Care is one of India’s largest health insurers, offering a range of comprehensive as well as affordable health insurance plans. It is the good insurer based on numerous metrics. However, today, let’s concentrate on Care’s Incurred Claim Ratio (ICR). ICR is a critical metric in health insurance as it is a barometer for an insurance company's financial health and ability to pay out claims. Simply put, ICR represents the percentage of premiums an insurer collects paid out in claims.
Understanding ICR is essential as it gives insight into how well an insurer manages its financial commitments and how likely it is to settle claims. In this article, we explore Care’s ICR, its significance, and what it means for current and potential policyholders.
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What is ICR (Incurred Claim Ratio) in Health Insurance?
The Incurred Claim Ratio (ICR) measures the total amount of claims paid by the insurance company against the total premium collected during a financial year.
Here is how ICR is calculated:
Incurred Claim Ratio = (The total value of claims settled by an insurer / The total value of premiums collected by the insurance company) x 100
What is Care’s Incurred Claim Ratio (ICR)?
| Year | Care ICR | Industry Average ICR |
|---|---|---|
| 2020 - 2021 | 55% | 76% |
| 2021 - 2022 | 65% | 91% |
| 2022 - 2023 | 54% | 80% |
| Average (2020 - 2023) | 58% | 82% |
This data represents the average of the past three years' figures, allowing us to compare it with the industry average. By averaging these numbers, we get a clearer picture of the company's consistency and overall operational efficiency.
Overview of Care Health Insurance
What is the significance of Care’s ICR for 2024?
Care Health Insurance has had inconsistent numbers over the years. While the current average ICR stands at 58%, there has been a lot of variance in the data. While 58% falls within the ICR Goldilocks zone, we must also consider other aspects of the insurer's functions. This will give a more holistic view.
What is the Significance of Incurred Claim Ratios in Health Insurance Plans?
| ICR Value | Significance |
|---|---|
| Less than 50% | Indicates that the insurer collects significantly more premiums than it pays out in claims, which may suggest profitability at the expense of claim settlement. |
| 50-70% | This range is ideal, suggesting that the insurer balances financial health and settles a fair share of claims. |
| 70-100% | This range indicates that the insurer pays out a significant portion of the premiums it collects in claims annually. While it shows a strong commitment to settling claims, it also suggests that the insurer might have less flexibility in managing its finances. However, if the insurer is large enough, this can be less of a concern. |
| Greater than 100% | This indicates that the insurer is paying out more in claims than it collects in premiums. This is unsustainable and might lead to higher premiums or lower claim settlements in the future. |
What is the Claim Settlement Process for Care Health Insurance?
- CASHLESS
STEP 1: Contact Care Health 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 Care Health Insurance ‘Self-Help Portal’ Link or download the Care Health-Customer App
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.
You can also receive guidance on your claim settlement by calling their helpline number - 1800-200-4488 for assistance.
What are the documents required to settle claims for Care Health Insurance?
When planning to file a claim to Care 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
2. REIMBURSEMENT
- Original discharge summary
- Original final hospital bill with item-wise break-up
- Original paid receipt against the final hospital bill
- For Accidental cases, MLC/FIR copy (if applicable)
- Alcohol history (if applicable)
- Investigation reports (like X-ray/MRI/CT Scan etc.)
- Attested copy of indoor case papers
- In case of implant surgery, invoice & sticker
- For all claims amounting to ₹1 lakh or above, please provide a copy of any of these KYC documents (Aadhaar Card, Passport, Driving Licence, Voter ID, etc).
Please ensure that the address on the KYC documents matches the Policy address.
Please note: Based on the underwriter’s decision, you may be required to submit some additional documents.
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Conclusion
Care Health Insurance holds great credibility across the industry. However, the fluctuations in Care Health Insurance’s Incurred Claim data are a concerning sign that needs to be addressed urgently since the brand’s credibility might take a severe hit. In that case, despite having a solid lineup of health insurance products, the unique perk of “no loading charges,” affordable premiums, and comprehensive policies, competitors – such as Aditya Birla – will have the edge over Care.
That’s it for this article, folks. Take care. Until next time!
