Choosing the Right Health Insurer in India – A Broker’s Deep-Dive Guide

Claim Settlement Ratio FY 2024 - 2025

Why This Blog Exists

Every other ad out there shouts — “Choose us! 99% Claim Settlement Ratio!”.Sounds great, right? But here’s the truth: claim settlement ratio is just the tip of the iceberg.

Over the years as a broker, I’ve seen clients stuck with:

• High premium jumps after a year.

• Long delays in claim payout despite a “high” settlement ratio.

• Hidden limits that left them paying big from their own pocket.

So, I decided to dig deep. Not marketing brochures. Not hearsay. Actual regulator data, annual reports, and grievance records. The result? This Top 10 Health Insurer Comparison 2025 — with real numbers, traffic-light ratings, and zero sugar-coating.

The 5 Big Things You Should Look At

Here’s what matters most when picking a health insurer in India (and what I’ve actually used in my analysis):

#	Factor	Why It Matters
1	Claim Settlement Ratio (CSR)	Measures how many claims get approved (by count). Good, but doesn’t show claim amount fairness.
2	Average Claim Processing Time	A quick payout matters during emergencies — some insurers take weeks, others days.
3	Grievance Ratio	Grievances per 10,000 policies – the lower, the better. It’s a hidden indicator of customer service.
4	Ombudsman Cases	If many cases go to the ombudsman, that’s a sign of disputes not resolved internally.
5	Premium Stability	Some insurers hike premiums steeply every renewal. Others are more predictable.

(Sources: IRDAI Public Disclosures NL-45, Company Annual Reports, Insurance Ombudsman Annual Report FY24)

The Top 10 Health Insurers – Data Table

Here’s the latest compiled data for 2025 from verified sources. RAG Rating: Green = Excellent, Amber = Okay, Red = Needs Improvement.

Insurer	Claim Settlement Ratio (%)	Avg. Claim Processing Time (days)	Claim Settled by Amount (%)	Premium Revision (FY24–25)	Grievances per 10k Policies	Claim Complaints per 10k Claims	Health Incurred Claim Ratio	Solvency Ratio	Network Hospitals	Inhouse TPA	Ombudsman Cases (FY24)	RAG (Grievances)
ICICI Lombard	99.0	14	Not disclosed	No data publicly available	0.63	10.5	70.79	2.69	10200	Yes	Not disclosed	🟢
HDFC ERGO	98.5	16	Not disclosed	No data publicly available	1.1	6.9	87.7	1.997	15000	Yes	Not disclosed	🟢
Niva Bupa	96.0	15	Not disclosed	No data publicly available	2.4	45.7	59.02	3.03	10000	Yes	Not disclosed	🟢
Star Health	99.6	12	Not disclosed	No data publicly available	3.2	45	66.47	2.21	14000	Yes	Not disclosed	🟠
Care Health	95.5	17	Not disclosed	No data publicly available	4.5	47	57.69	1.74	11400	Yes	Not disclosed	🔴
Manipal Cigna	97.8	14	Not disclosed	No data publicly available	0.9	42	63.78	1.75	8500	Yes	Not disclosed	🟢
Aditya Birla Health	95.0	15	Not disclosed	No data publicly available	1.8	22	68.31	1.637	5900	Yes	Not disclosed	🟢
TATA AIG	98.0	14	Not disclosed	No data publicly available	1.2	20	69.25	1.91	10000	Yes	Not disclosed	🟢
Reliance General	96.5	18	Not disclosed	No data publicly available	2.9	7	74.98	1.78	9000	Yes	Not disclosed	🟠
SBI General	97.0	15	Not disclosed	No data publicly available	.59	18.8	83.11	1.86	16700	Mixed	Not disclosed	🔴

Note: “Claim Settled by Amount” is not publicly disclosed by IRDAI or companies – this is a big transparency gap in the industry. Premium revisions are also not publicly available

What This Table Really Tells You

1. CSR Alone is Misleading Star Health tops CSR but has a higher grievance rate — meaning customers still face issues despite claims being “settled”.

2. Low Grievances = Better Experience ICICI Lombard, ManipalCigna, and TATA AIG have the cleanest grievance ratios.

3. Ombudsman Numbers Matter If an insurer has many Ombudsman cases, it could mean unresolved disputes.

4. Premium Stability is Key A “cheap” first-year premium can double in 2–3 years if you don’t check past revision patterns.

5. Transparency Gaps Exist Not disclosing “claim settled by amount” keeps customers in the dark — you should ask your insurer about this directly

   
   

   My Broker Take – Who Fits Where

   
   

   • Best All-Rounder → ICICI Lombard, HDFC ERGO, TATA AIG, SBI General (balanced ICR, low grievances, moderate premiums)

   • Fast Claims, But High Complaints → Star Health

   • Budget-Friendly, Decent Service → Niva Bupa, Aditya Birla

   • Proceed with Caution → Care Health, STAR, NIVA, Manipal (higher complaints)

Final Word

Choosing a health insurer isn’t about picking the company with the biggest ad budget or the most celebrity endorsements. It’s about looking at real, verifiable data — and making sure your insurer’s strengths match your needs.

That’s where a broker like me comes in. I do the boring (but important) data digging so you don’t end up with unpleasant surprises when you need your policy the most.

If you’d like me to personally review your current health policy or recommend the right fit for your family/business, just drop me a message.

9920099273

info@ckpinsurance.co.in

📚 Sources

• IRDAI Public Disclosures NL-45 (Grievance Data) – IRDAI Website

• Insurance Ombudsman Annual Report FY24 – CIO India

• Company Annual Reports FY24 – Public Disclosures section of each insurer.