Health Insurers Settle Majority of Claims in FY 24

In the fiscal year 2024, health insurers managed to settle 71.3% of the Rs 1.2 lakh crore claims registered and outstanding, as per the latest data from Irdai. This significant figure highlights the challenges and achievements within the health insurance sector.

Claims Breakdown and Settlement Details

Insurers registered over 3 crore claims amounting to Rs 1.1 lakh crore during the year, alongside 17.9 lakh claims from previous years totaling Rs 6,290 crore. Of these, nearly 2.7 crore claims were settled, amounting to Rs 83,493 crore, representing 82% by volume and 71.3% by value of the reported claims.

Challenges in Claim Settlements

Despite the high settlement rate, Rs 15,100 crore worth of claims were disallowed due to policy terms, and 36 lakh claims worth Rs 10,937 crore were repudiated or rejected. Additionally, 20 lakh claims worth Rs 7,584 crore remain outstanding, showcasing the complexities in the claim settlement process.

Premium Collection and Profitability

Against the claims paid, insurers collected Rs 1.1 lakh crore in health insurance premiums. Public sector insurers led the collection with Rs 40,993 crore, followed by private insurers and standalone health insurers. The incurred claims ratio varied across sectors, with PSU general insurers showing the highest ratio at 103%.

Complaints and Resolutions

The office of the insurance ombudsman received 34,336 complaints under health insurance, with 6,235 decided in favor of the policyholder. This highlights the ongoing efforts to address and resolve policyholder grievances in the health insurance sector.