Health Insurer Hides 44%? Check 3 Numbers Before You Buy

Before buying health insurance, check your insurer's claim settlement ratio, complaint volume, and coverage limits. IRDAI publishes this data publicly every year — but most buyers never look at it, and end up with a policy that rejects claims when it matters most.

Here's what happened: IRDAI requires every health insurer to publish annual public disclosures — including claim settlement ratios, complaint data, and product-level details — in a standardised format called Schedule NL-47.. Claim settlement ratios vary dramatically across insurers, with some paying out under 60% of health claims filed — a gap most policyholders discover only at the time of a medical emergency.. Most Indian buyers choose health insurance based on premium price or agent recommendation, without ever checking publicly available IRDAI data that shows how each insurer actually performs on claims..

What you should do: Visit IRDAI's official website (irdai.gov.in) and look up your shortlisted insurer's annual report — compare Claim Settlement Ratio, Incurred Claims Ratio, and complaints per 10,000 claims before buying.. Check the insurer's cashless hospital network specifically in your city or district — use their online hospital locator filtered by your pin code, not the national headline number.. Avoid any IRDAI-registered health insurer with a Claim Settlement Ratio below 85% or more than 30 complaints per 10,000 claims, regardless of how low their annual premium looks..

Pro tip: An Incurred Claims Ratio (ICR) between 70–100% signals a financially healthy insurer — below 50% often means aggressive claim rejection, above 110% signals the insurer may be heading for trouble.

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