Health Insurance: The cost of treatment has been increasing continuously since the Corona period. In comparison to this, the premium of health insurance is also increasing, but the cases of claim rejection by the companies are increasing even more rapidly. In such a situation, what should policyholders do?
After the COVID-19 pandemic, there has been a rapid increase in health insurance
premiums in the country, the main reason for which is the exorbitant increase in the cost of treatment. This is the reason that on an average, health insurance renewal premiums have increased by 10 to 15 percent in the year 2024. A report by Policybazaar states that more than 53 percent of policyholders have reported a jump of more than 10 percent in their premiums. On the other hand, the number of health insurance claims being rejected has also reached above 50 percent. In such a situation, what should the insurance holders do.
Health insurance is becoming so expensive that the premium for senior citizens has increased by 100 percent. After this, the Insurance Regulatory and Development Authority of India (IRDAI) in January 2025, keeping in mind this sharp increase, directed the insurers to limit the annual renewal premium increase for senior citizens to 10 percent. Apart from this, there is a lot of dissatisfaction among the policyholders regarding the record of settlement of insurance claims.
Why are policyholders angry
The Insurance Brokers Association of India (IBAI) report for 2022-23 has raised concerns about health insurance claim rejections. It states that out of 28 non-life insurers, 11 have reported less than 70 percent payment. In this, most standalone health insurance companies which mainly serve retail policyholders have performed the worst.
How many claims are getting rejected
A survey conducted by social media portal and survey firm LocalCircles between June and December 2024 revealed that 5 out of 10 policyholders faced partial or complete rejection of their claims. 95 per cent of health insurance complaints from policyholders are related to partial or complete rejection of claims. According to IBAI officials, one of the reasons for the low claims settlement ratio is that insurers pay small claims without any hassle, but take time to issue large claims, increasing the problems of customers.
How can you reduce insurance premium?
Policybazaar’s Chief Business Officer Amit Chhabra says that customers can reduce their premium amount by adopting some methods. Under this, paying some expenses yourself can reduce the premium. If you pay Rs 15,000, the premium can fall by 15 percent. You can also save up to 15 percent premium by choosing fewer hospitals in the insurance network. Apart from this, companies also give 8 to 15 percent discount on paying 2 or 3 years’ premium in lump sum.
What to do if the claim is rejected
If you are not happy with the claim decision of your insurance company, write to its Grievance Redressal Officer (GRO). You can also register your complaint through IRDAI’s Insurance Bharosa portal. If the insurance company is unable to resolve or respond to your complaint within 30 days, you can contact the Insurance Ombudsman office of your district. If the Ombudsman feels that the matter can be resolved through mediation, an order will be passed within one month of receiving mutual written consent. In other cases, the Ombudsman can give a decision within three months from the date of receipt of all documents and other information. If all these efforts are insufficient, then the insured can resort to the Consumer Court.
