Aditya Birla Health Insurance Claim Settlement Ratio

Over the years, the demand for health insurance products has increased exponentially. This growth can be attributed to increased financial awareness, medical inflation, and the sudden onset of the global pandemic. However, health insurance plans have evolved over the years. Health insurance plans have come a long way from being mere “mediclaims” to becoming customisable policies. The credits for such tailored financial tools go to some new players in the health insurance industry who have crafted customised plans to cater to the evolving financial requirements.

One such insurer is Aditya Birla Health Insurance, which has built quite a reputation in the market for crafting tailored products (for senior citizens, the youth, and more). While the health insurance plans from this brand are pretty comprehensive and affordable, we want to know if the insurer’s credibility matches its market reputation. To ensure this, the first metric we must consider is the Aditya Birla Health Insurance Claim Settlement Ratio - its data, significance, insight, claim settlement process, and more.

What is the Claim Settlement Ratio?

The Claim Settlement Ratio (CSR) of a health insurer is calculated by -

(Total number of claims settled by an insurer in a year/ Total number of claims received by the insurer for the year) * 100

The ideal CSR of a health insurer is 90 and above. However, if the CSR exceeds 100, you are looking at an insurer that practices delayed claim settlement. Such delay in claim settlement is best avoided, considering that health insurance plans are crafted to safeguard your savings during times of health scare. A delayed settlement is a redundant hassle that defies the purpose of availing of a health insurance plan.

Now, let’s take a look at the Aditya Birla Health Insurance Settlement Ratio data track record!

What is the Aditya Birla Health Insurance Settlement Ratio for 2024?

(If you seek the Aditya Birla Health Insurance Claim Settlement Ratio for 2024, refer to Aditya Birla Health's data for 2022-2023. However, relying on a single year may not be adequate, as it's important to thoroughly assess the insurer's performance consistency. Therefore, we have compiled data from the past 3 years, calculated their average, and compared it with the industry average.)

Overview of Aditya Birla Health Insurance

What is the significance of Aditya Birla Health Insurance Claim Settlement Ratio 2024?

Considering the growing popularity of the health insurance plans from Aditya Birla Health Insurance Company, you must have an in-depth insight into the Claim Settlement track record and analyse its significance -

1. Consistency: The Aditya Birla Health Insurance Claim Settlement Ratio track record reflects its consistency. The numbers have been consistently improving over the last 3 years - what started in the late 80s has now reached close to some of the industry’s best (high 90s). This consistency and improvement is a great sign for its existing and potential policyholders.
2. Overall Performance: The consistency across the board for the Aditya Birla Health Insurance Claim Settlement Ratio on an average over the last 3 years and year-on-year is a sign of how the insurer has been working towards improvement to cater to the evolving customer requirements.

Why is the Claim Settlement Ratio important?

Claim Settlement Ratio or CSR of a health insurance provider is the first step towards measuring its credibility. This metric gives you an idea about the insurer’s claim settlement track record and history. However, CSR fails to indicate the time required to settle claims or the amount settled (against the claim amount filed). Thus, CSR remains just one metric to measure the credibility of an insurer. To get an in-depth idea, you must also look into the brand’s complaint volume and Incurred Claim Ratio (ICR) before purchasing a health insurance plan from an insurer.

What is the Claim Settlement Process for Aditya Birla Health Insurance?

• CASHLESS

STEP 1: Contact Aditya Birla Health Insurance 48 hours before the hospitalisation (planned treatment) or within 24 hours of hospitalisation (emergency hospitalisation) via the hospital insurance desk.

STEP 2: Submit the required documents (as mentioned below).

STEP 3: The hospital will request the insurer for their pre-authorisation approval.

STEP 4: The insurer approves the treatment, and you can go ahead with a cashless mode of claim settlement, which will be covered by your insurer when you are discharged.

(Please note that if your cashless request is denied, you can still proceed with the treatment. You will need to pay the bill from your pocket initially and can later file for a reimbursement claim settlement. The process for this is mentioned below.)

• REIMBURSEMENT

STEP 1: You can register your claim online by visiting the official site of Aditya Birla Health Insurance

STEP 2: Complete the claim form and submit it with the required documents (as listed below) online or at the nearest branch.

STEP 3: After cross-verification of your documents and the hospital desk, the insurer will disburse your claim amount to your bank account.

• CASHLESS ANYWHERE

STEP 1: Register on the official site of Aditya Birla Health Insurance and raise your claim by filling in the details.

STEP 2: Submit the required documents (as listed below)

STEP 3: Once the insurer approves the claim, you can proceed with the process, and the insurer will cover your invoice amount when you are discharged from the hospital.

You can also receive guidance on your claim settlement by calling their helpline number - 1800-270-7000 for assistance.

What are the documents required to settle claims for Aditya Birla Health Insurance?

When planning to file a claim to Aditya Birla Health Insurance, make sure you have the soft/hard (online/offline process) copies of the following documents handy -

• CASHLESS

- Policy number (health insurance card)

- Copy of ID proof

• REIMBURSEMENT

- Copy of duly filled Claim form

- Copy of ID proof of the patient

- Copy of Aadhar and PAN of the proposer

- Copy of Discharge summary

- Copy of investigation reports confirming diagnosis and all doctor consultation papers

- Copy of final bill with detailed breakup

- Copy of payment receipt against the payment made

- Copy of  cancelled cheque bearing  pre-printed name of the proposer on it or copy of last 3 months bank statement of the proposer bearing bank account number and IFSC code or copy of the first page of bank passbook of the proposer showing bank account details

Please note: Based on the underwriter’s decision, you may be required to submit some additional documents.

Conclusion

Aditya Birla Health Insurance is currently one of the best upcoming insurers across the industry. It has niche products crafted to cater to the evolving requirements of policyholders with various age brackets. The brand is reputed for its Activ One policy with 7 variants with unique perks for young policyholders. Moreover, look at the Aditya Birla Health Insurance Claim Settlement Ratio. Incurred Claim Ratio, Complaint volume, and count of network hospitals - and you will know that the insurer’s credibility in the market has a solid foundation. Overall, Aditya Birla Heath Insurance is a good pick if you know which plan to pick based on your financial bandwidth and medical requirements.