Claim Settlement Ratio: The health insurance game changer

  • postauthorSushant Tripathi
  • postdateFebruary 5, 2024
  • postreadtime5 min read
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As a small or medium-sized business owner, start-up founder, head of HR, or anyone looking to provide group health insurance benefits, you understand the significance of your employees’ health.

The well-being of your employees is crucial because it directly affects their happiness and productivity at work. However, finding the right health insurance policy for your business can be challenging. You need to strike a balance between the coverage you can afford and your employees’ satisfaction with the coverage. This is where the Claim Settlement Ratio comes into play.

Health insurance policies can be intricate and often require a thorough understanding of the rate at which claims are settled. The claim settlement ratio is a crucial metric to consider when choosing a policy. In this blog post, we will explain what the claim settlement ratio is, why it holds importance, and how it can assist you in selecting the best health insurance policy for your business.

What is Claim Settlement Ratio?

A company’s ability to settle claims is shown by its claim settlement ratio. It shows how many claims the insurance company has paid out during a specific period. A high claim settlement ratio means that the insurance company is reliable and has a good track record of paying out claims. A low claim settlement ratio could mean that the insurance company is struggling financially or has a bad customer service.

Claim Settlement Ratio =100 X (Total Claims Settled in a year / Total Claims Received in a year)

As a policyholder, you should think about the claim settlement ratio when deciding on a health insurance plan. When you buy a policy with a high claim settlement rate, you can be sure that the insurance company will give you and your employees the coverage and care you need. On the other hand, if a policy has a low claim settlement ratio, it could take a long time to process claims or even cause coverage to be denied.

Factors that affect Claim Settlement Ratio

  1. Many factors can impact how quickly an insurance company pays out claims.
  2. A low claim settlement ratio can be attributed to various factors including:
  3. The severity of the claims and adherence to the policy’s terms and conditions:
  4.  Are significant factors that can impact the Claim Settlement Ratio of an organization. If the terms and conditions of the policy are not met, it may lead to claim rejections, which can ultimately affect the organization’s Claim Settlement Ratio.

Insurer’s financial Stability

Another factor that can affect the rate at which claims are paid is an insurance company’s financial stability. If an insurer is facing financial challenges, they may not have the resources to pay claims quickly and adequately. This can lead to delays in claims processing and make it less likely for claims to be paid.

  • Customer service

The claim settlement ratio can also be affected by how well the insurance company treats its customers. Poor customer service can make it challenging for policyholders to file claims, leading to further delays in claim settlement and overall dissatisfaction.

Impact of Claim Settlement Ratio on premium rates

Claim Settlement Ratio is a metric that measures an insurer’s ability to settle claims. Premiums, on the other hand, are the amount policyholders pay to the insurance company for the coverage received. The premium amount is determined based on factors such as age, medical history, coverage type, and other risk factors.

Although premiums do not directly impact the Claim Settlement Ratio, they can have an indirect effect on it. For instance, if an insurance company charges very low premiums, it may not have enough funds to pay out all the claims it receives. In such scenarios, the claim settlement ratio may decrease as the insurer may have to deny some claims due to insufficient funds.

Therefore, it is crucial to maintain a balance between premiums and coverage when selecting a health insurance policy. Additionally, it is essential to choose an insurer with a high claim settlement ratio, as this indicates that the insurer is trustworthy and financially stable.

Insurance companies can improve their claim settlement ratio by investing in customer service and claims processing technologies. This can help them settle claims more efficiently and effectively, leading to a higher ratio of claims settled and increased customer satisfaction.


For example, several insurers are investing in artificial intelligence and machine learning technologies to automate claims processing and reduce the risk of errors and delays. This can help insurers process claims more quickly and accurately, leading to increased claim settlement rates and improved customer service.

Importance of choosing the right healthcare partner

Choosing the right health insurance provider is crucial for businesses to ensure that they get the best coverage for their employees. When selecting an insurer, claim settlement ratio is an essential factor to consider.

Other than Claim Settlement Ratio, businesses should also consider other factors when selecting a health insurance provider. These include coverage options, cost, customer service, and industry reputation. By taking a comprehensive approach to analysing potential insurers, businesses can ensure that they select a policy that meets their specific needs.

Why choose Onsurity as your health insurance provider?

Onsurity is a top health insurance company that offers businesses of all sizes a wide range of coverage options. With a 99% claim settlement rate, Onsurity has one of the highest rates in the industry, making it a reliable choice for businesses.

Businesses that choose Onsurity as their health insurance provider can enjoy several benefits, including a high claim settlement rate, competitive prices, telemedicine consultations, and health check-ups.

  1. Onsurity has a claim settlement ratio of 99% which is one of the highest in the industry.
  2. The company’s comprehensive healthcare plans are competitively priced, making them affordable for businesses of all sizes.
  3. The company provides free doctor tele-consultations, making it easier and more convenient for members to receive healthcare assistance at the click of a button.
  4. Onsurity offers discounts on preventive health check-ups to help employees stay healthy and detect health concerns early on.
  5. The company provides a unique feature of allowing customers to purchase health insurance plans for their family members, including partner, siblings, children, parents, and in-laws.
  6. The company has a dedicated claims concierge that is driven by qualified doctors to help manage claims end-to-end in a hassle-free manner.
  7. Onsurity offers a variety of wellness benefits including dental treatment, physical fitness perks, mental health benefits, among many others to ensure overall well-being.

Final thoughts

When choosing a group health insurance policy, an important metric to look at is how quickly claims are paid out. It can help you figure out how reliable and financially stable the insurance provider is.

A high Claim Settlement Ratio is a critical factor when selecting a health insurance provider. It implies that the insurer is dependable and has a history of paying claims on time, which can be a significant relief for your team. Additionally, it can also contribute to increased customer satisfaction.

Choosing Onsurity as your health insurance provider guarantees that your employees are covered when they need it the most, and you receive high-quality service and benefits that suit your employees’ requirements.

The claim settlement ratio is the percentage of claims settled by an insurance company out of the total claims received in a year. It is a measure of the insurer’s ability to pay claims.

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