HDFC ERGO Health Insurance Claim Settlement Ratio

What is the HDFC ERGO Health Insurance Claim Settlement Ratio in 2024-2025?

HDFC ERGO Health Insurance achieved a strong Claim Settlement Ratio (CSR) of 97.45% in FY 2024–25. The insurer has maintained this high standard consistently, with a three-year average of 96.71% from 2022–25. This reflects its high reliability and efficiency in settling claims.

Introduction

HDFC ERGO Health Insurance, one of India’s leading health insurers, has built a strong reputation over its 20+ year history for reliability and customer-focused products. But when buying health insurance, the key question is: how dependable is the company when it comes to settling claims?

That’s where the claim settlement ratio comes in. It reflects the percentage of claims an insurer settles in a year and gives a clear measure of how reliable an insurer is when policyholders need support.

While a high CSR indicates good claim approvals, factors like claim processing speed, complaint numbers, and reasons for rejections also matter for a complete picture of performance. HDFC ERGO Health Insurance has consistently maintained a strong CSR, but it’s just one of several metrics smart buyers should consider.

In this article, we’ll cover:

• HDFC ERGO Health Insurance Claim Settlement Ratio
• How is CSR calculated
• Other key performance metrics to evaluate
• Whether it is the right choice for you

HDFC ERGO Health Insurance Claim Settlement Ratio

The figures below are sourced from Insurer’s public disclosures (form NL 37):

Claim Settlement Ratio: How to Calculate it?

A CSR above 90%% is generally considered healthy; it indicates both reliability and operational efficiency, while a ratio below 90% may hint at inconsistencies in claim handling.

That said, a high CSR doesn’t mean every individual claim will be approved. Claims may still be rejected for reasons like missing or incorrect documents, non-disclosure of medical information, or exclusions within the policy. If you’d like to understand these better, you can also explore the common reasons behind health insurance claim rejections.

It’s worth noting that official CSR figures from insurers can sometimes differ from ours. At Ditto, we follow a consistent approach across all insurers, excluding claims closed without payment and averaging over three years. This gives a clearer, outcome-focused view of how reliably an insurer settles claims.

Our formula:

CSR = (Total claims settled ÷ Total claims available to settle) × 100

Where: Total claims available to settle = Claims outstanding at the start + Claims reported during the year − Claims closed without payment − Claims outstanding at the end

Other Performance Metrics of HDFC ERGO Health Insurance

While the HDFC ERGO Health Insurance claim settlement ratio is impressive, it’s just one part of the picture. Here are some of the other key metrics to look at when evaluating an insurer.

• Average Complaints: HDFC ERGO Health Insurance had low complaints in FY 2022-23 and FY 2023-24, but saw a rise in FY 2024-25, slightly increasing the three-year average. This may reflect higher claims or temporary service challenges, though overall responsiveness remains strong.
• Incurred Claim Ratio (ICR): With an ICR in the 79–81% range, HDFC ERGO Health Insurance sits comfortably within the ideal 50–80% benchmark. This suggests a healthy balance between honoring claims and sustaining business profitability.
• Annual Business / Gross Written Premium (GWP): With an average annual business around ₹6,118 crore, HDFC ERGO Health Insurance demonstrates strong market penetration, steady growth, and high customer trust in its offerings. Note that this number reflects only the health insurance segment. HDFC ERGO is a general insurer with many other products and operates at a much larger scale overall.
• Network Hospitals: Boasting a network of over 13,000 hospitals nationwide, HDFC ERGO Health Insurance provides policyholders with extensive access to cashless treatment and quality healthcare.

Beyond these metrics, prospective buyers should also consider factors such as the insurer’s claim settlement reputation, financial stability, customer feedback, product portfolio and policy terms to make a fully informed decision.

Top 10 Health Insurance Providers by Claim Settlement Ratio in 2025

To help you see how HDFC ERGO Health Insurance stacks up against other leading insurers in terms of claim reliability and efficiency, here’s a list of the the top 10 health insurance companies in India, ranked by their average CSR over the last three financial years:

Insight: HDFC ERGO Health Insurance ranks 4th among the top 10 insurers, with a strong three-year average CSR of 96.71% which reflects consistent reliability in settling claims. Its CSR has steadily improved from 95.49% in 2022–23 to 97.45% in 2024–25, showing enhanced efficiency and commitment to policyholders. 

While a few insurers like New India Assurance and Digit Health Insurance have slightly higher CSRs, HDFC ERGO remains among the most dependable choices for timely claim settlements.

Why Approach Ditto for Health Insurance?

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HDFC ERGO Health Insurance CSR (Ditto’s Take)

HDFC ERGO is also one of Ditto’s partner insurers, which means we work closely with them and have seen consistently dependable claim handling and post-sales support. With a strong brand presence and close to 9% market share in retail health, 

HDFC ERGO is among the largest and more stable insurers in the space. Its high CSR of 97.45%, low complaints, and wide hospital network highlight its reliability when it comes to issuing policies and settling claims. 

On the downside, premiums can be higher for some profiles. Overall, HDFC ERGO remains a solid, customer-focused insurer with a dependable claims track record.