Health insurance claims in India reveal a gap between the amounts claimed by patients and those paid by insurers. Recent data from the Insurance Brokers Association of India (IBAI) sheds light on the performance of various insurers in 2023.
Private Insurers Pay Less Than 80 Percent
In 2023, 20 private insurers paid less than 80 percent of the claimed amounts, leaving policyholders to bear a significant portion of the hospital bills. For instance, if a patient claimed Rs one lakh, the insurer covered only Rs 80,000 or less, with the remaining amount paid out-of-pocket by the patient.
Top Performers: Public Sector Insurers Lead
Public sector insurers outperformed private ones in terms of claims paid ratio. New India Assurance led with an impressive 98.74 percent payout of the claimed amount, followed by Oriental Insurance at 97.35 percent. This demonstrates a higher reliability in claims settlement by public insurers.
Private Sector Trends
Among private players, only four insurers had a claims paid ratio exceeding 90 percent. IFFCO Tokio (91.70 percent) and Bajaj Allianz (90.29 percent) emerged as top performers. However, several private insurers, including HDFC Ergo and ICICI Lombard, paid only 71.35 percent and 63.98 percent of the claimed amounts, respectively.
Claims Settled and Methods Used
According to the IRDAI Annual Report for 2022-23, insurers settled 2.36 crore health claims, amounting to Rs 70,930 crore. Of these, 56 percent were processed via cashless mode, while 42 percent were settled through reimbursement. This balance highlights the importance of understanding claim settlement processes.
Key Observations for Policyholders
Policyholders should evaluate insurers based on their claims paid ratio and settlement processes before choosing a health insurance provider. Public sector insurers generally show better performance, while private insurers exhibit significant variation in payouts.
Conclusion
The health insurance landscape in India underscores the need for transparency and informed decision-making by policyholders. Insurers’ claims paid ratios are a critical factor in determining the reliability of health coverage. As data for 2024 becomes available, it will offer further insights into the industry’s evolving trends.
