HDFC ERGO Claim Settlement Ratio

With the availability of numerous health insurance companies, selecting an appropriate and suitable health insurance plan has become quite a difficult task. Many times, you end up selecting an insurance plan that fails to meet your entire coverage requirements due to the lack of your awareness about health insurance. Thus, to make an informed selection while purchasing health insurance, one needs to have a thorough knowledge of various aspects.

The claim settlement ratio of the insurance company is one such aspect. In India, every health insurance company has a claim settlement ratio. Claim settlement is one of the important factors to be considered while selecting a health insurance company as it tells you about the claim settling ability of the insurance company. If the company is not able to settle claims in the given time period, then the whole purpose of purchasing insurance goes to vain.

In the article below, we will be discussing the HDFC ERGO Claim settlement ratio. Take a look below to explore the claim settlement ratio of HDFC ERGO health insurance and its claim settling process:

Health Insurance Claim Settlement Ratio

What is Claim Settlement Ratio?

Claim Settlement Ratio or CSR, is the number of claims settled against the total number of filed claims during a financial year. Let's understand how CSR is determined:

For example, ABC health company has a total of 100 registered claims during a financial year, and it settled only 90 claims out of them, then the health claim settlement ratio of that health company will be 90% for that particular year.

How Does CSR Beneficial to Policyholders?

Well, before buying any new product, we check its reliability and the brand's status. The same goes while buying a health insurance plan. By checking the claim settlement ratio of the company, one can get an insight into how the company is performing when it comes to claiming settlement.

Moreover, it will also give you an insight into the company's claim settlement ability. The higher the percentage, the better the company's ability to settle claims. Hence, this factor makes a company more trustworthy amongst its customers.

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HDFC ERGO Health Insurance Claim Settlement Ratio

As per IRDAI, HDFC ERGO Health Claim Ratio is 98.49%. Take a look at the below given table that will let you get an insight into the ability of HDFC ERGO Health Claim Settlement.

What is the Incurred Claim Ratio?

The Incurred Claim Ratio or ICR is the ratio of a health insurance company's net claims paid out to the total premium collected. For example, if an insurance company receives INR 10 crore in premium and pays out INR 8 crores in claims, the company's ICR would be 80%.

The greater the ICR, the better the insurance company's financial health. It means that the insurer is effectively resolving the majority of claims, which is something that every policyholder looks forward to while purchasing an insurance policy.

Claim Settlement Process of HDFC Ergo Health Insurance

There is two ways to file a claim. Let's take a look at them one by one:

Cashless Claim Settlement Process

• You avail of the cashless facility only at the network hospitals of HDFC ERGO where you are not required to pay any cash for your treatment.
• After reaching the insurance desk of the hospital, register with the HDFC Ergo Reach and show your health card issued by HDFC ERGO that includes health-related information.
• Download the pre-authorization form from the company's website. Fill in the details and submit the form. The hospital will share the details with HDFC ERGO.
• After the final enhancement of the claim request, the insurance company will then scrutinize all the documents and convey their judgment.
• On successful verification and acceptance of the claim, the insured can enjoy a cashless treatment facility.

Reimbursement Claim Settlement Process

• Reimbursement procedure includes paying the expenses incurred during the hospitalization procedures and getting the bill amount reimbursed from the insurer.
• For this, you have to file a claim, download the application form for claim processing, fill and attach all the required documents (listed in the claims form).
• Submit the form with the documents to your respective insurance company's branch.
• Once your claim is processed, the reimbursement amount is transferred directly to your registered bank account.

Check HDFC ergo general insurance Health Insurance Policy Claim Status

You can check the status of your claim through both online and offline mediums.

Procedure for Online

• Go to the HDFC ERGO general insurance official website and click on the claim tab.
• To get your claim status, enter the essential details asked by the portal.
• You will receive an OTP on your registered mobile number and email ID.
• Verify yourself using the OTP and click on 'Go'.
• After this step, you will be able to see the status of your claim.

Procedure for Offline

You call the customer care executive at +91 120 6234 6234 to enquire about the status of your claim.

You can also visit the nearest branch of HDFC ergo general insurance company to know the status of your claim.