Navi Health Insurance Claim Settlement Ratio

Quick Overview

A claim settlement ratio (CSR) shows what percentage of claims an insurer settles in a year out of all the claims it receives.

For 2024-25, Navi’s CSR stands at 80.39%, which is clearly on the lower side compared to its peers. To put this in perspective, the industry average sits at 91.22%, and insurers like HDFC Ergo and Bajaj General Insurance are well ahead on this metric.

Simply put, Navi has been settling a relatively smaller share of claims, and that lack of consistency is something policyholders should be cautious about.

Navi General Insurance (IRDAI Reg. No. 155) was founded in 2016 by Sachin Bansal and Ankit Agarwal, soon after Bansal’s well-known $1 billion exit from Flipkart. They wanted to use technology to reduce complexity and keep costs low.

But if you’re thinking of buying a Navi health insurance plan, one question matters above all else. How reliable are they at the time of claims and if the insurer is among the top 10 health insurance companies by CSR in India?

That’s where CSR comes in. CSR shows the percentage of claims an insurer settles in a year and is one of the clearest indicators of reliability.

In this article, we break down Navi’s claim settlement ratio, explain what it actually means, compare it with competitors, and help you decide whether Navi is the right choice for you.

How to Calculate the Navi Health Insurance Claim Settlement Ratio?

Claim Settlement Ratio (CSR), while not the only metric, is one of the most important ways to assess an insurer’s performance. Here’s how it’s calculated:

CSR = (Total claims settled / Total claims available to settle) X 100

Where:

‘Total Claims Settled’ includes partly and fully settled claims

‘Total claims available to settle’ = (Claims carried forward from the previous year) + (New claims reported) - (Claims closed without payment + Claims still pending at year's end)

Note: The IRDAI doesn’t have any specific formula for calculating the Claim settlement ratio. Hence, these numbers can differ depending on the formula used by different platforms and insurers.

We, at Ditto:

Use the formula mentioned above, as it better captures long delays in claim settlement by insurers.
Recommend looking at the 3-year average CSR, since a single year’s data isn’t enough to judge an insurer’s long-term stability.
Suggest reviewing the 3-year averages of other key metrics as well, such as average complaints received per 10,000 claims, the Incurred Claims Ratio (ICR) and Gross Written Premium (GWP). This is important because CSR alone doesn’t differentiate between partially and fully settled claims, and cannot give the full picture of an insurer’s performance.

CTA

Navi Health Insurance: 3-year Claim Settlement Ratio and Other Metrics

Metrics	FY 2022-23	FY 2023-24	FY 2024-25	3-year Average (FY 22–25)	Industry Average
CSR (in %)	70.45%	63.49%	80.39%	71.44%	91.22%
Average Complaints per 10,000 Claims	99.23	333.72	285.14	239.36	27.06
ICR (in %)	59.28%	59.4%	NA	49.08% (3-year average for 2021–24 used)	83.93%(3-year average for 2021–24 used)
Annual Business / Gross Written Premium (in crores) - Total Health	₹13	₹13	₹52	₹26	₹3969
Network Hospitals	N/A	N/A	N/A	12,000+ (as of today)	10,000+ recommended

Note:

The complaint numbers shown above reflect all of Navi’s products (health, motor, and others), as the insurer does not publish product-wise complaint data separately.
In the table above, ICR refers to Incurred Claims Ratio.

Key Insights:

CSR: Navi’s 3-year average Claim Settlement Ratio stands at 71.44%, making it the lowest among all insurers in the market.
Complaints: Navi received an average of 239.36 complaints per 10,000 claims over the last three years. This is the highest in the industry and almost 9 times the industry average of 27.06.
ICR: The insurer’s ICR averages 49.08%, which is the second-lowest across insurers and well below the industry average of 83.93%.
Annual Business: It has a relatively small gross written premium of just ₹26 crore, which places it among the smaller players in the industry. For comparison, this works out to only around 0.6% of the industry average of ₹3,969 crore.

Top 10 Health Insurance Providers by Claim Settlement Ratio

Rank	Health Insurance Company	CSR 2022–23	CSR 2023–24	CSR 2024–25	Average CSR (2022–25)
1	New India Assurance Co. Ltd.	99.80%	98.44%	98.83%	98.91%
2	Digit Health Insurance	98.18%	98.83%	98.98%	98.66%
3	Bajaj General Insurance	96.85%	96.16%	97.32%	96.78%
4	HDFC ERGO Health Insurance	95.49%	97.19%	97.45%	96.71%
5	Acko General Insurance	97.45%	96.31%	95.75%	96.50%
6	SBI General Insurance	94.20%	98.08%	96.13%	96.14%
7	Aditya Birla Health Insurance	95.95%	95.61%	95.88%	95.81%
8	National Insurance Co. Ltd.	95.60%	94.68%	93.56%	94.61%
9	Universal Sompo General Insurance	100%	93.39%	89.21%	94.20%
10	Oriental Insurance Co. Ltd.	93.05%	94.21%	93.38%	93.55%

Why Choose Ditto for Health Insurance?

At Ditto, we’ve assisted over 8,00,000 customers with choosing the right insurance policy. Why customers like Pallavi below love us:

Navi Health Insurance Claim Settlement Ratio

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Confused about the right insurance? Speak to Ditto’s certified advisors for free, unbiased guidance. Book your call now, slots fill up fast!

Ditto’s Take on Navi Health Insurance

Consistently weak performance across key metrics

Navi has repeatedly scored poorly on important indicators such as CSR, ICR, complaints, and annual business. Based on this data, it becomes difficult to recommend the insurer with confidence

TPA Usage

Navi relies on TPAs. This can sometimes lead to delays or inefficiencies in the claims process.

Higher Premiums

Navi’s plans are generally priced slightly higher than many peers, especially when viewed against its overall performance. For example, the premium for the ‘Navi Health’ plan for a 25 year old male residing in Delhi is ₹ 13,034

Read the Fine Print

Always go through the policy wording carefully so you’re clear about what’s covered, what’s excluded, and any limits that may apply.

Conclusion

Navi’s performance has remained consistently weak across most key metrics in recent years. To become more competitive, the insurer must significantly improve its claims experience and operational efficiency. Until that happens, it is wise to compare other health insurance options and choose a plan that best fits your individual needs.

Notes:

To know the methodology behind why the above plans are recommended, refer to Ditto’s Cut and Framework
Our assessment here is completely independent and based solely on publicly available data and the evaluation framework we use for all insurers. If you want to understand how Ditto reviews insurers across claims, complaints, business strength, and product suitability, read our methodology here.

The information provided is for general awareness and should not be used for financial or legal decisions. Please refer to the official website for the latest details.

Frequently Asked Questions

What is the claim settlement process at Navi health insurance?

For cashless claims, you get admitted to a network hospital, share your insurance details, notify the insurer (48 hours for planned admissions, 24 hours for emergencies), and complete the pre-authorization process. Then, the insurer settles the bills directly. For reimbursement claims, you pay the hospital bills yourself, submit the claim form, discharge summary, and original bills to the insurer for review.

Where can I find the claim settlement ratio for Navi Health Insurance?

You can calculate the claim settlement ratio for Navi by navigating to the NL-37 form on the ‘Public disclosure’ page of their official website.

What are the documents required for Navi Health Insurance Claims?

You need to submit your policy number (health insurance card) and a copy of ID proof for cashless claims. For reimbursement claims, you need a copy of a duly filled claim form, ID proof of the patient and proposer, copy of hospitalization documents, and the proposer’s bank details. Based on the underwriter’s decision, you may also have to submit some additional documents.

Does Navi’s CSR only include fully settled claims?

While there’s no fixed definition, CSR usually counts both fully and partially paid out claims as “settled.”

Does a higher sum insured reduce the chances of claim settlement?

No, a higher sum insured does not automatically reduce the chances of claim settlement. It depends on many factors, such as the admissibility or truthful disclosure of pre-existing conditions. However, it can attract greater scrutiny at the application stage due to the higher risk involved.

Last updated on: 20 Feb, 2026