Care Health Insurance Claim Settlement Ratio

Quick Overview

The Care Health Insurance Claim Settlement Ratio (CSR) stands at 96.74% for FY 2024-2025, with a 3-year average of 93.13% (FY 22-25). This indicates that Care Health Insurance settles a high percentage of claims, making it a fairly reliable option among insurers in India. However, a slightly higher complaint volume and a lower Incurred Claim Ratio (ICR) should be monitored.

Imagine paying health insurance premiums for years, only to have your claim rejected when you need your policy the most. That’s the biggest fear for most policyholders.

So, how do you decide if Care Health Insurance is a dependable insurer? This is where the Care Health claim settlement ratio becomes crucial.

In this guide, we’ll break down the Care claim settlement ratio, how it’s calculated, where it stands, and whether it’s good enough for you to trust.

What Is the Claim Settlement Ratio?

The Claim Settlement Ratio (CSR) is the percentage of claims an insurance company successfully settles out of the total it receives in a financial year.

For example, if an insurance company received 100 claims but settled only 91, its CSR will be 91%.

How to Calculate the Care Health Insurance Claim Settlement Ratio?

CSR = (Total Number of Claims Settled/ Total Number of Claims Available to Settle) X 100Where:

“Total Number of Claims Settled” includes partly and fully settled claims
“Total Number of Claims Available to Settle” is (claims carried forward from the previous year) + (new claims reported) - (claims closed without payment + claims still pending at year's end)

Note: The Insurance Regulatory and Development Authority of India (IRDAI) doesn’t prescribe a fixed formula for calculating CSR. So, numbers may vary depending on the methodology used by insurers and platforms like ours.

Our Approach at Ditto

The formula above is used because it better captures delays in claim settlements.
It’s recommended to look at the 3-year average CSR rather than a single year, as it smooths out year-to-year fluctuations and provides a more reliable, consistent view.
Additionally, we also suggest reviewing other metrics like:
1) Complaints per 10,000 Claims
2) Incurred Claim Ratio (ICR)
3) Gross Written Premium (GWP)
4) Network Hospitals

This is because CSR alone doesn’t distinguish between partially and fully settled claims.

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Where Can I Find the Claim Settlement Ratio for Care Health Insurance?

You can find the Care Health Insurance claim settlement ratio in:

IRDAI Annual Reports.
Care Health Insurance’s official public disclosures.
Trusted insurance advisory platforms like Ditto.

Care Health Insurance: 3-year Claim Settlement Ratio and Other Metrics

Metrics	3-year Average (FY 22-25)	Industry Average (FY 22-25)
Claim Settlement Ratio (CSR)	93.13%	91.22%
Average Complaints per 10,000 Claims	42.00	27.06
Incurred Claim Ratio (ICR)	58.68%	81.88%
Annual Business/ Gross Written Premium (GWP) (in Crore)	₹6,775	₹3,969

Key Insights:

The Care Health Insurance claim settlement ratio 2025 shows a strong upward trend, and the 3-year CSR is also above the industry average.
According to the insurer’s website, it has settled 74.5 lakh+ claims since its inception in 2012, highlighting its operational experience and ability to handle large claim volumes.
It’s worth noting that the complaint volume is higher than the industry average. This could indicate delays, communication issues, grievance escalation, and documentation friction.
While the ICR is lower than the industry average, it still falls in the healthy range of 50-80%.
Care’s GWP has risen meaningfully, indicating growing scale and stronger premium collection over time.

In addition to the above metrics, another important factor to consider is the hospital network. Care Health Insurance has 11,400+ network hospitals. You can use the network hospital locator on the official Care Health website to check whether your nearest hospital is included.

Top 10 Health Insurance Providers by Claim Settlement Ratio

Although Care Insurance Claim Settlement Ratio is strong, it still doesn’t make it to the list of the top 10 health insurance companies by CSR. That said, it remains a reliable insurer.

Care Health Insurance Claim Settlement Ratio

Why Choose Ditto for Health Insurance?

At Ditto, we’ve assisted over 8,00,000 customers with choosing the right insurance policy. Why customers like Pallavi below love us:

No-Spam & No Salesmen
Rated 4.9/5 on Google Reviews by 15,000+ happy customers
Backed by Zerodha
Dedicated Claim Support Team
100% Free Consultation

Confused about the right insurance? Speak to Ditto’s certified advisors for free, unbiased guidance. Book your call or chat over WhatsApp with our advisors.

Ditto’s Take on Care Health Insurance

The Care Health Insurance Claim Settlement Ratio has shown a steady improvement, reaching a strong 96.74% in FY 2024-25. When you look at the bigger picture, the consistently improving CSR helps reinforce its reliability over time. Its wide network of hospitals and growing business scale also make it a convenient and accessible option for many policyholders.

If you’d like to learn more about how Care performs as compared to other leading insurers, you can check out our comprehensive guide on the best health insurance companies in India.

Frequently Asked Questions

Which health insurance has a 100% claim settlement ratio?

Although Narayana Health Insurance reports a Claim Settlement Ratio of 100% (FY 22-25), no insurer consistently maintains a 100% CSR. A ratio above 90% is generally considered reliable.

Does a high CSR guarantee your claim will be paid?

No. A high CSR only shows that many claims were settled overall. Your claim may still be rejected due to exclusions, waiting periods, non-disclosure, or other reasons. For more details, you can check our guide on why CSR alone misleads buyers.

Why can an insurer have a good CSR but still give a bad claim experience?

Because CSR does not show claim speed, paperwork burden, partial settlements, communication quality, or escalations. An insurer may settle most claims overall yet still frustrate customers during the process.

Which company is no. 1 in the claim settlement ratio?

The top insurer varies yearly. While public insurers often have higher CSRs, they may face delays. Private insurers may settle claims faster, offering a smoother overall customer experience.

Which is better, Niva Bupa or Care?

Both are strong insurers with feature-rich plans and dependable performance. For more details, you can refer to our guide on Niva Bupa vs Care Health Insurance.

Last updated on: 10 Apr, 2026