Health Insurance Claim: A report by IRDAI has revealed that in the financial year 2023-24, insurance companies rejected up to 11 percent of health claims, while 6 percent of the claims are pending.
Health Insurance Claim: A shocking revelation has been made in the annual report of the industry regulator (IRDAI) regarding the country’s insurance companies. It was told that the insurance companies of India have rejected up to 11 percent of health claims till March 2024, while 6 percent of the claims are pending.
In the financial year ending March 2024, insurance companies rejected claims worth Rs 26,000 crore, which has increased by 19.10 percent compared to last year. According to the Insurance Regulatory and Development Authority of India (IRDAI), this figure was 21,861 crores in the financial year ending March 2023.
This is why the insurance company rejects the claim
The insurance company rejects a claim only when the policyholder does not fulfill the terms and conditions of the policy. Many times the claim is rejected simply because you do not disclose your diseases before taking the policy. In such a situation, if the company comes to know about your illness later, it rejects your claim. Before taking the policy, it is important to see which diseases are covered in your health insurance plan.
Take care of the waiting period
Apart from this, many times it is rejected while making a claim during the waiting period. The waiting period is different for every insurance company. The time you have to wait before getting the benefit of insurance is called the waiting period.
Suppose you took a health policy of Rs 5 lakh without knowing about the waiting period, now a week after taking the policy you got a heart attack and the waiting period of the policy is 30 days, then in this situation if you claim the expenses incurred in the treatment, then the company can reject your claim.
Pay the premium on time
Along with this, if you have not paid the premium on time and your policy has lapsed, then the company can refuse to provide medical coverage. Along with this, if you do not make a claim within a certain time limit, then also your claim is rejected.
The Irdai report also revealed that the total insurance penetration in India has declined for the second consecutive year to 3.7 percent in 2023-24. During Corona, it was 4 percent in 2022-23 and 4.2 percent in 2021-22. The amount collected as policy premium in a financial year is contributed to the country’s GDP in a certain percentage, this is called insurance penetration.
This is the claim settlement ratio
The report also revealed that the claim settlement ratio of public sector insurance companies in 2023-24 was 103.38 percent. That is, they paid more than the amount collected by them as premium.
At the same time, private sector insurance companies maintained a ratio of 88.71 percent and the claim settlement ratio of standalone health insurance companies was the lowest at only 64.71 percent.
The report said that an amount of Rs 48,512 crore was paid as death claims in the financial year ending March 2024, which is more than Rs 46,380 crore spent last year.
Keep these things in mind
Overall, if you want to get complete coverage and the claim is not rejected, then know about its terms and conditions well before buying the policy. Especially pay more attention to which diseases are being covered in the policy and what is its waiting period. Not only this, keep all your necessary documents ready before taking the policy and check them thoroughly before submitting them.
