Picking the right health insurance can feel overwhelming, but a quick check of four key numbers can save you from surprise rejections and poor service.
1. Claim Settlement Ratio (CSR) – 4‑year average
The CSR shows the share of claims an insurer approves. Look for a four‑year average above 95%. This signals clear policies and a smooth claim process.
2. Incurred Claims Ratio (ICR) – 4‑year average
ICR tells you how much of the premium collected is paid out as claims. An ICR between 60% and 100% indicates a healthy balance—enough payout to be fair, but not so high that the company risks solvency.
3. Complaints per 10,000 policies – 3‑year average
Fewer complaints mean happier customers. Aim for insurers with fewer than 20 complaints per 10,000 policies. High numbers often point to confusing terms or slow claim handling.
4. Network Hospital Coverage – 4‑year average
More network hospitals mean easier cash‑less treatment. A good benchmark is at least 10,000 hospitals in the network, roughly 13 per district across India.
How to Use the Framework
- First, filter insurers that meet the CSR, ICR, complaint and network benchmarks.
- Next, match the policy features (coverage limits, pre‑existing disease coverage, family add‑ons) to your personal needs.
- Finally, compare premiums only after you have a shortlist of financially sound insurers.
Bottom Line
Focusing on price alone can leave you exposed when you need help most. By checking claim settlement ratios, payout ratios, complaint levels, and hospital networks, you pick a plan that is both reliable and convenient.
Remember, this is just a guide, not a guarantee. Talk to a qualified advisor before finalising any health insurance purchase.