The average cost of health insurance claims in India is Rs 42,000, with 15% of these claims exceeding Rs 1 lakh, revealed a study by a research report by SecureNow on reimbursement health insurance claims.
SecureNow analysed 3,846 health claims filed through the reimbursement process (as opposed to cashless). These claims were geographically diverse and covered different kinds of insurers, family members, and both external and internal Third Party Administrators (TPA).
The report provides significant findings on hospitalisation duration, claim costs, settlement rates, and the efficiency of the claim settlement process in India.
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The study found that while the average cost of health insurance claims is Rs 42,000, 15% of claims exceed Rs 1 lakh, indicating substantial expenses for a portion of claimants. This highlights the need for policyholders and insurance providers to consider potential high-cost scenarios, such as hospitalisations exceeding five days and costing over Rs 5 lakhs, when designing coverage options.
Furthermore, less than 3% of claims are due to accidents, with a lower median cost of Rs 33,000. The research report emphasises that the duration of hospitalisation is a critical aspect of health insurance claims, according to SecureNow Insurance Broker, co-founder, Kapil Mehta.
The comprehensive study reveals that the typical hospitalisation period is two days, but more than 21% of hospitalisations extend beyond three days, said Mehta. “This underscores the necessity for comprehensive coverage that accounts for longer hospital stays,” he added.
Additionally, day care procedures constitute 29% of all claims, highlighting the importance of including coverage for these procedures in health insurance policies, SecureNow said.
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Mehta further said the research report also indicates relatively high claim settlement rates, with over 50% of claims having a settlement rate of 80% or higher of claims made. Maternity claims contribute significantly, comprising 20% of total claims as a segment.
Fever (5%), eye surgeries (5%), and accidents (3%) also make substantial contributions to the overall claim volume. Although cancer accounts for approximately 1% of claims, the per case cost is relatively high. Conversely, accidents, despite being frequent, have an average cost of Rs 33,000, which is lower than the overall average cost of claims.
Furthermore, the research report highlights the efficiency of the claim settlement process, stating that more than 82% of required documents are submitted at the time of claim intimation. In 76% of cases, there are no deficiencies in the documents.
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