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As many as 20 private insurers shelled out less than 80 per cent of the amount claimed by the insured patients in the health insurance segment in the country in the year 2023.
This means if an insured patient made a claim of Rs one lakh as hospital bill, the insurer paid only less than Rs 80,000 while the balance amount was paid by the patient.
In the case of claims paid ratio of the actual amount claimed — the amount paid during the year from the total amount of claims available for processing — New India Assurance leads with a payout of 98.74 per cent of the amount claimed. It was followed by Oriental Insurance with a payout of 97.35 per cent, data released by the Insurance Brokers Association of India (IBAI) on Thursday shows.
The claim ratio for the year 2024 is yet to be compiled.
The actual amount shelled out by HDFC Ergo was 71.35 per cent of the claimed amount and for ICICI Lombard, it was at 63.98 per cent, IBAI data says.
Meanwhile, only four insurance companies have reported a claim paid ratio (on the number of claims) of over 90 per cent in the year 2023 out of 29 insurers involved in health insurance business. As many as ten insurers, mostly private insurers, showed a claim paid ratio below 80 per cent, IBAI data shows.
IBAI data shows that New India Assurance leads with a claim paid ratio (on the number of claims) of 95.04 per cent, followed by Aditya Birla Health at 94.52 per cent, Iffco Tokio 91.70 per cent and Bajaj Allianz at 90.29 per cent for 2023.
Claims paid ratio on number of claims means the number of claims paid during the year from the total number of claims available for processing. IBAI says that claims repudiation ratio of 23 insurers – mostly private players – was between 5 and 18 per cent for the year 2023.
According to the IRDAI Annual Report, during 2022-23, general and health insurers settled 2.36 crore number of health insurance claims and paid Rs 70,930 crore towards settlement of health insurance claims. The average amount paid per claim was Rs 30,087. In terms of number of claims settled, 75 per cent of the claims were settled through TPAs and the balance 25 per cent of the claims were settled through in-house mechanism.
In terms of mode of settlement of claims, 56 per cent of total number of claims were settled through cashless mode and another 42 per cent through reimbursement mode. Insurers have settled two per cent of their claims amount through “both cashless and reimbursement mode”, IRDAI said.
IRDAI is yet to come out with data on the insurance claims for the fiscal 2023-24.
Insurer Claims settled against total claims Claim amount over total amount claimed by policyholder TOTAL NUMBER OF CLAIMS
PSU INSURERS
1 New India 95.04% 98.74% 90,56,011
2 Oriental Insurance 87.97% 97.35% 25,98,779
3 National Insurance 84.61% 87.95% 24,48,869
4 United India 84.28% 73.03% 45,24,241
PRIVATE SECTOR
1 IFFCO Tokio 91.70% 80.44% 6,70,026
2 Bajaj Allianz 90.29% 86.23% 9,56,559
3 SBI General 88.86% 88.30% 5,98,707
4 Go Digit 87.30% 79.50% 84,006
5 HDFC ERGO 86.90% 71.35% 9,06,914
6 Future Generali 83.83% 74.32% 1,42,952
7 ICICI Lombard 82.59% 63.98% 9,39,388
8 Tata AIG 75.56% 74.65% 2,46,126
9 Chola MS 69.53% 68.18% 1,31,546
10 Reliance general 58.06% 71.07% 4,78,120
STANDALONE HEALTH INSURERS
1 Aditya Birla Health 94.52% 71.56% 8,60,863
2 Niva Bupa 88.57% 67.76% 4,51,369
3 Manipal Cigna 88.48% 56.14% 4,13,835
4 Care Health 88.06% 67.55% 7,98,382
5 Star Health 75.10% 54.61% 19,55,549
Source: IBAI
