Health Insurance Claim Settlement Ratio

The claim settlement ratio (CSR) is a crucial metric that reflects how reliable and responsive an insurance company is when handling customer claims. Specifically, it shows the percentage of claims successfully settled compared to the total number of claims received by the insurer.

A high health insurance claim settlement ratio indicates that the insurer is more likely to honour your claim quickly and fairly, reducing stress during emergencies. It helps you assess how smoothly your health insurance claim might be processed if the need arises.

On Bajaj Markets, you can choose from insurance companies with some of the best settlement ratios in health insurance, going up to 99.41%.

Important Update (Dated May 30, 2024) – Good news for Health Insurance policyholders! According to the Master Circular on Health Insurance Business 29052024 rolled out on May 29, 2024 by IRDAI, insurers are now required to:

• Approve or reject cashless claim authorisation within 1 hour in emergency situations
  

• Provide final authorisation within 3 hours of receiving a hospital discharge request, ensuring no delay in the policyholder’s discharge
  

• Assume responsibility for any additional hospital charges arising from delays exceeding 3 hours, funded from insurer capital, not the insured

Insurers had until July 31, 2024 to implement these processes successfully. 

The Master Circular on Health Insurance Business 29052024 circular is available here - https://irdai.gov.in/document-detail?documentId=4942918

When choosing a policy, one of the most important indicators to evaluate is the insurer’s claim settlement ratio. This figure reflects how many claims the company successfully honours, helping you identify reliable providers.

For example, if a health insurance company receives 100 claims in a year and settles 98 of them, its CSR would be 98%. A higher ratio like this suggests a better chance of your claim being approved during a medical emergency.

The Insurance Regulatory and Development Authority of India (IRDAI) publishes this data annually for all registered insurers. You can also find it listed on the official websites of insurance companies.

To make a more informed decision, it’s also worth learning what is the incurred claim ratio, which shows how much the insurer spends on claim payouts relative to the premiums collected. Understanding both ratios gives you better insight into an insurer’s financial responsibility and service reliability.

Before buying a medical policy, compare the claim settlement ratios of your shortlisted insurers. The table below highlights key details for some of the top insurance providers offering health plans on Bajaj Markets.

Here is the updated table with monthly premiums:

Disclaimer: The information is subject to change as per updates from insurance companies.

Before buying a medical policy, it's essential to review its inclusions, exclusions, waiting periods, and policy conditions. A strong CSR gives you confidence that your claim is likely to be honoured when you need it most. 

This ratio:

• Acts as a benchmark for comparing health insurance providers
  

• Reflects the insurer’s ability and willingness to settle valid health insurance claims
  

• Indicates how consistently insurers process claims on time

IRDAI typically reports CSR based on claims settled within 3 months of intimation. Below are the latest figures from the IRDAI report for FY 2023–24, published in 2025:

Public Sector Insurers (CSR – Within 3 Months)