Star Health Insurance Claim Settlement Ratio (2024)

When seeking a health insurance policy, you often seek health insurance providers with an extensive track record. We often assume that an insurer who has been in the insurance industry for a long time and holds a market reputation for being credible is an ideal health insurance provider. Star Health Insurance checks both these boxes – the insurer commenced its operations in 2006 as one of the first private standalone health insurers in India and, by word-of-mouth, once held a monopoly in the health insurance industry.

Unfortunately, contrary to popular assumptions, a long-standing insurer with a market reputation often isn’t the best health insurance provider in the country. Star Health Insurance holds a testament to this. The insurer, despite its extensive insurance track record and market reputation, doesn’t make it to the top 5 health insurers in India. Much of this can be attributed to the insurer’s non-comprehensive insurance product portfolio, delisting of partner hospitals, rejection of valid claims, withdrawal of crucial health insurance plans and more.

However, Star Health Insurance has a major advantage—the insurer offers health insurance plans to those with critical ailments (like cancer) and offers a diverse range of products that cater to a niche audience. If you are considering this or are a brand loyalist, you need to check up on the credibility of the brand – the first step is analysing the Star Health Insurance Claim Settlement Ratio 2024.

What is the Claim Settlement Ratio?

The Claim Settlement Ratio (CSR) of a health insurance provider is given by –

(Total number of claims settled by an insurer in a year/ Total number of claims received by the insurer for the year) * 100

CSR is often the first step in measuring the credibility of an insurer. It offers a surface insight into the brand’s claim settlement track record. The ideal range of CSR for any top-notch health insurance provider is above 90 and below 100. On the other hand, any insurer with a CSR of above 100 indicates that the insurer has an issue with delayed claim settlement, while a provider with a CSR of below 80 suggests that the insurer may be rejecting a lot of claims. Thus, as a policyholder, you should steer clear of an insurer with a CSR that is below 80 and above 100 and go ahead with an insurer with a CSR within the ideal range.

However, please remember that CSR has a few shortcomings and hence, it can’t be the only parameter when deciding upon a brand as your preferred health insurance provider.

What is the Star Health Insurance Settlement Ratio for 2024?


CSR for Star Health Insurance

Years CSR for Star Health Insurance Industry Average of CSR
2020 – 2021 83.64 91.484
2021 – 2022 82.33 89.967
2022 – 2023 80.07 91.460
Average (2020 – 2023) 82.01 90.970

(When seeking the Claim Settlement Ratio of an insurer for a particular year, you should always look at the CSR data for the last financial year. So, if you want to know the Star Health Insurance Claim Settlement Ratio 2024, you need to check the Star Health Insurance Claim Settlement Ratio for 2022-2023. However, acknowledging the CSR data for a year isn’t enough since you can’t get an idea about the consistency of the overall performance of the insurer via a single year’s data. Hence, we have drawn the data for the last 3 years from 2020 to 2023, drawn an average of the same, and compared them against the industry average.)

Overview of Star Health Insurance

Overview of Star Health Insurance

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What is the significance of Star Health Insurance Claim Settlement Ratio 2024?

As you can see, the Star Health Insurance Claim Settlement Ratio data from 2020 to 2023 has shown some consistency. However, you, as existential or potential policyholders of the brand, need to analyse what these numbers mean for you. Does this indicate that Star Health Insurance is a credible insurer, and can you trust the brand to opt for a health insurance plan from this stable? Let’s explore to find out!

  1. Consistency: The Star Health Insurance Claim Settlement Ratio from 2020 to 2023 shows certain consistency, considering that the numbers are always in their 80s. Unfortunately, the numbers have been slowly decreasing and considering that the data already falls below the pre-set threshold of 90, this is not a great sign for its policyholders.
  2. Overall Performance: The Star Health Insurance Claim Settlement Ratio keeps dropping below the industry average each year for 3 years. Such deteriorating numbers aren’t encouraging enough to avail of a health insurance plan from this stable unless you are a brand loyalist.

Why is the Claim Settlement Ratio important?

The Claim Settlement Ratio of a health insurance provider is a crucial metric when determining the brand’s credibility. It offers insight into the claim insurance track record of the provider and is, hence, often the first parameter that is considered.

Unfortunately, CSR misses out on revealing a few things about claim settlement and the brand, for example – the future sustainability of the insurer, its claim settlement potential, the time required to settle claims, and the amount of the claim settled (partial or in full). Hence, while CSR is an important parameter in determining the credibility of a health insurance provider, it can’t be the only factor. You must also consider the brand’s Incurred Claim Ratio (ICR), complaint volume, and the number of partner hospitals involved.

What is the Claim Settlement Process for Star Health Insurance?

  1. CASHLESS

STEP 1: Contact Star 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.)

2. REIMBURSEMENT

STEP 1: You can register your claim online by visiting the official link

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 assistance on your claim settlement by calling their helpline numbers, as mentioned on their site.

What are the documents required to settle claims for Star Health Insurance?

When planning to file a claim to Star Health Insurance, make sure you have the soft/hard (online/offline process) copies of the following documents handy –

  1. CASHLESS
  • Policy number (health insurance card)
  • Copy of ID proof

2. 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 the diagnosis and all doctor consultation papers
  • Copy of final bill with detailed breakup
  • Copy of payment receipt against the payment made
  • Copy of the cancelled cheque bearing the pre-printed name of the proposer on it or a copy of the last 3 months’ bank statement of the proposer bearing the bank account number and IFSC code or a copy of the first page of the bank passbook of the proposer showing the bank account details

Please note: Based on the underwriter’s decision, you may be required to submit some additional documents.

Conclusion

Unless you are a brand loyalist, Star Health Insurance, unfortunately, has a few quality competitors. Considering the deteriorating metrics across the Claim Settlement Ratio (CSR), Incurred Claim Ratio (ICR), and complaint volume – it wouldn’t be surprising if you decided to go ahead with the alternatives. Additionally, the available health insurance plans are neither comprehensive nor affordable and often come with room rent restrictions,  co-payments, disease-wise sub-limits, and more terms and conditions that limit the perks significantly.

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