The claim ratio, or claim settlement ratio, tells us about the percentage of claims that are settled by the insurance company out of the total number of claims raised. The higher the claim ratio of an insurance company, the better the chances of your claim being settled. This ratio gives you an idea as to how reliable the health insurance company can be in case you need to make a claim.
Every year the Insurance Regulatory and Development Authority (IRDAI) releases all life insurers' claim settlement ratios. The Oriental health claim ratio is 90.18%.
In the following sections we will discuss the types of claims Oriental Health Insurance Company offers.
When buying an insurance policy, you need to check various aspects before deciding which insurance company is right for you. You have to find out about the various policies and covers offered by the insurance company. You need to know how their customers review them in terms of services and customer relationship management. However, many people ignore the need to check the claim settlement ratio, which is a huge mistake. Here are two reasons why checking claim settlement ratio is important:
1. Measure the insurer’s reliability
Buying a policy is a big investment plan. You have to pay a good number of premiums over a long duration to avail of the benefits offered by the policy. So, if your claim is rejected for some reason in the future then that can seriously hurt your financial planning. The settlement ratio is a very reliable measurement indication that helps you know if a certain insurer is trustworthy or not. A favorable ratio indicates that the insurer is right for you.
2. Gives assurance about your dependent’s financial future
Checking the claim settlement ratio is important to ensure the financial security of your family. The last thing any family can endure after suddenly losing a family member is the rejection of an insurance claim. It is your job as a policyholder to make sure that your family does not have to go through that trouble. With the help of the settlement ratio, you can make the right decision when buying a policy.
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 policy holder 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. Oriental Health Insurance 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 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|
If you are undergoing treatment at a network hospital, then you can avail cashless claims. The steps to file cashless claims are given below:
Step 1: Find a network hospital in the city where you can avail the medical treatment.
Step 2: Then you must inform the Oriental Insurance Company in case of an emergency and before hospital admission for planned hospitalization.
Step 3: Show your cashless health card and a photo ID proof at the network hospital.
Step 4: Get the pre-authorization form from the hospital, fill it and submit it to the hospital authority.
Step 5: Then, the hospital cross-checks the customer's identity and then sends a pre-authorization form to Oriental Health Insurance Company /Insurer’s TPA.
Step 6: The insurer or the third-party administrator checks and approves the coverage. If the health insurance claim is approved, the medical expenses will be taken care of by Oriental Health Insurance Company.
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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 a 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 Oriental Health Insurance Company before the claim is processed, meaning that it can take slightly more time to get through.
Reimbursement claims can be filed in both network and non-network hospitals. You can follow the reimbursement claim process as given below:
Step 1: On getting admitted to any network or non-network hospital, intimate Oriental Insurance Company about the hospitalization as soon as possible.
Step 2: The customer can get reimbursement claim form from the insurer or download it from Oriental Insurance Company website.
Step 3: Provide the required details while filling the form.
Step 4: On getting discharged, pay the hospital bills and collect all original bills, documents, and reports.
Step 5: Sign all documents and send them to the Oriental Health Insurance Company along with the claim form. If all the information is correct, Oriental Health Insurance Company will settle the claim as per the policy terms and conditions.The payment will be done in the policyholders bank account
A claim settlement ratio of more than 85% is a good sign, making the insurer trustworthy. But insurance companies having a high CSR of more than 90-95% is a better option.
Claim Settlement Ratio or CSR can be calculated by taking the total number of insurance claims settled by the insurer and dividing it by the total number of insurance claims received by the insurer.
Let’s consider the claims settled by the company are 89 and the claims filed by policyholders are 100 in a year,then the CSR of that insurance company will be:
CSR=Total no. of insurance claims settled successfully / Total no. of insurance claims filed by the policyholders
Oriental Health Insurance offers a wide range of health insurance plans to fulfill the medical needs of individuals, families, and senior citizens.
A comprehensive policy that is designed to secure the healthcare needs of a family. The plan comes in 4 variants and the SI goes up to 20 lacs.
A one year policy covering medical expenses following hospitalization, domiciliary and otherwise.The plan offers coverage up to 10 Lakhs.
The policy focuses on securing the health of PNB account holders/employees and their families. The SI goes up to 10 lacs and covers 116 day care procedures.
A medical expenses covering policy for the account holders of Oriental Bank of Commerce (OBC) and covers individuals and family. The SI is up to 10 lacs.
The policy offers Daily Cash Benefit during hospitalization. It also provides a 25% extra daily cash benefit for female policyholders at no additional premium.
Arogya Sanjeevani is a standard health insurance plan that covers hospitalization expenses and comes with a sum insured of Rs 20 Lacs.
It provides health insurance coverage to the financially constrained sections of society at very nominal premiums ranging between Rs. 50 to 70.
The policy safeguards the Indian emigrant workers who intend to emigrate or have done so. The policy provides a Sum Insured of 10 lacs.
Oriental Super Top-up policy is an add-on policy that is designed to provide coverage to the insured and his family in case their base coverage is exhausted.
Designed to offer health insurance coverage to senior citizens aged 60 years and above and comes out with a compulsory co-payment of 20%.
Coverage for medical expenses of various ailments to the policyholders residing outside of India for study and employment.
Specially designed to offer coverage on detection of Dengue Fever without any sub-limit/ co-payment. The plan comes with a coverage of up to Rs. 20,000.
A combination of travel and health insurance that contains health benefits and offers coverage against loss during travel abroad.
The plan is designed to cover the policyholder who is diagnosed with any of the 22 specified critical illnesses.
Available on both an individual and family floater basis, it protects the policyholder from the expenses incurred due to COVID-19 treatment.
Group Mediclaim Policy covers a target group, association, institution, or corporate batch of 50 families or 50 persons or more.
A group health insurance product for the Bancassurance partners of the company. Prosper can include family and the Sum Insured goes up to 25 lacs.
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Read what our customers have to say about Oriental Health Insurance Company
June 9, 2022
I purchased an insurance plan from oriental insurance and I am happy to be a part of this organization.
October 19, 2021
happy with the claim settling speed....they responded within no time and were super efficient during the whole process
October 18, 2021
good service...in fact super quick repsponse time of the customer support team...they have knowledge and are effective
October 8, 2021
i raised my claims and they covered most of my surgery expenses ...they truly want to help which is the greatest thing about them
September 8, 2021
Man I was pleasantly surprised with the customer agent I spoke to at Oriental...so detailed and thoruough about every query I had...going to get a health plan super soon!
September 8, 2021
all the death benefits that were promised to us were delivered. my husband s deathn has not been easy but the quick support from Oriental was really helpful
September 8, 2021
I was very very doubtful about insurance in general becaus lots of frauds happening around. however, Oriental has been the most supportive throughout my father s death and gave us the benefits...
September 8, 2021
guys i would 1000% recommend this insurer... when I first bought it, its support staff was great. and wehne it came to settling my recent medical bills, they stuck to their words
Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.