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Updated on Jul 01, 2025 4 min read
Oriental Health Insurance Claim Settlement Ratio
The claim ratio, or claim settlement ratio, tells us about the percentage of claims the insurance company settles 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 of how reliable the health insurance company can be if 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 95.49%.
Why Is Claim Settlement Ratio Important?
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 the 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.
Types Of Oriental Health Insurance Claims
There are two types of health insurance claims you can choose from
Cashless Claim
Reimbursement Claim
Cashless Claims
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. Oriental Health Insurance’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.
Oriental Health Insurance Cashless Claim Procedure
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 of 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.
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 Oriental Health Insurance Company before the claim is processed, meaning that it can take slightly more time to get through.
Oriental Health Insurance Reimbursement Claim Procedure
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 a reimbursement claim form from the insurer or download it from the Oriental Insurance Company website.
Step 3: Provide the required details while filling out 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 made in the policyholder’s bank account
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Oriental Health Insurance Claim Settlement Ratio: FAQs
1. What percentage of CSR is considered the best to buy a plan from a company?
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.
2. What is the formula to calculate Oriental Claim Settlement Ratio?
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
=89/100
=89%
Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.
CSR of the company 
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