Selecting the right health insurance provider can be a complicated process. With various policy features, premium rates, and hospital networks to consider, it’s easy to overlook one of the most crucial indicators of an insurer’s reliability—the claim settlement ratio. If you’re evaluating Aditya Birla Health Insurance, understanding its claim settlement ratio can offer insights into how efficiently the company handles and processes claims. After all, the last thing anyone wants during a medical emergency is delays, excessive paperwork, or uncertainty. A high claim settlement ratio reflects the insurer’s ability to provide timely and hassle-free support when it matters most. But what exactly does the claim settlement ratio of Aditya Birla Health Insurance signify, and why should it influence your decision? Let’s explore its relevance and what it tells us about the company’s commitment to its policyholders.
Insurance shouldn’t be confusing. That’s why we’re here. If you’re unable to understand how the claim settlement ratio affects you or need help choosing the perfect policy for all your needs, speak to a Ditto advisor and find the ideal plan for you. Book a call now!
Best Health Insurance Plans in India 2025
| Plan Name | Restoration | Renewal Bonus | Network Hospitals | CSR | ICR |
|---|---|---|---|---|---|
| HDFC ERGO Optima Secure | 100% of base SI, once/year (addon: unlimited) | 50% pa, up to 100% (irrespective of claims) | 13k+ | 98% | 86% |
| Care Supreme | Up to base SI, unlimited times | 50% pa, up to 100% (addon: up to 500% irrespective of claims) | 11.4k+ | 90% | 59% |
| Aditya Birla Activ One Max | 100% of base SI, unlimited times | 100% pa, up to 500% (irrespective of claims) | 12k+ | 95% | 68% |
| Niva Bupa Aspire Titanium+ | Unlimited restoration after the first claim | Booster+: Carry forward unused cover up to 10x | 10k+ | 91% | 58% |
| ICICI Elevate | Unlimited restoration of base cover | 20% pa upto 100% Addon: Up to unlimited renewal bonus | 10.2k+ | 85% | 83% |
What is the Claim Settlement Ratio in Health Insurance?
The Claim Settlement Ratio (CSR) in health insurance refers to the percentage of claims an insurer successfully settles in a given financial year. For instance, a CSR of 93% means the company paid out 930 out of every 1000 claims it received. This figure provides potential policyholders a sense of the insurer’s reliability and efficiency.
The numbers regarding the claim settlement ratio of Aditya Birla Health Insurance are pretty promising. According to industry data, the claim ratio of Aditya Birla Health Insurance was 95 on average, indicating a strong commitment to settling claims in a timely and fair manner.
Why is the Claim Settlement Ratio Important?
A high claim settlement ratio is a positive indicator—it suggests that the insurer is consistent and dependable when honoring claims. During medical emergencies, quick and smooth claim approvals can make a difference.
Policyholders can expect a relatively smooth claim process with the Aditya Birla Claim Settlement Ratio at 95%. It reflects the brand’s dedication to customer satisfaction and financial responsibility.
However, CSR alone shouldn't be the only deciding factor. A policy might come with a high CSR but also have downsides like limited network hospitals, exclusions, or higher premiums. That’s why it’s equally important to look at additional aspects such as:
- Coverage and inclusions
- Hospital network size
- Claim settlement turnaround time
- Customer service reviews & complaints volume
- Pre/post-hospitalization coverage and wellness benefits
How is the Claim Settlement Ratio Calculated?
The basic formula for calculating the claim settlement ratio is:
Claim Settlement Ratio = (Number of Claims Settled ÷ Number of Claims Received) × 100
An ideal CSR is generally above 80%. Here’s a quick breakdown:
- Above 95%: Highly reliable
- 90% – 95%: Dependable
- 80% – 90%: Average; proceed with caution and research further
- Below 80%: Consider avoiding due to low reliability
As for insurers with CSRs above 100%, they could be dealing with spillover claims from previous years, which may indicate delays in settlement. Those with a CSR below 80% may reject too many claims or have an inefficient claim process.
Aditya Birla Health Insurance Claim Settlement Ratio
Here’s a list of the top 10 health insurance companies based on their claim settlement ratio (CSR):
| Health Insurance Companies | CSR 2021-2022% | CSR 2022- 2023% | CSR 2023-2024% | Average of 2021-2024% |
|---|---|---|---|---|
| Aditya Birla | 94 | 96 | 96 | 95 |
| Bajaj Allianz | 91 | 97 | 96 | 95 |
| Care Health | 87 | 90 | 93 | 90 |
| HDFC ERGO | 100 | 95 | 97 | 98 |
| ICICI Lombard | 86 | 85 | 85 | 85 |
| IFFCO Tokio | 96 | 95 | 93 | 95 |
| Max Bupa (Niva Bupa) | 91 | 91 | 92 | 91 |
| SBI General | 97 | 94 | 98 | 97 |
| Star Health | 82 | 80 | 86 | 83 |
| Zurich Kotak | 91 | 93 | 89 | 91 |
The claim settlement ratio of Aditya Birla Health Insurance has generally been around 95% on average in recent years. Let’s look at past CSR trends to get a better understanding:
| YEAR | CSR% | Industry Average% |
|---|---|---|
| 2019 - 2020 | 79 | 89 |
| 2020 - 2021 | 89 | 88 |
| 2021 - 2022 | 94 | 86 |
| 2022 - 2023 | 96 | 91 |
| 2023 - 2024 | 96 | 92 |
| AVG (2021- 2024) | 95 | 90 |
Data sourced from IRDAI Reports: The Claim Settlement Ratio (CSR) mentioned in this article is based on public disclosures on the insurer’s website, IRDAI reports, and statistics handbook. The figures are subject to change periodically based on updated insurance company reports.
Of course, it's important to remember that the claim settlement ratio alone doesn’t provide the complete picture. While it’s a strong indicator of reliability, choosing the right health insurance policy also involves evaluating other critical factors like policy features, customer service quality, and network hospitals. That said, Aditya Birla Health Insurance has consistently maintained a strong CSR, placing it among the more dependable private insurers in the market. Whether you're considering past performance or recent trends, the claim settlement ratio of Aditya Birla Health Insurance reflects its steady commitment to resolving claims efficiently and supporting its policyholders when they need it most.
How Does Aditya Birla Health Insurance Ensure a Smooth Claim Settlement Process?
Aditya Birla Health Insurance aims to make the claim settlement process straightforward and stress-free, whether you opt for a cashless or reimbursement claim. With a blend of digital convenience and customer support, the process is designed to minimize hassles during medical emergencies.
Here’s how you can file a claim online:
Step 1: Go to their website
(https://www.adityabirlacapital.com/healthinsurance/homepage)
Step 2: Navigate to the Claims section by clicking “Claims” in the main menu.
Step 3: Select Cashless Hospitalization or Reimbursement Claim based on your situation.
Step 4: Log in using your mobile number.
Step 5: Submit the required details. Choose a network hospital for cashless claims and present your Health ID card at admission. For reimbursement claims, download and fill out the claim form, attach relevant documents (hospital bills, discharge summary, etc.), and submit them online or via email.
Step 6: Once submitted, you can track the status of your claim through the “Track Claim” option on the website by entering your claim number or policy details.
If you face any issues, Aditya Birla’s customer care team is just a call away. They provide step-by-step assistance throughout the process to ensure a seamless experience.
Note: If you have taken the policy through Ditto, use this link or call 080-48816818 for prompt claims assistance around the clock.
Claim Process of Aditya Birla Health Insurance
Whether planning or dealing with a sudden medical emergency, Aditya Birla Health Insurance has built a streamlined claim process to help you focus on recovery rather than paperwork.
Here’s how you can file a claim through the app:
- Download the App: The Activ Health App by Aditya Birla is available on both Android and iOS platforms.
- Sign In/Register: Log in with your registered mobile number or policy details.
- Initiate a Claim: Head to the Claims section and follow the prompts to begin.
- Upload Documents: Submit necessary files like consultation papers, hospital bills, diagnosis reports, and discharge summaries.
- Track in Real Time: Keep an eye on the status of your claim through the app’s tracking feature.
Cashless Claim Process:
Cashless claims are accepted at over 12,000+ network hospitals across India.
- Pre-Authorization:
- For planned hospitalization, notify the insurer 48–72 hours in advance.
- For emergency admission, inform them within 24 hours.
- At the Hospital: Present your Aditya Birla Health ID card and a valid photo ID at the hospital’s insurance desk.
- Form Submission: The hospital fills and sends a cashless pre-authorization request to Aditya Birla.
- Approval: The insurer evaluates the request and shares approval (or additional queries) with the hospital.
- Treatment & Discharge: After treatment, the final bill is settled directly between the insurer and the hospital.
Result: You walk out without the burden of arranging funds or dealing with billing headaches.
- Reimbursement Claim Process:
You can still recover your expenses if you’ve been treated at a non-network hospital.
- Pay the Bills: Settle all hospital charges at the time of discharge.
- Gather & Submit Documents: Post-treatment, submit all required documents, including hospital bills and receipts, prescriptions and diagnostic reports, discharge summary, filled claim form, canceled cheque for bank details, etc.
- Claim Verification: The insurer reviews the documents and may contact if anything is missing.
- Reimbursement: Once approved, the claim amount is credited to your bank account.
Whether you choose the cashless route or go for reimbursement, Aditya Birla Health Insurance ensures the process is efficient, transparent, and policyholder-friendly—just the way it should be.
How Long Does it Typically Take for Aditya Birla Health Insurance to Settle a Claim?
Aditya Birla Health Insurance is committed to providing timely claim settlements, ensuring policyholders receive support when they need it most. Here's an overview of their claim settlement timelines
Cashless Claims:
For planned hospitalizations, inform Aditya Birla Health Insurance at least 3 days before admission. In case of emergencies, notify them within 48 hours of hospitalization. Once the pre-authorization is approved, the insurer settles the hospital bills directly, facilitating a seamless discharge process.
Reimbursement Claims: Policyholders must submit all required documents within 30 days post-discharge. After receiving the necessary documents, Aditya Birla Health Insurance reviews and processes the claim as per the policy terms and conditions.
Documents Required for Aditya Birla Health Insurance Claims
For cashless claims at network hospitals, ensure the following documents are available:
- Health Insurance ID Card or Policy Number: Present your Aditya Birla Health Insurance ID card or provide your policy number at the hospital's insurance desk.
- Valid Photo Identification: Submit a government-issued photo ID, such as a PAN card, passport, or voter ID, to verify your identity
- Pre-Authorization Request Form: Obtain and complete the pre-authorization request form from the hospital's insurance desk. This form is then submitted to Aditya Birla Health Insurance for approval.
- Hospitalization Details: Provide information regarding the diagnosis and the proposed treatment plan.
Note: It's advisable to submit the pre-authorization request at least 2-3 days before a planned hospitalization. In emergencies, inform the insurer within 24 hours of admission
- Reimbursement Claims:
If treatment is received at a non-network hospital, the following documents are necessary for reimbursement claims:
- Duly Filled Claim Form: Complete and sign the claim form provided by Aditya Birla Health Insurance.
- Hospital Discharge Summary: Obtain the original discharge summary detailing the treatment and hospitalization period.
- Final Hospital Bill with Breakup: Submit the original final bill from the hospital, including a detailed cost breakup.
- Payment Receipts: Provide original receipts for all payments made towards the hospital bills.
- Investigation Reports: Include copies of all diagnostic reports, such as X-rays, MRIs, CT scans, and laboratory test results.
- Prescriptions and Pharmacy Bills: Attach prescriptions and corresponding pharmacy bills for medications prescribed during hospitalization.
- Canceled Cheque or Bank Passbook Copy: Provide a canceled cheque or a copy of your bank passbook to facilitate direct credit of the claim amount.
Note: All original documents should be submitted within 30 days post-discharge to the nearest branch or the address specified by Aditya Birla Health Insurance.
Factors Affecting the Aditya Birla Health Insurance Claim Settlement Ratio
Any insurer's Claim Settlement Ratio (CSR), including that of Aditya Birla Health Insurance, is influenced by a combination of operational, policy-related, and customer-driven factors. While Aditya Birla has maintained a strong CSR, understanding what affects this number can help you make more informed choices.
Type of Policyholders and Claims Filed
Aditya Birla caters to a wide range of policyholders—individuals, families, and corporations. A higher number of complex or high-value claims, such as for critical illnesses, can impact the CSR if they require deeper scrutiny or documentation.
- Completeness of Documentation
A significant reason for delays or rejections in claim processing is incomplete or incorrect documentation. If policyholders fail to submit necessary records like hospital bills, discharge summaries, prescriptions, etc., it can lead to claim denials, affecting the overall CSR.
- Network vs Non-Network Hospital Usage
Aditya Birla offers cashless claims across 12,000+ network hospitals. Claims made outside this network (i.e., reimbursement claims) tend to involve longer verification timelines, impacting both settlement speed and the approval rate.
- Timely Intimation and Claim Filing
Delayed notification of hospitalization or late submission of documents—especially in emergency or reimbursement cases—can cause processing issues or outright rejections. Aditya Birla emphasizes pre-authorization (for planned admissions) and intimation within 24 hours (for emergencies).
- Policy Terms and Coverage Limits
Every policy has specific inclusions, exclusions, and sub-limits. Claims that fall outside the scope of the policy, such as non-covered treatments or breaches of waiting periods, are likely to be rejected, thus affecting the CSR.
- Fraud Detection and Underwriting
Aditya Birla Health Insurance maintains robust fraud prevention mechanisms. Claims flagged for potential fraud or misrepresentation (e.g., fake bills or incorrect disclosures) undergo additional checks, influencing the final claim settlement numbers.
- Turnaround Time & Operational Efficiency
The internal efficiency of claim processing teams, especially for a high-volume insurer like Aditya Birla, directly impacts the CSR. The faster and more accurately claims are handled, the higher the ratio.
These factors determine how efficiently and transparently an insurer handles claims. A streamlined process boosts customer trust and contributes to a higher Claim Settlement Ratio (CSR).
Why Choose Aditya Birla for Health Insurance
Choosing the right health insurance provider isn’t just about picking the cheapest premium—it’s about choosing a company that supports you when you need it the most. Aditya Birla Health Insurance stands out for its comprehensive health plans, customer-centric approach, digital convenience, and added wellness benefits. Here's why it's worth considering:
High Claim Settlement Ratio (CSR)
With an average CSR of 95%, Aditya Birla demonstrates a strong track record of settling claims efficiently. This means your chances of getting your claim approved—on time—are reassuringly high.
Widespread Hospital Network
The company has 12,000+ network hospitals across India, ensuring easy access to cashless hospitalization, even during emergencies. That’s one less thing to worry about during stressful times.
Comprehensive Plans for Every Need
Whether you’re looking for individual coverage, family floater plans, critical illness protection, or super top-up options, Aditya Birla has something for everyone. Plans like Activ One come packed with features like mental wellness coverage and even coverage for alternative treatments (AYUSH).
Wellness and Reward Programs
One of the standout features is its HealthReturns™ program, which rewards you for staying fit. By tracking fitness activities through their app and wearable integrations, you can earn back a portion of your premium—something few insurers offer.
User-Friendly Digital Experience
Their mobile app and website make policy management, claim filing, and wellness tracking a breeze. From cashless claim intimation to real-time tracking, everything is at your fingertips.
Quick Claim Assistance
Need help during a medical emergency? The company offers 24/7 claim support and a structured claim process that ensures minimal delays—whether it’s a cashless claim or reimbursement.
If you're looking for a health insurance provider that combines high claim reliability, smart wellness benefits, and tech-savvy service, Aditya Birla Health Insurance checks all the boxes. It’s more than just a policy—it’s a partner in your health journey.
Why Your Aditya Birla Health Insurance Claim May Get Rejected
What happens when your Aditya Birla Health Insurance claim gets rejected? It's frustrating—and in most cases, avoidable. Understanding the common reasons for rejections and how to avoid them can save you a lot of stress later. Let’s break it down.
- Incomplete or Incorrect Documentation
Submitting the wrong documents—or missing some altogether—is one of the most common reasons claims are rejected. Whether it's a missing discharge summary or incorrect billing format, even minor errors can delay or derail your claim.
- Pre-existing Illness Not Disclosed
If you didn’t mention a pre-existing condition (like diabetes, asthma, or hypertension) while buying the policy, and the treatment is linked to it, your claim might get rejected.
- Waiting Period Clauses
Most policies have waiting periods for specific diseases or procedures—like hernia, cataracts, or knee replacements. If you raise a claim during this period, it's likely to be declined.
- Non-Disclosure of Hospitalization
Aditya Birla requires you to inform them within 24 hours of an emergency hospitalization or at least 48 hours before a planned admission (for cashless claims). Missing this step may affect your claim approval.
- Treatment at a Non-Network Hospital (for Cashless Claims)
If you’re aiming for a cashless claim, the hospital must be on Aditya Birla's network hospital list. Getting treated at a non-network hospital without informing them will push you into a reimbursement claim—and potentially increase rejection risk if paperwork isn’t perfect.
- Claim Exceeds Sum Insured
Your policy has a coverage cap. If your hospital bill crosses that, the extra amount won’t be covered—and may be misunderstood as a partial or rejected claim.
Tips to Avoid Claim Rejections
Don’t Exceed Your Insured Sum Without Knowing the Consequences: The insurer won't cover the excess if your bill exceeds your policy limit. Understand your insured sum and explore super top-up options if needed. Try to stay in rooms that fall under your budget as the other medical costs, such as consultation fees, consumables, etc, are also directly proportional to room rents.
Keep All Medical Documents Handy: Missing or incorrect documentation is a common reason for rejection. You submit accurate medical reports, prescriptions, bills, and discharge summaries.
Stick to Network Hospitals for Cashless Claims: Using a non-network hospital can complicate or delay the claim. Always check if the hospital is on Aditya Birla’s approved network list to enjoy a seamless cashless experience.
Inform the Insurer on Time: Timely intimation is key. For planned hospitalization, inform Aditya Birla at least 48 hours in advance. For emergencies, update them within 24 hours of admission.
Understand Your Policy Inside Out: Take time to read your policy documents. Knowing the waiting periods, exclusions, and sub-limits can help avoid surprises during the claim process.
Always Disclose Pre-existing Conditions Honestly: Don’t try to hide or downplay any medical condition during the application process. Nondisclosure or misinformation can lead to claim rejection later, especially if your treatment is linked to an undisclosed illness.
Claim rejections aren’t always the insurer’s fault. Many times, they happen due to avoidable missteps. You can breeze through the claim process with Aditya Birla Health Insurance by staying informed, acting promptly, and maintaining transparency. A little preparation today can go a long way in ensuring peace of mind tomorrow.
How to Track Your Aditya Birla Health Insurance Claim Status
Once you’ve submitted a claim with Aditya Birla Health Insurance, you’ll want clarity on the status—” Has it been approved?” “Are any documents pending?” Thankfully, Aditya Birla makes tracking your health insurance claim easy, giving you real-time updates and keeping the stress of uncertainty at bay.
- The official Aditya Birla Health Insurance website is the easiest way to track your claim. Simply visit https://www.adityabirlacapital.com/healthinsurance/homepage and hover over the “Claims” section on the main menu. From the dropdown, click on “Track Claim.” You’ll be directed to a dedicated page where you can enter your claim or policy number along with your registered mobile number or email ID. Once you hit submit, you can view your claim status instantly.
- Another convenient method is the Activ Health App, which is available on Android and iOS platforms. After logging in with your registered mobile number or email, navigate to the “Claims” section within the app dashboard. From there, you can view all updates regarding your claim—whether it's in process, approved, or requires additional documentation. The app also makes it easy to stay on top of any notifications or pending steps needed from your side.
- If you prefer speaking to someone directly, Aditya Birla’s customer care is just a call away. Dial their toll-free number, 1800-270-7000, and keep your policy and claim reference numbers handy. Their representatives can walk you through the latest updates and even help you resolve any issues.
In a time when medical needs already bring enough anxiety, Aditya Birla Health Insurance offers multiple user-friendly ways to stay updated on your claim status. Whether you’re a tech-savvy app user, a website browser, or someone who prefers to speak directly to customer support, your peace of mind is just a few steps—or clicks—away.
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Conclusion
The Aditya Birla Health Claim Settlement Ratio has averaged around 95% recently, highlighting the company’s commitment to hassle-free claim processing and policyholder satisfaction. While CSR is crucial when selecting an insurer, assessing the overall offering—like hospital network, premium affordability, and wellness benefits- is vital. Aditya Birla Health Insurance is dependable, especially for those seeking prompt financial support during medical emergencies.
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