Why did 11 of 15 private health insurers pay under 75% of claimed amounts?
Fresh data from FY22–23 reveals that most private health insurers settled less than 75% of the amount claimed by policyholders. In contrast, PSU insurers displayed far stronger ratios, settling both a higher number of claims and a greater share of amounts claimed.
- 11 of 15 private insurers paid below 75% of claim amounts.
- PSU insurers like New India & Oriental led with ratios above 90%.
- Standalone health insurers showed mixed results, from 54% to 71% ratios.
Claim Settlement Performance (2022–23)
| Insurer | % Claims Settled | % Claim Amount Paid |
|---|---|---|
| PSU Insurers | ||
| New India | 95.04% | 98.74% |
| Oriental Insurance | 87.97% | 97.35% |
| National Insurance | 84.61% | 97.85% |
| United India | 84.28% | 73.03% |
| Private Sector Insurers | ||
| IFFCO Tokio | 91.70% | 80.44% |
| Bajaj Allianz | 90.29% | 75.96% |
| SBI General | 88.86% | 80.53% |
| Go Digit | 88.52% | 76.79% |
| HDFC ERGO | 86.90% | 71.35% |
| Future Generali | 83.34% | 74.32% |
| ICICI Lombard | 77.10% | 71.52% |
| Tata AIG | 75.56% | 74.65% |
| Chola MS | 72.51% | 73.18% |
| Reliance General | 58.06% | 71.07% |
| Standalone Health Insurers | ||
| Aditya Birla Health | 94.52% | 71.56% |
| Niva Bupa | 91.84% | 67.10% |
| Manipal Cigna | 88.48% | 56.14% |
| Care Health | 88.20% | 57.82% |
| Star Health | 75.10% | 54.61% |
The wide spread—from 98% in PSU insurers to nearly 55% in some standalone players—shows why customers should focus on past claim performance when buying policies, not just premium pricing.
- Claim amount ratio trends over 3 years
- % of claims settled directly vs via TPA
- Cashless hospital coverage in your city
- Exclusions, sub-limits, and co-pays
SEBI Disclaimer: The information provided in this post is for informational purposes only and should not be construed as investment advice. Readers must perform their own due diligence and consult a registered investment advisor before making any investment decisions. The views expressed are general in nature and may not suit individual investment objectives or financial situations.
Written by Indian-Share-Tips.com, which is a SEBI Registered Advisory Services
Tags: health insurance, claim settlement ratio, claim amount ratio, PSU insurers, private insurers, personal finance, insurance tips
