When selecting a health insurance company, most individuals look at numbers such as the ICICI Lombard General Insurance Company’s claim settlement ratio. Although metrics like the claim settlement ratio are important, they don't provide the full picture. Life is unpredictable, and when unforeseen medical bills come your way, having an insurer that you can actually rely on is the real deal-maker. An insurer’s good record of dealing with claims can offer much-needed financial stability in difficult times.
In this article, we will focus on ICICI Lombard General Insurance Company’s claim settlement ratio in detail, its key features, and compare it with other competitors in the insurance market. If you are thinking of taking a new policy or just evaluating your options, knowing how ICICI Lombard handles claims can assist you in making an informed choice for your health and finances.
What Is The Claim Settlement Ratio And How It Is Calculated?
The claim settlement ratio for health insurance is the percentage of claims an insurance firm successfully settles in a financial year against the total number of claims received. It is easy to calculate by employing this formula:
Claim Settlement Ratio = (Number of claims settled) / (Number of claims received + Outstanding claims at the beginning of the year) × 100
Though this ratio will provide a rough estimate of how reliable an insurer is, it should not be the sole determinant. A higher CSR can seem comforting, yet it does not necessarily reveal everything about how the claims are managed or the frustrations insureds could experience in going through the process.
In the next section, we’ll take a closer look at ICICI Lombard General Insurance Company’s performance and what it means for individuals.
ICICI Lombard General Insurance Company Key Features and Benefits
ICICI Lombard General Insurance Company Limited was formed through a partnership between ICICI Bank Limited and Fairfax Financial Holdings Limited in 2001. It is a private general insurance company, headquartered in Mumbai, Maharashtra, which caters to insurance requirements across multiple dimensions, like health, automobiles, personal accidents, crops, fires, and marine.
As managing director and chief executive officer of the company, Mr. Bhargav Dasgupta heads the company's expansion and drives innovation-focused strategies within the sector.
Let's consider some of ICICI Lombard General Insurance Company's major features now:
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% of Complaints Received On Overall Claims
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% of Complaints Received For After-Sales Service
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Claims Settled In Less Than 30 Days
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No. of Cashless Hospitals
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Source: ICICI Lombard General Insurance Company’s official website and public disclosure for the financial year 2023-2024.
ICICI Lombard General Insurance Company’s Health Benefits:
Health insurance is a financial buffer when you have an unexpected medical bill. The greatest advantage? It pays for the majority of medical care expenses, so you don't have to deplete your savings. From hospitalisation to treatments, it covers different medical bills and has other benefits as well.
- Covers Hospitalisation Expenses
Health insurance covers the cost of hospitalisation when you require inpatient treatment. A minimum stay of 24 hours is usually necessary for coverage. Once a patient is hospitalised, the policy covers charges such as room rates, nursing charges, medical investigations, surgeries, and other hospital expenses.
- Includes Pre- and Post-Hospitalisation Costs
Health insurance not only pays for your hospitalisation time, it also covers medical charges prior to and after hospitalisation for a specified duration. Costs prior to hospitalisation, including laboratory tests and doctor visits, are paid for as long as they are directly associated with the condition that led to hospitalisation and are approved as a part of inpatient hospitalisation expenses. Likewise, post-hospitalisation expenses should relate to the same illness and must fall under the scope of the inpatient coverage.
- Covers Daycare Treatments
Due to significant advancements in medical technology, many procedures can now be performed without necessitating an overnight stay in the hospital. Your health insurance will pay for short procedures, including surgery such as gallbladder removal, hernia repair, and procedures like chemotherapy. It keeps you from worrying about the costs as you receive the required medical care.
- Facilitates Domiciliary Treatments
At times, treatment must be administered at home, either because of a patient's serious condition or due to limited availability of beds in hospitals. In these situations, most health insurance policies come to your rescue and fund domiciliary treatments, so you can get medical attention at home comfortably without any burden.
- Offers Preventive Health Check-ups
Remaining healthy is not just about treatment but also prevention. Most health insurance policies cover routine check-ups, which enable you to detect any possible health conditions early. Constant screenings and tests can be of great help in maintaining your wellness before issues develop into something complicated.
- Rewards You with a No Claim Bonus
If you file no claims within a policy year, most health insurance policies provide a No Claim Bonus. Your sum insured could increase, or your premium could be cut down on your policy renewal. It's one good incentive towards a healthy lifestyle with some additional savings in terms of medical expenditure in the future.
- Includes Tax Benefits
Health insurance is not only about paying for doctor bills; it also offers you tax benefits. The amount of premium you pay can be claimed as a deduction under Section 80D of the Income Tax Act, provided you fulfil the required conditions. The extent of deduction differs according to who is insured, with additional benefits if dependent parents or senior citizens are covered under the policy.
- Provides Cashless Treatment
The ability to receive cashless treatment is another important benefit of health insurance. The insurance provider pays the hospital directly, so you don't have to bother about arranging payment in advance if you receive treatment at a network hospital. This makes filing a claim easy and convenient, especially in an emergency where time is of the essence. You will only be required to pay for items that your coverage does not cover.
A vital safety net that aids in controlling medical costs, health insurance covers everything from regular checkups to hospital stays. It provides all-round coverage, tax benefits, and flexible options for added protection, helping you manage unpredictable healthcare expenses with ease.
With all that said, all insurance policies are not alike. Coverage, conditions, and terms differ among companies, so do read the fine print and know what is covered. In addition, tax benefits are based on prevailing tax legislation.
What Is The ICICI Lombard Claim Settlement Ratio?
As of March 2024, ICICI Lombard General Insurance Company has a claim settlement ratio of 80.97%, according to its public disclosures for the financial year 2023-24.
What Is The Claim Process Of ICICI Lombard General Insurance Company?
ICICI Lombard General Insurance Company provides two options for filing a claim:
Cashless Claim
If you get treated at a hospital that is part of the insurer's network, you can make use of the cashless claim facility. ICICI Lombard General Insurance Company has arrangements directly with the hospitals to make the process easier for you so you can concentrate on your recovery rather than worrying about payments. The medical bills are settled directly by the insurer with the hospital, so you just have to pay for anything that is not covered under your policy.
Cashless Claim Process
Here's how you can go about making a cashless claim:
- Verify whether the hospital you have selected is under your insurer's network and provides cashless facilities.
- Ensure the hospital is not an excluded provider.
- Go through your policy to see what limitations or out-of-pocket expenses you may have to bear.
- Collect necessary documents, such as your policy document, proposer's PAN and Aadhaar, patient ID, medical records, etc., before filing the claim.
- File your claim request; if it's an emergency, do so within 24 hours of hospitalisation. In the case of scheduled treatments, file it at least 3–4 days prior.
- Provide all documents that are needed for pre-authorisation, such as your health card, proposer's KYC (PAN, Aadhaar), patient's ID, policy details, and details of the treating doctor.
- In case of a delay in pre-authorisation, be ready to pay an advance deposit to the hospital.
- After your discharge date is established, go to the hospital insurance desk to verify that all the paperwork has been gathered.
- Be attentive to any correspondence from your insurer and react promptly to any further document requests.
- Monitor your claim status at each step to prevent delays.
- Carefully examine the final bill and discharge summary to determine what costs are covered and what will need to be paid.
- If you are ever in doubt or encounter problems, don't panic and call your insurer directly or speak to your financial advisor.
- Before you actually leave the hospital, ensure you're prepared to pay for those expenses not incurred under your cover.
- Make sure all formalities are done so that you face no last-minute hassles.
Reimbursement Claims
If you are treated in a non-network hospital, you will have to pay the medical bills yourself at the time of treatment. After the treatment is over, you can submit a reimbursement claim to your insurer. The insurer will examine your claim, check the documents and then reimburse the eligible costs as per the terms and conditions of your policy.
Reimbursement Claim Process
Here's what you have to do to make a reimbursement claim:
- Verify that the hospital you select is not in your insurer's list of excluded healthcare providers.
- Inform your insurance company within 24 hours of hospitalisation.
- At the time of discharge, gather all original documents, such as receipts, invoices, discharge summaries, medical reports, MRI/X-ray images, doctor's prescriptions, and the claim form (a part of which is filled out by the hospital).
- Ask for a duplicate of the patient's indoor case papers or case sheet and a comprehensive hospital bill that lists all the charges.
- Ensure that the patient's name, age, and gender are properly stated on all the records and have any mistakes corrected prior to submission.
- Collect required documents, including your health card, policy document, proposer's KYC (PAN, Aadhaar, passport-size photograph), and bank information. Add the patient's ID proof, signed claim form, original discharge summary, and if the case is applicable, the IOL sticker/invoice for implantation claims (e.g., knee replacement, cataract).
- Duplicate all the documents and store them properly in a folder.
- Fill up the claim form and send it to your insurance company along with all the supporting documents.
- Ask your insurer to acknowledge receipt of the documents that have been forwarded.
- Follow up with your insurer to monitor the progress of your claim.
- Provide extra documents as needed promptly.
- Read the summary of the claim payment thoroughly, also noticing any deductions.
- If you are unsure or in need of clarification, contact your insurer or financial advisor.
Documents Required For ICICI Lombard General Insurance Company Claims
Making a health insurance claim at ICICI Lombard General Insurance Company might look like a complex procedure, but possessing the correct documents in hand makes it so much easier. Whether you're going for a cashless claim or reimbursement, preparation can save you time and effort.
For Cashless Claims:
- Insurer's health card
- The proposer's KYC documents (PAN card, Aadhaar card, recent passport-size photograph, etc.)
- Patient's identity proof while undergoing treatment
- KYC information of the insured individual
- Policy number for cross-checking
- Insured's full name
- Full name and address of the insured individual making the claim
- Information about the illness or injury and the treatment or procedure required
- Contact number and address of the treating physician
- Date of expected hospitalisation
- Medical history, including any pre-existing illness, as any variation from the original policy declarations may affect claim sanction
For Reimbursement Claims:
- Health card or a photocopy of the insurance policy
- KYC documents of the proposer, such as:
- PAN card
- Aadhaar card
- Recent passport-size photo
- Bank details for reimbursement (any one of the following):
- Bank statement with printed name of bank, account number, and IFSC code
- Passbook with the latest transaction page
- Original cancelled cheque with the name of the insured printed on it
- Identity proof of the patient
- Duly filled and signed claim form
- All relevant medical records, such as test reports, prescriptions, X-rays, and treatment receipts
- Original discharge summary from the hospital
- IOL (Intraocular Lens) sticker and receipt for claims connected with implantation procedures (e.g., cataract surgery, knee replacement)
Note: It's always better to clarify with ICICI Lombard General Insurance Company as to whether there are any specific requirements or additional formalities involved in your claim.
How To Track Your ICICI Lombard General Insurance Claim Status?
To verify the status of your ICICI Lombard General Insurance Company’s claim, you can go to their official claims tracking website. Just type in your claim intimation number, and you'll receive real-time information about your claim status.
If you want to talk to a representative, you can call 1800-2666. Tell them you want to track your claim, and they'll walk you through it step by step.
In Conclusion
The claim settlement ratio of ICICI Lombard General Insurance Company as of March 31, 2024, is 80.97%. Having the right documents and knowing the process will make the process smooth and hassle-free, whether you wish to file a reimbursement claim or go cashless. Choosing a reputable insurance provider ensures that you and your loved ones will be able to enjoy the financial protection you need when you need it most in an uncertain world where healthcare expenses may be unexpected.
FAQs
The ICICI Lombard General Insurance Company claim settlement ratio as of March 2024 is 80.97%. (Source: Public Disclosure FY-2023-24)
The insurer will process and either approve or deny a claim within 30 days from the date of receiving the final required document. However, if the insurer determines that an investigation is necessary, the claim shall be settled or rejected within 45 days from the receipt of the last essential document. ICICI Lombard General Insurance Company has settled 99.78% of claims in less than 30 days in FY 2023-24. (Source: Public Disclosure FY-2023-24).
The documents required to make a health insurance claim against ICICI Lombard General Insurance Company will vary based on whether it is a cashless or reimbursement claim. Health card, KYC details, policy documents, and medical documents are normally necessary for cashless claims. Claim forms with complete information, a copy of the policy document, original bills received at the hospital, discharge summary, medical reports, and a cancelled cheque are normally necessary for reimbursement claims. Even though these are the general requirements, it is always best to ask the insurer whether any specific documentation is needed.
ICICI Lombard General Insurance Company covers pre-existing diseases, though, after serving the required waiting period mentioned in the policy document. The waiting period can be a maximum of three years, subject to the choice of plan you opt for. For complete knowledge about the coverage, exclusions, and conditions, it's necessary to read the policy details thoroughly before deciding.
Even with a good health insurance policy, not all claims will be approved. Insurers evaluate claims under the terms and conditions of the policy, and there are some reasons why an insurer can refuse a claim. Some of these reasons include falling under the category of exclusions, failure to observe the waiting period, failure to provide key documents, or not adhering to the claim procedure of the insurer. It always pays to read your policy carefully so that you are not left in the dark.
Monitoring your ICICI Lombard General Insurance Company claim status is simple. You can easily check the status online using their site or mobile application or even contact their customer service for a quick update. If you would like, you may also stop by the closest branch for a visit. What's more, insurers usually notify claim status changes via SMS or email, so you'll always be in the loop.
A number of factors determine the claim settlement ratio, including the number of claims submitted and settled, the pace and efficiency of claim settlement, the adequacy of documents presented, and whether the claims meet the terms and conditions of the policy.
A good claim settlement ratio shows that an insurance company has a good history of settling claims efficiently. It doesn't, however, mean that all claims will be settled. Every claim is evaluated based on the terms of the policy, the exclusions, and the validity of the documents presented.
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