Partial hospital bill payout: Boost policy cover to secure full claims

In particular, avoid room rent caps that lead to proportionate deduction

The Insurance Regulatory and Development Authority of India (IRDAI) chairman, Ajay Seth, recently highlighted a gap in health insurance claim settlement: while most claims are approved, the amounts paid are often lower than customers expect. 

“High claim settlement ratios (CSRs) can mask the fact that settled amounts may be much lower than what customers claim. CSR counts approvals but does not reflect the actual amount paid,” says Manju Dhake, head – insurance advisory practice, 1 Finance. 

Partial settlements typically result from policy conditions. “Health insurance policies frequently include clauses such as co-payments, room rent caps, sub-limits on treatments, exclusions for