According to a SecureNow study on health insurance claim reimbursement, the average cost of health insurance claims in India is Rs 42,000, with 15% of these claims costing more than Rs 1 lakh.
3,846 health claims submitted via the reimbursement method (as opposed to cashless) were examined by SecureNow. Geographically diversified, these claims included a range of insurers, family members, and third party administrators (TPA) both internal and external.
Significant information is included in the study on the length of hospital stays, claim expenses, settlement percentages, and the effectiveness of the claim settlement procedure in India.
While the average cost of health insurance claims is Rs 42,000, the survey revealed that 15% of claims cost more than Rs 1 lakh, suggesting significant costs for certain claimants. This demonstrates the need of taking into account probable high-cost situations, including hospitalizations lasting more than five days and costing more than Rs 5 lakhs, while establishing coverage alternatives for customers and insurance companies.
Additionally, accidents account for fewer than 3% of claims and have a lower median cost of Rs 33,000. According to Kapil Mehta, co-founder of SecureNow Insurance Broker, the study report emphasizes how important the length of hospitalization is to health insurance claims.
According to the extensive research, the average hospital stay is two days, while more than 21% of hospital stays go more than three days, according to Mehta. This emphasizes the need for comprehensive insurance that takes lengthier hospital stays into account, he said.
Additionally, 29% of all claims are for day care operations, underscoring the need of health insurance plans covering these procedures, according to SecureNow.
Mehta said that the study report also shows very high claim settlement rates, with over 50% of claims having an 80% or greater settlement rate of claims submitted. Maternity claims make around 20% of all claims, which is a considerable contribution.
Accidents (33%) and fever (5%), as well as eye procedures (5%), make significant contributions to the total number of claims. Even though just 1% of claims are for cancer, the cost per case is rather substantial. Contrarily, although being common, accidents only cost Rs 33,000 on average, which is less than the average cost of claims as a whole.
More than 82% of the necessary papers are supplied at the time of claim notification, according to the study report, which also emphasizes the effectiveness of the claim settlement procedure. There are no document issues in 76% of instances.
