Health insurance policies have always remained a popular financial tool to protect your savings during health scares. Such purchases are smart financial moves, considering the recent spike in medical inflation. Considering this recent rise in demand, it is no surprise that new players have surfaced in the market. However, there still are some traditional insurers with excellent brand equity, like TATA AIG Health Insurance, which was founded in 2001 as a joint venture of TATA Group and American International Group. Such health insurance providers have a solid foothold in the market, considering a long queue of brand loyalists associated with TATA.
Now, while it makes sense for TATA loyalists to avail themselves of health insurance plans from this insurer, as potential policyholders, should you approach this insurer for your plan? This can be determined by ensuring its true credibility against its market reputation. To measure this, you need to bank on a few metrics - one of which is the TATA AIG Health Insurance Claim Settlement Ratio. Let’s explore this metric!
What is the Claim Settlement Ratio?
The Claim Settlement Ratio or CSR of a health insurance provider is one of the many metrics considered when analysing its credibility. It is computed by -
(Total number of claims settled by an insurer in a year / Total number of files raised to the insurer across the year) * 100
Ideally, the usual recommendation is to approach health insurance providers with a CSR of 90 and above. However, say you approach an insurer with a CSR of above 100 or below 80. It’s best to avoid them, irrespective of how good their policies look on paper, because these companies might reject or delay the claims raised to them.
So, here’s a look at the data for the TATA AIG Health Insurance Claim Settlement Ratio!
What is the TATA AIG Health Insurance Claim Settlement Ratio for 2024?
| Years | CSR for TATA AIG Health Insurance | Industry Average of CSR |
|---|---|---|
| 2020 - 2021 | 87.7 | 91.484 |
| 2021 - 2022 | 90.85 | 89.967 |
| 2022 - 2023 | 88.65 | 91.460 |
| Average (2020 - 2023) | 89.07 | 90.970 |
(Please remember this - if you are looking for the TATA AIG Health Insurance Claim Settlement Ratio for 2024, you need to look at its CSR for the last financial year: 2022 to 2023. However, the data for a single year won’t suffice since you won’t be able to evaluate if the insurer is consistent with its claim settlement track record. Thus, we have gathered the TATA AIG Health Insurance Claim Settlement Ratio data for the last 3 years: 2020 to 2023. We then drew out an average of these 3 years and then tallied them against the industry average of these years.)
What is the significance of TATA AIG Health Insurance Claim Settlement Ratio 2024?
The TATA AIG Health Insurance Claim Settlement Ratio track record from 2020 to 2023 reflects the insurer’s degree of credibility and consistency. Here is an insight into these factors based on the data collected.
- Consistency: Over the last 3 years (2020 to 2023), the TATA AIG Health Insurance Claim Settlement Ratio has consistently remained close to the 90% threshold. However, the insurer has crossed the threshold only once. The numbers also fluctuate, with no signs of gradual improvement. This is not an encouraging sign for its existing and potential policyholders.
- Overall Performance: The track record for the TATA AIG Health Insurance Claim Settlement Ratio isn’t too impressive, considering that, unlike the top-notch health insurance providers in the industry, TATA AIG’s CSR never reaches the high 90s - neither in its average nor in its year-on-year (except once when it barely crosses 90). Thai speaks volumes about the insurer's claim settlement intent.
Why is the Claim Settlement Ratio important?
The Claim Settlement Ratio of a health insurance provider is a crucial metric that measures an insurer’s credibility. This metric offers an initial, on-the-surface view of a provider's claim settlement intent.
However, the CSR fails to capture a few essential details regarding an insurer's claim settlement intent, including the time taken to settle a claim and whether the claims settled were partial or in full. Hence, CSR can’t be the sole determining factor when choosing a health insurance provider. You also need to consider other metrics like the number of network hospitals an insurer has, its Incurred Claim Ratio (ICR), and its complaint volume.
What is the Claim Settlement Process for TATA AIG Health Insurance?
- CASHLESS
Contact TATA AIG 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 TATA AIG 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.
(Please note that 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 TATA AIG 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 - 1800 - 267 - 7233 for assistance.
What are the documents required to settle claims for TATA AIG Health Insurance?
When planning to file a claim to TATA AIG 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
- 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.
Conclusion
TATA AIG has become one of the market's most popular health insurance providers. However, This popularity can be attributed to its brand equity only because health insurance plans (like Medicare Premier, Medicare Protect, Medicare Senior, etc.) from TATA AIG tend to be expensive without unique features and many sub-limits and restrictions. Additionally, the TATA AIG Health Insurance Claim Settlement Ratio and other metrics aren’t too encouraging. So, if you are looking at any plans from the stable of TATA AIG, maybe you should look at a few of the top health insurers in the industry and plans offered by these brands.