Kolkata: Data from the Insurance Regulatory and Development Authority of India (IRDAI) has revealed that the claim rejections by the health insurance companies in India in the last financial year (FY24) has risen by a high 19.10% compared to the number of rejections in FY23. From another yardstick, the total rejections amounted to 11% of all health insurance claims that Indians made in FY24.
The amount of claim that stood rejected in FY23 was Rs 21,861 crore. The total value of the health insurance rejections in the last financial year (FY24) amounted to a humongous Rs 26,000 crore. Significantly, insurance penetration declined for the second year on a trot in FY24, when it fell to 3.4% in India. Insurance penetration was at a peak of 4.2% in FY22 (due to Covid 19 pandemic) while it dipped to 4% in FY23. Insurance penetration is determined by the percentage of total premium collected to a country’s GDP.
Insurance claims processed in FY24, death claims
Health and general insurance companies processed a total of 2.69 crore health insurance claims in FY24, revealed the IRDAI report. It involved an average claim settlement amount of Rs 31,086. The IRDAI report also paid down the statistics of how many claims were settled through TPAs (third party administrators). As much as 72% were settle with the assistance of TPAs while 28% were settled internally. Significantly, an amount of Rs 48,512 crore was paid in FY24 to settle death claims. The death claim settlement amount for FY23 was Rs 46,380 crore. IRDAI data also provided the breakdown – Rs 28,868 crore death claims originated from individual insurance policies while Rs 19,644 crore came via group policies.
When are health insurance claims rejected
Many reasons can lead to rejection of a health insurance claim. If the validity of the insurance policy in question is question, claims might be rejected. Such validity issues could rise if there are mistakes or discrepancies in the documentation of the policyholder and/or terms and procedures. If there are waiting period for the treatment of a particular ailment and the claim was made within that period, the claim will stand rejected. Therefore, personal finance advisers always advise extreme caution on reading policy documents/riders when buying an insurance claim filing claims adhering to the policy of the insurance company.
As much as 11% of all health insurance claims were consigned to the basket by health insurance companies in India in FY24. Data from insurance regulator IRDAI show that claims totalling to Rs 26,000 crore were not entertained in FY24 – a rise of 19.10% compared to FY23. Biz News Business News – Personal Finance News, Share Market News, BSE/NSE News, Stock Exchange News Today
