Insurance Awareness - Health Insurance
Which of the following is TRUE about the claim settlement ratio in relation to cashless and reimbursement claims?
Which of the following is TRUE about the claim settlement ratio in relation to cashless and reimbursement claims?
medium Q7 of Q15
Step-by-Step Solution
Step 1: Understand claim settlement ratio
Claim settlement ratio is the percentage of claims settled by the insurer out of total claims received, including both cashless and reimbursement claims.Step 2: Analyze options
Claim settlement ratio is calculated separately for cashless and reimbursement claims. is incorrect as the ratio is overall, not separate. Reimbursement claims do not affect the insurer's claim settlement ratio. is wrong because reimbursement claims affect the ratio. Claim settlement ratio only considers cashless claims. is incorrect as both claim types are included.Step 3: Correct option
Higher cashless claim settlements contribute positively to the overall claim settlement ratio.Final Answer:
Higher cashless claim settlements improve the insurer's claim settlement ratio. → Option AQuick Check:
Both claim types impact the ratio; efficient cashless settlements enhance insurer reputation.
Quick Trick: Claim settlement ratio = (All claims settled / All claims received) × 100.
Common Mistakes:
MISTAKES- Thinking claim settlement ratio excludes reimbursement claims.
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