According to SecureNow, more than half of all health insurance claims in India received a claim settlement refund of 80% or more
According to a study by insurance broker SecureNow, more than 50% of insurance claims in India received payout of at least 80%.
Between April 2022 and March 2023, the survey was carried out. 3,846 health claims from various locations, insurers, relatives, and third-party administrators (TPAs), both internal and external, were examined in the study.
Along with other parts of India’s health insurance environment, the study provides insight into the typical magnitude of health insurance claims there.
In a news release, SecureNow co-founder Kapil Mehta states: “The research emphasises that the length of hospitalisation is a critical aspect of health insurance claims.” According to the report, 15% of the claims were for amounts more than Rs 1 lakh.
Policyholder Considerations For Adequate Coverage
The average health insurance claim in India is $42,000, with 15% of claims above $1 lakh, the research highlights the need of consumers and insurance providers considering probable high-cost circumstances when designing coverage alternatives.
A coverage limit of Rs 5 lakh could not be sufficient in certain cases, such as when hospital stays run longer than five days or when prices rise over the coverage limit. This emphasises how crucial greater coverage alternatives are to lessen the financial strain of unforeseen medical costs.
Prioritise Important Health Concerns And Maternity Coverage
Key areas of health conditions covered by insurance are also highlighted in the study. Even though nursery treatments make up 29% of all claims, it’s important to make sure that such situations are covered by health insurance plans. Additionally, maternity claims make almost 20% of all claims, which is a significant chunk. Therefore, policies should offer comprehensive maternity coverage and effectively meet the requirements of pregnant moms.
The survey also finds that over 21% of hospitalisations in India go more than three days, highlighting the need for coverage choices that take longer stays into consideration. It is crucial to evaluate the possible expenses linked to prolonged hospital stays and make sure that insurance coverage corresponds with these circumstances.
Recognising Cost Elements And Using Proper Documentation
The paper also looks at the costs involved with making claims on Indian health insurance. Even though cancer claims only make up around 1% of all claims, they can have a high per-case cost. On the other side, although being frequent, accidents only cost Rs 33,000 on average, which is less than the average cost of all claims.
The process of settling claims depends heavily on proper documentation. It is crucial to provide correct and comprehensive documentation, including all necessary claim forms, insurance papers, prescriptions, diagnostic reports, discharge summaries, and medical bills and prescriptions. These papers must be submitted in order for the claim to be processed quickly and efficiently. They also serve as critical proof for the claim.
According to the research, India’s claim procedure exhibits extraordinary efficiency, with more than 82% of the required papers being supplied at the claim intimation stage. Only 24% of instances had document deficiencies, highlighting how crucial it is to follow the right documentation procedures for a successful claim settlement.
People may make educated choices to safeguard their financial security in medical crises by knowing important health concerns, such as nursery policies and maternity claims, and ensuring correct paperwork.
