Health insurers in India have on average a 94% approval rate for health insurance claims, rising to 97% for online claims, according to a Policybazaar report that provides insights into health insurance claims.
Regarding the remaining 6% of claims that are rejected, the report suggests that involving both online and offline intermediaries to improve the approval rate and overall claim outcomes. Nearly half of these rejected claims are because of the non-disclosure of pre-existing or uncovered diseases.
“This brings out the need for increased awareness and transparency in the industry along with product simplification so that there’s a better understanding between the consumer and the industry,” the report reads.
The study found that while cashless claims offer a seamless experience with lower rejection rates, reimbursement claims are often sought when preferred healthcare providers are not in the insurer’s network. However, upfront payment for treatment remains a challenge for many, with approximately 70% of reimbursement claimants seeking financial aid through formal or informal loans or breaking their savings funds meant for other life goals.
Claims experience
Additionally, 86% of policyholders express satisfaction with their claims experience, with 40% expressing extreme satisfaction. Cashless claims, online channels, and reduced paperwork are identified as the primary factors contributing to customer satisfaction.