More than 50 per cent of insurance claims in India got a compensation of 80 per cent or more in insurance claims, a survey by insurance broker SecureNow says.
The survey was conducted between April 2022 and March 2023. The report analysed 3,846 health claims covering diverse locations, insurers, family members, and third-party administrators (TPAs), both external and internal.
The research sheds light on the average size of health insurance claims in India, besides various aspects of the country’s health insurance landscape.
Says Kapil Mehta, co-founder of SecureNow, in a press statement: “The research emphasises that the duration of hospitalization is a critical aspect of health insurance claims.” The study shows that 15 per cent of the claims exceeded Rs 1 lakh.
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Adequate Coverage Considerations For Policyholders
The report emphasises the importance of policyholders and insurance providers taking into account potential high-cost situations when crafting coverage options, as the average health insurance claim in India is Rs 42,000, with 15 per cent of claims surpassing Rs 1 lakh.
A coverage limit of Rs 5 lakh may not address certain situations, such as hospitalisations lasting more than five days and incurring costs exceeding the coverage limit. This underlines the importance of higher coverage options to mitigate the financial burden of unexpected medical expenses.
Focus On Key Health Issues And Maternity Coverage
The report also highlights key areas of health issues covered by insurance. While daycare procedures constitute 29 per cent of all claims, it is crucial to ensure that health insurance policies include coverage for such scenarios. Furthermore, maternity claims constitute a significant portion, accounting for 20 per cent of total claims. Therefore, policies should adequately address the needs of expectant mothers and provide comprehensive maternity coverage.
Additionally, the report reveals that approximately 21 per cent of hospitalisations in India extend beyond three days, emphasising the need for coverage options that account for more extended stays. Assessing the potential costs associated with extended hospitalisations and ensuring that policy coverage aligns with these scenarios is essential.
Understanding Cost Factors And Proper Documentation
The report also examines the cost factors related to health insurance claims in India. While cancer claims represent only around one per cent of the total claims, they tend to have a relatively high per-case cost. On the other hand, accidents, although common, have an average cost of Rs 33,000, which is lower than the overall average cost of claims.
Proper documentation plays a critical role in the claim settlement process. Submitting accurate and complete documents, including medical bills, prescriptions, diagnostic reports, discharge summaries, claim forms, policy documents, and any other requested supporting documents, is essential. Submitting these documents serves as crucial evidence for the claim and facilitates a streamlined and expedited claim settlement process.
As per the report, the claim process in India demonstrates exceptional efficiency, with over 82 per cent of the necessary documents submitted during the claim intimation stage. Deficiencies in documents were identified in only 24 per cent of cases, indicating the importance of adhering to proper documentation practices for successful claim settlements.
By understanding key health issues, such as daycare procedures and maternity claims, and ensuring proper documentation, individuals can make informed decisions to protect their financial well-being in medical emergencies.
