ICICI Lombard 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 ICICI Lombard’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 ICICI Lombard’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 ICICI Lombard’s Incurred Claim Ratio (ICR)?
| Year | ICICI Lombard ICR | Industry Average ICR |
|---|---|---|
| 2020 - 2021 | 78% | 76% |
| 2021 - 2022 | 92% | 91% |
| 2022 - 2023 | 77% | 80% |
| Average (2020 - 2023) | 82% | 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 ICICI Lombard Health Insurance
| Metrics | ICICI Lombard 3-year Average Metrics | Industry Averages |
|---|---|---|
| Claim Settlement Ratio (average from 2021 - 2024) |
91% | 90% |
| Incurred Claim Ratio (average from 2020 - 2023) |
57 | 82% |
| Complaint Volume (average from 2021 - 2024) |
43 | 23 |
| Annual Average Business Volume (in ₹ Crores) (average from 2021 - 2024) |
₹4,077 (in crores) | ₹3,157 |
What is the significance of ICICI Lombard’s ICR for 2024?
A high ICR signifies that ICICI Lombard is consistently settling claims in favour of policyholders. It indicates financial stability and reliability, ensuring that claims are processed without unnecessary delays or rejections.
| 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 ICICI Lombard Health Insurance?
- CASHLESS
STEP 1: Contact ICICI Lombard 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 ICICI Lombard Health Insurance ‘Self-Help Portal’ Link or download the ICICI Lombard TakeCare 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 2666 for assistance.
What are the documents required to settle claims for ICICI Lombard Health Insurance?
When planning to file a claim to ICICI Lombard 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
ICICI Lombard Health Insurance has only a couple of policies across the board. Hence, although the insurer might be a common name in the health insurance industry, its limited product portfolio, accompanied by its less-than-preferred Claim Settlement Ratio numbers and a tad bit pricey plans, have led to the provider losing its foothold. You are naturally encouraged to look for more comprehensive options at affordable prices from its competitors.
