Claim Settlement Ratio
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Choosing an ideal health plan is a tedious task; however, choosing an ideal health insurance company is more hectic. With more than 20 health insurance companies claiming to offer the best services, selecting the best one for you and your family can be quite confusing. So, one of the significant criteria to consider when choosing an insurance company from which to purchase insurance is the claim settlement ratio.
This factor not only helps you to understand the company’s performance but will also smoothen the selection process. If the claims are not resolved, the entire point of purchasing insurance coverage is defeated. Thus, before zeroing down on your choice of one insurance company, you need to check the company’s claim settlement history.
In the section below, let us explore the ICICI Lombard Claim Settlement Ratio, and discuss its importance:
According to Claim statistics for FY 2022-23 and computed based on individual claims settled (paid) over total individual claims within 30 days, ICICI Lombard’s health insurance claim settlement ratio is 98.53%.
Let us get a better understanding of the ICICI Lombard Claim Settlement Ratio
There are two types of health insurance claims you can choose from
Cashless claims in health insurance is a mode of claim settlement where the policyholder does not have to pay cash for treatment and the settlement of the bills is taken care of directly between the hospital and the insurance company. ICICI Lombard’s cashless claim settlement helps in paying off the hospital bill instantly, upfront. Cashless claims are gaining popularity every day, and more and more people getting health insurance policies are availing of this feature for the comfort it offers.
| Financial Year 2021-22 | ||||||
| Age Analysis of Number of Claims Paid (%) | < 3 months | 3 months to 6 months | 6 months to <1 year | 1 year to <3 year | 3 years to <5 years | 5 years |
| Claims Settled | 97.07 | 1.69 | 0.59 | 0.37 | 0.12 | 0.17 |
Step 1: Find the network hospitals of ICICI Lombard Health Insurance and get admitted to only those hospitals that fall into the network of your insurer.
Step 2: Now, notify ICICI Lombard Health Insurance Company about the hospitalization. In case of pre-hospitalization inform the insurer about the hospitalization prior to getting admitted.
Step 3: The customer needs to fill out the pre-authorization form and submit it to the hospital. The pre-authorization form is then sent for approval to ICICI Lombard Health Insurance Company. Once the form is approved, the customer can avail the medical treatment.
Step 4: At the time of discharge fill in all the medical documents and pay for the services that are not covered under the policy.
Step 5: The hospital will send the hospital bills to ICICI Lombard Health Insurance Company. After review the company will pay the bill directly to the hospital.
ICICI Lombard has a simple, app-based claim process to make your experience hassle-free. You can contact the company for a claim, submit your documents, and check your claim status easily on their IL Take Care app.
Reimbursement Claims
In this type of claim, you can visit any hospital, not just those under your insurer’s cashless network. Here, you get your treatment done at the hospital, pay out of your pocket, and then apply for reimbursement for the expenses with your insurer. At the time of making the claim, the customer needs to submit all hospital bills, prescriptions, and medical documents. These will need to be approved by ICICI Lombard Health Insurance Company before the claim is processed, meaning that it can take slightly more time to get through.
Step 1: You need to call ICICI Lombard Health Insurance within two days of your admission date. Post the company’s call, they send you a link where you can upload the soft copies of all original documents (bills, reports, etc) and bank details of your desired bank account.
Step 2: Before uploading, you need to sign all the documents yourself.
Step 3: Upload the documents maximum within 30 days from the date of discharge or when you receive the link.
Step 4: You will receive the payment within 30 days from the receipt of the last necessary claim document.
ICICI Lombard Health Insurance provides a 15-day grace period for reimbursement claims. If the documents have not reached the company post this grace period due to an inadvertent delay, you can contact the company with the explanation for the same and resend/re-upload the documents.
The claim settlement ratio is one of the most useful parameters that showcases the number of claims settled by the company in a financial year. It is an important factor that helps you to evaluate how soon the company will settle your claims in the time of need. Before buying health insurance, one should always check the history of claims settled by that company.
Prospective buyers might use the claim settlement ratio to determine how well the insurance company honors their claims. It is recommended to check the claim settlement ratio of all the plans having the lowest premiums and highest benefits.
A higher health insurance claim settlement ratio indicates the company’s financial performance and its ability to pay off the claims made by its customers.
To cater to the different medical needs of an individual & their family, ICICI Lombard Health Insurance offers several Health Plans ranging from senior citizen plans to specialized plans for autistic children, to health insurance for cardiac patients, and many more.Take a look below to ICICI Lombard Health Insurance plans explore more:
Individual and Family Health Insurance
ICICI Lombard Health AdvantEdge plan is a comprehensive health insurance plan designed to cater to all your health care needs. A family health insuran...
Unique Features
Accident Health Insurance
ICICI Lombard Personal Protect Policy is a comprehensive health insurance policy that offers an array of benefits and extensions to safeguard the insu...
Unique Features
Senior Citizen Health Insurance
Golden Shield Plan by ICICI Lombard is designed especially for senior citizens and to cater to all their health care needs. With growing age, the huma...
Unique Features
Individual and Family Health Insurance
ICICI Lombard Arogya Sanjeevani is a versatile plan that pays for your medical bills in case of hospitalization. If you are looking for a health plan ...
Unique Features
Top Up and Super Top Up
ICICI Lombard Health Booster is a comprehensive super top-up health insurance plan designed to enhance your existing coverage. The policy acts as a s...
Unique Features
Individual and Family Health Insurance
ICICI Lombard MaxProtect health insurance plan is a multiple-benefit provider plan that comes with affordable premiums. It has two variants ie, Classi...
Unique Features
Individual and Family Health Insurance
Worried about your medical expenses? Boost your healthcare experience with the ICICI Lombard Health Shield 360 insurance policy. Healthcare is one of ...
Unique Features
Individual and Family Health Insurance
Customize your ICICI Lombard Complete Health Plan with 4 available variants ICICI Lombard Complete Health Insurance is a comprehensive health insuranc...
Unique Features
Group Health Insurance
ICICI Lombard Group insurance is a type of insurance plan that covers many people in the same proximity, for example, employee-employer, bank customer...
Unique Features
Know More About Health Insurance Companies
The higher the claim settlement ratio, the higher could be the chances of your claim approval. Whereas, a poor claim settlement ratio could mean the insurance company follows stringent criteria for claim approval.
The claim settlement ratio, also known as CSR, can be calculated by dividing the total number of claims settled by the insurance company by the total number of claims received by the insurance company. Lets take an example: the total number of claims received by ICICI Lombard in a year is 1,000, out of which 980 are settled. In this case, the claim settlement ratio of ICICI Lombard for this particular year would be: CSR=Total number of claims settled by ICICI Lombard / Total number of claims filed by the policyholders =980/1000 =98%
The loss of the breadwinner of the family causes severe emotional and financial turmoil. However, ICICI Lombard Insurance Plan can reduce your worries and burden. While there are so many things to consider when buying a life insurance policy, the claim settlement ratio of the insurance company should be one of the key factors amongst them.
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Naval Goel is the Founder and CEO of PolicyX.com (IRDA- Approved Insurance Comparison Website). He is a CFA charter holder (USA) and FRM (GARP). He holds an MBA from IIFT, Delhi, and is also an Associate from the Insurance Institute of India. Naval is an avid investor and entrepreneur who has a deep understanding of the Indian equity market and insurance sector. He has been investing for more than 10 years now and is a CFA charter holder.
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