HDFC ERGO is one of India’s leading health insurers, offering a range of comprehensive health insurance plans. It is the leading insurer based on numerous metrics. However, today, let’s concentrate on HDFC ERGO’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 HDFC Ergo’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 HDFC ERGO’s Incurred Claim Ratio (ICR)?
| Year | HDFC ERGO ICR | Industry Average ICR |
|---|---|---|
| 2020 - 2021 | 79% | 76% |
| 2021 - 2022 | 97% | 91% |
| 2022 - 2023 | 79% | 80% |
| Average (2020 - 2023) | 85% | 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 HDFC ERGO Health Insurance
What is the significance of HDFC ERGO’s ICR for 2024?
A high ICR signifies that HDFC ERGO is consistently settling claims in favour of policyholders. It indicates financial stability and reliability, ensuring that claims are processed without unnecessary delays or rejections.
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 HDFC ERGO Health Insurance?
- CASHLESS
Contact HDFC ERGO Health Insurance 48 hours before the hospitalisation (planned treatment) or within 24 hours of hospitalisation (emergency hospitalisation) via the hospital insurance desk.
STEP 1: Register your claim on the official site of HDFC ERGO Health Insurance and fill in the required details.
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.
(You can still proceed with the treatment if your cashless request is denied. 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 HDFC ERGO 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.
You can also receive guidance on your claim settlement by calling their helpline number- 022 6234 6234 - for assistance.
What documents are required to settle a claim with HDFC ERGO Health Insurance?
When planning to file a claim to HDFC ERGO 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
- 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.
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Conclusion
From the best health insurance plans (like HDFC Ergo Optima Super Secure and more) in the industry to the best features and industry-best numbers across Incurred Claim Ratio, complaint volume, Claim Settlement Ratio, and partner hospitals - HDFC ERGO has it all. If you don’t mind the slightly higher premiums, HDFC ERGO is a solid pick.
If you need personalised, spam-free health insurance advice, you can always contact our IRDAI-certified advisors at Ditto. We don’t just sell insurance; we help you understand it.
