Health insurers disallowed claims worth Rs 15,100 crore or 12.9 per cent of the total claims filed during fiscal 2023-24, according to data released by regulator Irdai. Of the total Rs 1.17 lakh crore claims under health insurance of general as well as standalone health insurers, only Rs 83,493.17 crore or 71.29 per cent were paid during the year ending March 2024.

Further, insurers repudiated claims amounting to Rs 10,937.18 crore (9.34 per cent) while outstanding claims totalled Rs 7,584.57 crore (6.48 per cent), said the annual report 2023-24 of Insurance Regulatory and Development Authority of India (Irdai).

There were about 3.26 crore health insurance claims during 2023-24 with insurers, of which 2.69 crore (82.46 per cent) claims were settled. Irdai said the average amount paid per claim was Rs 31,086. In terms of number of claims settled, 72 per cent of the claims were settled through TPAs and the balance 28 per cent of the claims were settled through in-house mechanism.

In terms of mode of settlement of claims, 66.16 per cent of total number of claims were settled through cashless mode and another 39 per cent through reimbursement mode. During the year 2023-24, general and health insurance companies collected Rs 1,07,681 crore as health, excluding personal accident and travel, insurance premium registering a growth of about 20.32 per cent over the previous year.

The general and health insurance companies had covered 57 crore lives under 2.68 crore health insurance policies, excluding policies issued under personal accident and travel insurance. At the end of March 2024, there were 25 general insurers and 8 standalone health insurers.

Public sector general insurers — New India, National and Oriental Insurance — are doing health insurance business in foreign countries. During the year 2023-24, they procured gross premium of Rs 154 crore from health, personal accident and travel insurance and covered 10.17 lakh lives.

The insurance industry covered a total of 165.05 crore lives under personal accident insurance during the last fiscal. It includes 90.10 crore lives covered under government flagship schemes — Pradhan Mantri Suraksha Bima Yojana (PMSBY), Pradhan Mantri Jan Dhan Yojana (PMJDY), and IRCTC travel insurance for e-ticket passengers.

Source: The Economic Times