The average cost of a health insurance claim in India is Rs 42,000 and 15% of these claims exceed Rs 100,000, according to a study called ‘Reimbursement Health Insurance Claims’ by tech-enabled insurance broker SecureNow. became clear in
This comprehensive report contains key findings on length of hospital stay, claims costs, settlement rates and efficiency of the claims resolution process in India.
SecureNow analyzed 3,846 health insurance claims submitted through the reimbursement process (rather than cashless). These claims were geographically diverse, covering different types of insurers, their families, and his TPAs, both external and internal.
According to the study, the average cost of a health insurance claim was Rs 42,000, but 15% of the claims exceeded Rs 100,000, indicating a high cost for some claimants. shown. This highlights the need for policyholders and insurers to consider potential high-cost scenarios when designing coverage options, such as hospitalization of more than 5 days and his cost of over Rs.5 lakh. to
Furthermore, accident claims are less than 3% and the median cost is as low as Rs 33,000. According to SecureNow co-founder Kapil Mehta, the report highlights length of stay as an important aspect of health insurance claims.
Mehta said a comprehensive study revealed that while the typical length of stay is two days, more than 21% of hospitalizations were longer than three days. “This highlights the need for comprehensive coverage that considers long-term hospitalization,” he added.
Additionally, day care procedures account for 29% of all insurance claims, highlighting the importance of including these procedures in health plans, SecureNow said.
Mehta added that the research report also showed a relatively high claim resolution rate, with claims resolution rates of 50% and above being 80% and above. Among the segments, maternity claims are a major contributor, with him accounting for 20% of total claims.
Fever (5%), eye surgery (5%) and accidents (3%) also contribute significantly to overall claims. Cancer accounts for about 1% of claims, but the cost per case is relatively high.
Additionally, the research report highlights the efficiency of the claims resolution process, stating that over 82% of the documents requested are submitted at the time of notice of the claim. In 76% of cases there are no deficiencies in the documents.
