Premium
The amount you pay the insurer for the cover, monthly or yearly.
Example: ₹12,000 a year for a health policy.
How to read an insurance policy
Most claim disputes come from a few terms in the fine print. Learn them before you buy, not at the hospital.
This page is for education only. It is not investment, insurance, tax or legal advice, and it does not recommend any security, fund or policy. Saifu is not a SEBI registered investment adviser and is not an insurer, broker or insurance web aggregator, and it does not sell insurance or investments. Examples are illustrations, not promises. Mutual fund investments are subject to market risks; read all scheme related documents carefully. Past performance does not guarantee future results. Rules, rates and product terms change, so check the current policy wording or offer document. Please discuss with a qualified financial adviser before taking any decision.
A checklist before you buy any policy
- What exactly is covered, and what is excluded? Read the exclusions list first.
- Which waiting periods apply, and for how long?
- Is there a room rent cap, a sub-limit or a co-payment?
- What is the cover per rupee of premium? Compare the sum insured, not only the premium.
- Did you disclose every existing condition the form asks about?
- Is your nominee named? Is the policy in your name or your family's?
- Use the free look period to read the full policy wording, and return it if it is not what you were told.
Term insurance and savings plans
Term insurance is pure life cover. Savings and investment plans (endowment, ULIP) add a maturity benefit, but for the same premium the life cover is usually much smaller. Ask each seller to state the cover and the total charges in writing and compare them side by side.
What the regulator's numbers show
Source: IRDAI Annual Report 2024-25, the regulator's own yearly report for 2024-25. Figures are for the whole industry or as reported by each insurer. They describe the past and say nothing certain about any single policy or claim. Checked on 2026-10-06.
Life insurance: individual death claims
Out of 10,34,455 individual death claims handled in the year (Table I.11, printed page 18), 97.82% were paid, 1.01% were repudiated (turned down under Section 45, usually for non-disclosure or misstatement), 0.66% were rejected under policy terms and 0.48% were still pending at year end. By amount, 96.29% of the money claimed was paid and 2.74% was repudiated. The report does not give these figures for each insurer, so check an insurer's own public disclosure for its claim figures before you compare.
Life insurers: individual death claims, as each insurer reports them
Every insurer must publish its own claims form (IRDAI Form L-40, individual death claims, number of claims, year ended 31 March 2025, as published by each insurer). The table below copies the numbers from those forms for the insurers we have read so far, in alphabetical order. It is not a ranking and it does not cover every insurer. The last column is our own division: claims paid out of claims pending at the start of the year plus claims received in it. Insurers define their own claim settlement ratios in different ways (for example, whether repudiated, rejected or pending claims are counted), so a ratio an insurer advertises can differ from this one. Small insurers have few claims, so one claim moves their percentage a lot. Checked on 2026-10-06.
| Insurer | Claims received | Paid | Repudiated | Pending at year end | Paid share (%) |
|---|---|---|---|---|---|
| Aviva Life Insurance | 754 | 747 | 7 | 0 | 99.07 |
| Axis Max Life Insurance | 20,225 | 20,165 | 60 | 0 | 99.70 |
| Bajaj Allianz Life Insurance | 14,094 | 13,994 | 96 | 4 | 99.29 |
| Bharti AXA Life Insurance | 2,085 | 2,068 | 17 | 0 | 99.18 |
| Edelweiss Life Insurance | 560 | 556 | 4 | 0 | 99.29 |
| HDFC Life Insurance | 19,729 | 19,666 | 58 | 5 | 99.68 |
| IndiaFirst Life Insurance | 3,706 | 3,640 | 61 | 5 | 98.22 |
| IndusInd Nippon Life Insurance | 8,376 | 8,286 | 88 | 1 | 98.93 |
| LIC of India | 8,69,086 | 8,48,145 | 9,137 | 4,790 | 97.59 |
| PNB MetLife India Insurance | 5,639 | 5,615 | 24 | 0 | 99.57 |
| Pramerica Life Insurance | 728 | 722 | 4 | 1 | 99.18 |
| Tata AIA Life Insurance | 8,577 | 8,526 | 49 | 2 | 99.41 |
IndusInd Nippon Life Insurance: The form in this file is headed with the insurer's earlier name, Reliance Nippon Life Insurance. The form also lists 0 claims rejected under policy terms and 1 unclaimed, which are not in the paid or repudiated columns.
LIC of India: LIC separately states a 99.41% death claim settlement ratio for FY25 in its corporate presentation. The ratio above uses only the form's counts, so the two differ. The form also lists 6,827 claims rejected under policy terms and 187 unclaimed, which are not in the paid or repudiated columns.
Pramerica Life Insurance: The form also lists 1 claims rejected under policy terms and 0 unclaimed, which are not in the paid or repudiated columns.
Health insurance: what happens to claims
Insurers handled about 372.58 lakh health claims (Table I.29, printed page 43). In number, 87.5% were paid, 7.92% repudiated and 4.58% were still outstanding. In rupees the picture is different: only 71.14% of the amount claimed was paid, 13.98% was disallowed as per the terms and conditions of the policy, 8.61% was repudiated and 6.27% was outstanding. This is why caps, waiting periods and exclusions matter: a claim can be paid and still be paid in part.
Health insurers: claims, as each insurer reports them
General and standalone health insurers publish a claims form (IRDAI Form NL-37, number of claims in the Health column, year ended 31 March 2025, as published by each insurer). The table copies the numbers from those forms for the insurers we have read so far, in alphabetical order. It is not a ranking and it does not cover every insurer. Claims received are claims pending at the start of the year plus claims reported in it, including reopened claims. "Closed without payment" is a separate line in some forms and is empty in others, and insurers use it differently, so the paid share in the last column is our own division and cannot be compared fairly from one insurer to the next. Cashless claims, wellness components and the mix of retail and group business also differ. Checked on 2026-10-06.
| Insurer | Claims received | Paid | Repudiated | Closed without payment | Pending at year end | Paid share (%) |
|---|---|---|---|---|---|---|
| Bajaj General Insurance | 31,13,603 | 27,16,710 | 77,873 | 99,101 | 25,744 | 87.25 |
| Care Health Insurance | 15,08,929 | 14,36,282 | 46,710 | 0 | 25,937 | 95.19 |
| Go Digit General Insurance | 2,19,114 | 1,99,367 | 2,210 | 11,520 | 6,017 | 90.99 |
| HDFC ERGO General Insurance | 10,95,609 | 10,42,906 | 27,029 | 0 | 25,674 | 95.19 |
| ManipalCigna Health Insurance | 4,92,997 | 4,58,808 | 30,779 | 0 | 3,410 | 93.07 |
| Star Health and Allied Insurance | 28,05,908 | 24,45,991 | 3,17,661 | 0 | 42,256 | 87.17 |
| Zurich Kotak General Insurance | 1,28,235 | 96,546 | 8,329 | 18,723 | 4,637 | 75.29 |
Bajaj General Insurance: The form also lists 1,94,175 partial payments, which are not in the Paid column. Its "closed without payment" figure is the form's "other than repudiated" line.
Care Health Insurance: Cashless claims awaiting payment to the hospital are counted as settled in the form.
ManipalCigna Health Insurance: The form also lists 543 unclaimed claims as a memo item, which are not counted in the columns above.
Star Health and Allied Insurance: Cashless claims awaiting payment to the hospital are counted as settled, and the form says reported and paid claims include wellness components.
Health incurred claims ratio, by insurer
The incurred claims ratio is the part of the premium earned that an insurer paid out or set aside for claims. A higher number is not automatically better or worse: it can mean generous payment, or a loss-making book that may push premiums up. It is not a claim settlement ratio and does not predict how your claim would go. The table is in alphabetical order on purpose and is not a ranking. Insurers that did not report a figure are left out. The report's Statement 10 gives the figure for health business as a whole.
Statement 10, printed page 142. Read the policy wording and the insurer's own claim disclosures, and discuss with a qualified financial adviser, before you decide.
Terms
Sum insured
The most the insurer will pay in a year for health cover, or the amount paid to your family on death for term cover.
Example: ₹10 lakh sum insured.
Waiting period
The time after buying a policy during which certain claims are not paid. Health policies have an initial wait, longer waits for named illnesses and a wait for existing conditions, which IRDAI now caps at 3 years.
Example: Read the list of waits in the policy wording.
Pre-existing disease
A condition you already had, or were told of, before buying the policy. Hide it and a claim can be refused. Tell the insurer everything the form asks.
Example: Honest disclosure protects your claim.
Co-payment
A share of every claim you pay yourself. A 20% co-pay on a ₹1 lakh bill means you pay ₹20,000.
Example: Lower premium, more cost at claim time.
Deductible
A fixed amount you pay before the insurer starts paying.
Example: With a ₹50,000 deductible, a ₹2 lakh claim pays ₹1.5 lakh.
Sub-limit and room rent cap
Caps inside the policy: a daily limit on room rent or a limit on one treatment. If your room costs more than the cap, the insurer may cut the whole bill in proportion, not just the room part.
Example: Check the room rent cap before you buy.
Cashless and reimbursement
Cashless means the insurer pays the network hospital directly. In reimbursement you pay first and claim the money back with the bills.
Example: Cashless works only at network hospitals.
Claim settlement ratio
The share of claims an insurer paid out of the claims it received. It does not tell you why the other claims were refused or how long payment took.
Example: A high ratio is useful but is not the full picture.
Free look period
A window after you get the policy, 15 days in most cases, in which you can return it and get your premium back with small deductions.
Example: Read the policy fully within this time.
Term insurance
Pure life cover. If you die during the term, your family is paid. If you outlive the term, nothing is paid back. It gives the largest cover for the smallest premium.
Example: ₹1 crore of cover for a modest yearly premium.
Endowment and ULIP
Plans that mix life cover with saving or investing. The cover is usually much smaller than a term plan costing the same, and charges can be high. Compare the total cost, not only the promised payout.
Example: Ask what the cover is per rupee of premium.
Surrender value
The money you get if you stop a savings policy early. In the first years it is often much less than you paid in.
Example: Do not buy one you may stop.
Rider
An optional add-on cover bought with a policy for an extra charge, such as critical illness or accidental death.
Example: Add only the riders you will use.
Nominee
The person you name to receive the money if you die. Keep it updated after marriage or a child.
Example: A missing nominee slows the claim.
Moratorium period
After 60 continuous months on a health policy, the insurer generally cannot refuse a claim for non-disclosure, except for proven fraud. Check your policy and the IRDAI rule that applies to it.
Example: Staying continuously insured matters.
Insurance ombudsman
A free dispute service for policyholders in India. You can go there if your insurer rejects or delays a claim and your complaint to it fails.
Example: Try the insurer's grievance team first.
If a claim is refused
Ask for the refusal in writing, with the policy clause it relies on. Write to the insurer's grievance team. If that fails, you can take the complaint to the insurance ombudsman, a free service for policyholders.
Policy rules and IRDAI circulars change. This page is a general guide and is checked from time to time, so confirm the current position on irdai.gov.in or in your own policy document.
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