claim settlement ratio is the ratio of the claims settled by a health insurance company to the claims submitted to them during a particular time-period. If all the claims submitted to the company are not settled, it shows that they have rejected some claims

1. Reason I
Judge your insurance provider by knowing claim settlement
Main point of buying health
insurance is to know the
claim settlement ratio of
insurance companies
What is claim
settlement ratio?
 It is the ratio of the claims settled by a health
insurance company to the claims submitted to them
during a particular time-period
 If all the claims submitted to the company are not
settled, it shows that they have rejected some claims
Closer inspection of claims
denial puts the blame on the
insured
The claims do not
fulfill the conditions
under the insurance
contract
 An insurance contract contains certain conditions such as
exclusions, sub-limits on some ailments and waiting
periods
 Insurance companies include these conditions for keeping
their health insurance policies viable and for offering
policies at affordable premiums
 When there is a violation of any of the conditions, they
reject the claims
 If a hospital or the doctor who has provided the treatment
has charged exorbitantly, the claim may be rejected
 If facts have been misrepresented in the proposal form,
the policy itself may get cancelled
 If the patients and the hospital collude with each other
and submit fraudulent claims, insurance companies will
certainly reject the claims
The claimants have
misrepresented facts in
their proposal forms or
they have submitted
fraudulent claims
Reason II
Consider below
points while
buying health
insurance
In certain cases, insurance companies may deduct appropriate amounts
from the claims and make partial settlement
But it is wrong to link such denials of settlements and deductions to the
efficiency of the insurance company in settling claims
On the other hand, their ability to identify these wrongs and deny such
claims is an indicator of their efficiency in settling claims
1. Fill the proposal form yourself. Do not just sign the form and allow the agent to fill it later
2. Check if your declarations including those about your past and present health conditions are
correct
If you are buying health insurance for your family members or parents, get the right
information about their health declarations from them
3. Understand the terms and conditions of the policy you are planning to buy because
insurance companies reject many claims by quoting valid terms and conditions
4. Take professional assistance, if needed, for preparing and submitting your claim
5. Ensure to adhere to the submission timelines
By following the above suggestions,
you can improve your claim
settlement ratio significantly
For more information visit at www.bayzat.com
How can you measure the efficiency of
an insurance company in claim
settlement?
Reason II
Insurance
company
People believe this ratio can help in
gauging the providers’ service and
efficiency. However, this ratio in
isolation is not a meaningful indicator.