Health Insurance Claims in India: Average of Rs 42,000, with 15% Crossing Rs 1 Lakh

In a report, it has been stated that the average cost of health insurance claims in India is ₹42,000, of which 15% claims are above ₹1 lakh.

The report highlights the need to consider potential high-cost scenarios when designing coverage options for policyholders and insurance providers, such as hospitalization for more than five days and costs exceeding ₹5 lakhs.

SecureNow’s report provides important insights into the duration of hospitalization, claim costs, settlement rates, and the efficiency of the claims settlement process in India. It analyzed 3,846 health insurance claims processed through the reimbursement process.

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These claims varied geographically and covered different types of insurers, family members, and external and internal third-party administrators (TPAs). Additionally, it is stated that less than 3% of claims are due to accidents, with an average cost of ₹33,000.

According to Kapil Mehta, co-founder of SecureNow Insurance Broker, the report emphasizes the significance of the duration of hospitalization for health insurance claims. He stated that extensive studies reveal that the average hospitalization duration is two days, but more than 21% of hospitalizations last for more than three days.

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He said, “It highlights the need for comprehensive coverage for prolonged stays in hospitals.” The report also indicates a higher claim settlement rate for more than 50% of claims, exceeding 80%. Maternity claims contribute significantly, accounting for 20% of total claims as a category. Fever (5%), eye surgeries (5%), and accidents (3%) also make significant contributions to the total number of claims. However, while the contribution of cancer claims is around 1%, the cost per case is significantly higher. On the contrary, the average cost of accidents, despite their frequent occurrence, is ₹33,000, which is lower than the overall average cost of claims.

Commenting on National Insurance Awareness Day, Bhargav Dasgupta, Managing Director of ICICI Lombard General Insurance Company, stated, “We recognize the crucial mission of increasing insurance penetration in India. In a country full of possibilities and opportunities, awareness and understanding of insurance play a pivotal role.”

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He stated that the transparency, consumer-centric practices, and outreach initiatives initiated by IRDAI have enhanced visibility and ultimately built trust. Insurance Awareness Day provides an opportunity for Sanjeev Bajaj, Managing Director of Bajaj Capital, said, “Factors influencing insurance purchase decisions are of utmost importance and premium affordability plays a vital role.”

As requested, I have provided the translation of the given Hindi content into English in a human-friendly tone.

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