insurance TPA Pvt. Ltd · 3 months ago `
    Vinit Shah FACT Fintracking · 3 months ago `
    What is the method of arriving at the claim settlement ratio ? Even if a claim is partially settled, it would get accounted as settled claim ?
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