The common value of medical insurance claims in India is Rs 42,000, with 15% of those claims exceeding Rs 1 lakh, as per a analysis report by SecureNow.

The report — ‘Reimbursement Health Insurance Claims’ — supplies important findings on hospitalization period, declare prices, settlement charges, and the effectivity of the declare settlement course of in India.

SecureNow analysed 3,846 well being claims filed by means of the reimbursement course of (versus cashless). These claims had been geographically numerous and coated totally different sorts of insurers, members of the family, and each exterior and inside TPAs.

The research discovered that whereas the typical value of medical insurance claims is Rs 42,000, 15% of claims exceed Rs 1 lakh, indicating substantial bills for a portion of claimants. This highlights the necessity for policyholders and insurance coverage suppliers to think about potential high-cost situations, reminiscent of hospitalizations exceeding 5 days and costing over Rs 5 lakh, when designing protection choices.

Furthermore, lower than 3% of claims are because of accidents, with a decrease median value of Rs 33,000. The analysis report emphasizes that the period of hospitalization is a important facet of medical insurance claims, in response to SecureNow Insurance Broker co-founder Kapil Mehta.

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The complete research reveals that the everyday hospitalization interval is 2 days, however greater than 21% of hospitalizations lengthen past three days, stated Mehta.

“This underscores the necessity for comprehensive coverage that accounts for longer hospital stays,” he added.

Additionally, day care procedures represent 29% of all claims, highlighting the significance of together with protection for these procedures in medical insurance insurance policies, SecureNow stated.

Mehta additional stated the analysis report additionally signifies comparatively excessive declare settlement charges, with over 50% of claims having a settlement price of 80% or larger of claims made. Maternity claims contribute considerably, comprising 20% of complete claims as a section.

Fever (5%), eye surgical procedures (5%), and accidents (3%) additionally make substantial contributions to the general declare quantity. Although most cancers accounts for about 1% of claims, the per case value is comparatively excessive. Conversely, accidents, regardless of being frequent, have a median value of Rs 33,000, which is decrease than the general common value of claims.

Furthermore, the analysis report highlights the effectivity of the declare settlement course of, stating that greater than 82% of required paperwork are submitted on the time of declare intimation. In 76% of instances, there are not any deficiencies within the paperwork.