Incurred Claim Ratio in Health Insurance

An incurred claim ratio of 50% to 100% is generally considered the most optimal claim settlement ratio and is a good indicator that the insurance company is providing a good product and taking efforts to educate its subscribers regarding claim processes. 

ICR in Health Insurance Company

Here is the list showing Incurred Claim Ratio of health insurance companies in India for the year 2020.

Source: https://economictimes.indiatimes.com/wealth/insure/health-insurance/latest-health-insurance-claim-settlement-ratio-of-companies-in-2021/articleshow/83230938.cms?from=mdr

Claim Ratio in Health Insurance signifies the financial health of a company. An insurance company showing the best claim ratio in health insurance means the company is doing well. Let us take a look at the incurred claim ratio value and what it denotes.

• Incurred Claim Ratio of Health Insurance Company Is More Than 100%

What if the  incurred claim ratio is above 100%? A ratio above 100% indicates that the insurance company is not in a good position. It means the insurer has spent a considerable amount settling claims versus the amount it collected in health insurance premiums.

Financially, these numbers are loss-making. This ICR bandwidth is not sustainable for the company. They will be facing losses and will start rejecting claims soon. These insurance companies will have to take drastic steps to recover from this situation.

• Incurred claim ratio of the health insurance company is less than 50%

If the ICR is less than 50%, it indicates that the insurance company favours its own business over claim settlement. The company is earning high benefits, but it is not favourable toward its policyholders. The claim settlement will amount to 0-50% of the total premiums received in a single year i.e. the company has received a lot more premium than the claims it has been paying out.

The health insurance claim process will likely be less transparent and the cost of the policy will be on the higher side. The chances of claim rejection will be high as the policy may have a lot of exceptions.

• Incurred claim ratio of the health insurance company is more than 50% and less than 100%

If the ICR is between 50 and 100%, it signifies that the insurance company is financially stable. The insurer can easily manage the insurance claim settlements using the total premiums received in the year. This is an ideal situation for the health insurance company and the policyholders.

The insurance policy will be affordable and the claim settlement process will be more transparent. The policy will have a good set of features and the exceptions will not be too stringent. The claim settlement process will be easy and the policyholders will be mostly happy.

The ideal range of the  incurred claim ratio is between 70% to 90%.

How to Calculate Incurred Claim Ratio in Health Insurance

Now, you may have understood the Incurred Claim Ratio meaning. So, let us learn how to calculate the Incurred Claim Ratio:

ICR = Net Claims Incurred / Net Earned Premium

Let us consider the following example to understand the formula better.

Consider that the insurance company you are planning to buy health insurance from has an  incurred claim ratio of 95%. The premium is ₹100. The 95% ICR means that the insurance company will use ₹95 for settling claims out of every ₹ 100 the company receives as a premium payment. Therefore, the profit of the company will be ₹5.

List of Health Insurance Plans available at Bajaj Markets with good Health Incurred Claim Ratio

Take a look at the various health insurance plans you can opt for:  

Things to Consider When Calculating Incurred Claim Ratio

Before buying a policy, you should consider a few other factors when calculating the ICR of a health insurance company. They are:

• Claim Settlement Time
  You should check the claim settlement time of the company you choose. Even if the insurer has a high ICR, it may take more than six months to process the claim. Such a scenario is not favourable.

• New Entrants
  Since  incurred claim ratio is a ratio, a low denominator will show a high quotient value. If a new insurance company in the market has collected a lower number of premiums in the initial years, it may indicate a comparatively higher ICR. There is nothing to be concerned about because they may have witnessed many claims in the initial years.

• Type of Insurance Products
  An insurance company will have different products like health insurance, life insurance, motor insurance, etc. The overall  incurred claim ratio will be an average of them. Hence, keep in mind that the ICR you see may be of the health insurance alone or the overall average.

Comparison of Private and Standalone Health Insurers Incurred Claims Ratio

Check out the comparison of the  incurred claim ratio for health insurers in India given below.

Source: https://economictimes.indiatimes.com/wealth/insure/health-insurance/latest-health-insurance-claim-settlement-ratio-of-companies-in-2021/articleshow/83230938.cms?from=mdr

Difference Between Incurred Claim Ratio and Claim Settlement Ratio

As discussed earlier, ICR is the ratio between the net claims incurred and net premiums collected. In contrast, Claim Settlement Ratio or CSR is the number of claims received, and the number of claims settled in a financial year. You can't use them interchangeably.

ICR has a broader scope compared to CSR. CSR is only concerned with the claim settlement. For example, if an insurance company has a claim settlement ratio of 90%, they have settled 90% of their claims in the year, while the remaining 10%, are either rejected or pending.

Choose health insurance wisely for yourself and your family members. An insurance provider with a good ICR will be trustworthy so that you can trust it for long-term investment.

Health Insurance Plans Available at Bajaj Markets