This page explains ICICI Lombard Health Insurance’s incurred claim ratio, what it tells policyholders, and why it should be checked with CSR, complaints, hospital network, and claim process. ICICI Lombard’s older 3-year ICR average was 82%, while the FY 2022 to 2025 average stands at 79.47%, close to the industry average of 81.88%. At Ditto, we rate insurers by checking CSR, ICR, complaints per 10,000 claims, network hospitals, business volume, product restrictions, and claim experience. ICICI Lombard has 10,200+ network hospitals, ₹6,793.97 crore GWP, and 10.67 complaints per 10,000 claims, but its 84.50% CSR is below Ditto’s ideal benchmark. This guide is for buyers checking ICICI Lombard’s claim-paying record before buying or renewing.
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.
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
ICICI Lombard Incurred Claim Ratio
Year
ICICI Lombard ICR
Industry Average ICR
2022 - 2023
77.33%
79.94%
2023-2024
78.85%
81.33%
2024-2025
82.24%
84.38%
Average (2022 - 2025)
79.47%
81.88%
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.
Annual Average Business Volume (in ₹ Crores)(average from 2022 - 2025)
₹6794 crores
₹3969 crores
What is the significance of ICICI Lombard’s ICR?
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.
CTA
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)
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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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.
Frequently Asked Questions
What is ICICI Lombard Health Insurance incurred claim ratio?
ICICI Lombard Health Insurance incurred claim ratio shows how much of the premium collected by the insurer is paid out as claims in a financial year. The formula is total value of claims paid divided by total premium collected, multiplied by 100. ICICI Lombard’s older 3-year ICR average was 82% for 2020 to 2023. In the FY 2022 to 2025 average metric set, the insurer’s ICR stands at 79.47%. This means it pays a fairly high share of collected premiums as claims.
What does incurred claim ratio mean in health insurance?
Incurred claim ratio, or ICR, measures the value of claims an insurer pays compared to the premiums it collects. For example, if an insurer collects ₹100 crore in premiums and pays ₹80 crore in claims, the ICR is 80%. This metric helps you understand the insurer’s claim outgo and financial balance. A very low ICR may need closer review, while a very high ICR can raise sustainability concerns. However, ICR should always be read with claim settlement ratio, complaints, and policy terms.
What is ICICI Lombard’s latest ICR?
ICICI Lombard’s FY 2022 to 2025 average incurred claim ratio is 79.47%. This is close to the health insurance industry average of 81.88% for the same period. The older article dataset showed ICICI Lombard’s 3-year ICR average as 82% from 2020 to 2023, with yearly figures of 78%, 92%, and 77%. The number looks stable overall, but buyers should not rely only on ICR. ICICI Lombard’s CSR is 84.50%, and that needs attention while comparing health insurers.
Is ICICI Lombard’s ICR good or bad?
ICICI Lombard’s ICR is good from a claim outgo perspective. A 79.47% FY 2022 to 2025 average means the insurer pays a healthy share of collected premiums as claims. This is close to the industry average of 81.88%. However, a good ICR does not automatically mean the insurer is the best choice. ICICI Lombard’s CSR is 84.50%, which is lower than Ditto’s preferred benchmark for health insurers. At Ditto, we recommend checking ICR, CSR, complaints, network hospitals, and exact plan restrictions together.
Why is ICICI Lombard’s ICR important for policyholders?
ICICI Lombard’s ICR is important because it helps policyholders understand how much of the insurer’s premium pool goes toward claim payouts. A 79.47% FY 2022 to 2025 average ICR suggests that ICICI Lombard is paying a significant share of premiums as claims. But this does not show how many claims are settled or how smooth the process is. That is why you should also check its 84.50% CSR, 10.67 complaints per 10,000 claims, cashless hospital network, exclusions, and product-level limits.
How is ICICI Lombard Health Insurance ICR calculated?
ICICI Lombard Health Insurance ICR is calculated by dividing the total value of claims paid by the total premium collected during a financial year, then multiplying the result by 100. For example, if the insurer collects ₹100 crore and pays ₹79 crore in claims, the ICR is 79%. This metric focuses on claim value, not the number of claims settled. So, even if ICR looks healthy, you should also check claim settlement ratio, which shows the percentage of claims settled by count.
What is the difference between ICR and claim settlement ratio?
ICR and claim settlement ratio measure different things. ICR measures claim value paid against premium collected. Claim settlement ratio, or CSR, measures the number of claims settled against total claims received. ICICI Lombard’s FY 2022 to 2025 average ICR is 79.47%, while its CSR is 84.50%. That means its claim outgo looks reasonable, but the claim settlement count metric is not as strong as some competitors. At Ditto, we recommend checking both because one metric alone can give an incomplete picture.
Is a higher ICR always better in health insurance?
No, a higher ICR is not always better. A higher ICR means the insurer pays more of its collected premiums as claims, which can be good for policyholders. But if ICR crosses 100%, it may show that the insurer is paying more in claims than it collects in premiums, which can affect long-term pricing. A very low ICR can also raise questions. ICICI Lombard’s 79.47% ICR is close to the industry average of 81.88%, so the number is stable but still needs context.
What is the ideal incurred claim ratio for health insurance?
There is no perfect incurred claim ratio, but 50% to 100% is generally a useful range to study. A 50% to 70% ICR can show balance, while a 70% to 100% ICR can show that the insurer pays a large share of premiums as claims. ICICI Lombard’s FY 2022 to 2025 average ICR is 79.47%, which sits in the higher but still reasonable range. However, buyers should not stop there. Claim settlement ratio, complaint volume, exclusions, and hospital network matter just as much.
Should I buy ICICI Lombard Health Insurance based on ICR?
You should not buy ICICI Lombard Health Insurance only based on ICR. The insurer’s 79.47% FY 2022 to 2025 average ICR is close to the industry average, and it has 10,200+ network hospitals and ₹6,793.97 crore GWP. But its 84.50% CSR is below Ditto’s preferred benchmark for health insurers. At Ditto, we recommend shortlisting a plan only after checking room rent limits, co-payment, disease-wise sub-limits, waiting periods, exclusions, add-ons, premiums, and claim experience.
What does ICICI Lombard’s 82% ICR mean?
ICICI Lombard’s older 82% average ICR means that, during the 2020 to 2023 period used in the article, the insurer paid about ₹82 in claims for every ₹100 collected as premium. This suggests a healthy claim payout pattern. In the FY 2022 to 2025 metric set, the ICR is 79.47%, which is still close to the industry average of 81.88%. But ICR only tracks claim value. It does not tell you whether claims were approved easily, settled quickly, or paid fully.
ICICI Lombard Customer Reviews
4.4
74 reviews
ICICI Lombard's Complete Health Insurance plan has been reliable over the years. The cashless network is wide, the digital claims process is intuitive and my claim was processed without any unnecessary back and forth. A dependable insurer overall.
VS
Vivek Sharma
ICICI Lombard's pre-authorisation for my wife's planned surgery was approved well in advance and the discharge process was completely hassle-free. Their coordination with the hospital was excellent and the claim was settled in full. Very satisfied.
AP
Arjun Pillai
ICICI Lombard's claim settlement track record and low complaint volume were the primary reasons I chose them. Three years in, both of those reputations have been validated by my experience. A reliable insurer with a professional service team.
RM
Rajesh Menon
My Ditto advisor walked me through ICICI Lombard's plan options in detail and helped me compare them against other health insurers on key parameters like room rent, restoration, and claim complaint ratios. The analysis was thorough and completely bias-free. Very helpful!
SB
Sneha Bose
ICICI Lombard's health insurance plans have improved over the years but their network of hospitals is noticeably smaller than some competitors. For policyholders in Tier-2 cities this can be a real limitation when trying to access cashless treatment.
PV
Preethi Verma
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