Out of 15 private health insurers, 11 paid less than 75% of the claimed amount

Published By: The Indian Express​

Published Date: 29th November 2024​​

According to data from the Insurance Brokers Association of India (IBAI), in the fiscal year 2022–23, 11 out of 15 private health insurers paid less than 75% of the amount claimed by policyholders. For instance, New India Assurance had a claims paid ratio of 95.04% based on the number of claims, while Iffco Tokio and Bajaj Allianz had ratios of 91.70% and 90.29%, respectively. In contrast, Reliance General Insurance paid only 58.06% of the claimed amount.

Additionally, the average amount paid per claim was ₹2,30,087. The claims settlement process also revealed that 56% of claims were settled through cashless mode, 42% through reimbursement, and 2% through both methods. The Insurance Regulatory and Development Authority of India (IRDAI) has noted that 10 private insurers had a claim paid ratio below 80%, indicating a significant disparity in claim settlements among insurers.