Common medical health insurance declare in India is Rs 42,000, with 15% exceeding Rs 1 lakh: Examine

The common price of medical health insurance claims in India is Rs 42,000, with 15% of those claims exceeding Rs 1 lakh, revealed a examine by tech-enabled insurance coverage dealer SecureNow known as Reimbursement Well being Insurance coverage Claims.

The excellent report has vital findings on hospitalisation period, declare prices, settlement charges, and the effectivity of the declare settlement course of in India.

SecureNow analysed 3,846 well being claims filed by the reimbursement course of (versus cashless). These claims have been geographically numerous and coated completely different sorts of insurers, relations, and each exterior and inside TPAs.

In accordance with the examine, whereas the typical price of medical health insurance claims was Rs 42,000, 15% of claims exceeded Rs 1 lakh, indicating substantial bills for a portion of claimants. This highlights the necessity for policyholders and insurance coverage suppliers to think about potential high-cost situations, resembling hospitalisations exceeding 5 days and costing over Rs 5 lakh, when designing protection choices.

Moreover, lower than 3% of claims are attributable to accidents, with a decrease median price of Rs 33,000. The report emphasises that the period of hospitalisation is a vital side of medical health insurance claims, in keeping with SecureNow’s co-founder Kapil Mehta.

The excellent examine reveals that the everyday hospitalisation interval is 2 days, however greater than 21% of hospitalisations lengthen past three days, stated Mehta. “This underscores the need for complete protection that accounts for longer hospital stays,” he added.

Moreover, day-care procedures represent 29% of all claims, highlighting the significance of together with protection for these procedures in medical health insurance insurance policies, SecureNow stated.

Mehta added that the analysis report additionally signifies comparatively excessive declare settlement charges, with over 50% of claims having a settlement fee of 80% or larger. Amongst segments, maternity claims contribute considerably, comprising 20% of whole claims.

Fever (5%), eye surgical procedures (5%), and accidents (3%) additionally make substantial contributions to the general declare quantity. Though most cancers accounts for roughly 1% of claims, the fee per case is comparatively excessive.

Moreover, the analysis report highlights the effectivity of the declare settlement course of, stating that greater than 82% of required paperwork are submitted on the time of declare intimation. In 76% of circumstances, there aren’t any deficiencies within the paperwork.