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Health insurance claim settlement refers to an insurance process whereby an insured requests the insurance provider for availing medical benefits listed in the health plan. Such benefits are in the form of cashless treatment or reimbursement for treatment undertaken.

Health insurance Claim Settlement Ratio (CSR) indicates the ratio of claims which have been settled against the overall claims put forth during a given financial year. CSR is a reliable technique for measuring an insurance provider’s standing for the settlement of claims.

What is the Health CSR?

  • The ratio of claims accepted as valid by the insurance provider and settled to the overall claims made by the policyholders for a financial year.
  • CSR between 80% - 90% is good, anything above 90% is considered excellent. 

What is Health CSR Formula?

Health CSR = (Total claims settled) / (Total claims filed + outstanding claims at the beginning of the financial year)

Why is Health CSR Important?

  • One of the key factors to be considered before choosing a health insurance policy
  • CSR helps in comparing and buying the right health insurance policy
  • Helps consumers in evaluating the claim settlement ability of the health insurance company
  • Higher CSR for a company means more claims are accepted as valid
  • Instils confidence in the buyer for the policy taken and the coverage provided to meet their health needs
  • Good CSR shows the reliable and efficient working of the insurance provider 

Points to Remember: 

The Insurance Regulatory and Development Authority of India (IRDAI) is the main regulatory body that calculates CSR for all the registered insurance providers on an annual basis.

IRDAI publishes CSR on its website. You can also check the CSR on the website of each insurer.

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