Policybazaar Report Reveals High Health Insurance Claim Approval Rates In India
The report reveals that health insurance claims in India are increasingly successful, with an impressive 94 per cent approval rate
In celebration of Insurance Awareness Day, Policybazaar, India’s leading online insurance platform, has released its latest report titled "Is India Happy With Health Insurance Claims?"
In a press statement on Thursday, the company said that the report, recognising the critical role of claims in the health insurance ecosystem, captures the nuanced nature of health insurance claims experience across regions, tiers, and demographics. With a sample size of over 2,100 respondents from 39 cities, the study provides a comprehensive narrative of the health insurance claims index in India.
The report reveals that health insurance claims in India are increasingly successful, with an impressive 94 per cent approval rate. This indicates that the vast majority of policyholders are successfully getting their claims approved. Moreover, the approval rate comes with a high level of satisfaction, with 86 per cent of respondents reporting satisfaction with their claims experience. The research suggests that both online and offline intermediaries could help increase the approval rates even further, particularly addressing the 6 per cent of claims that were rejected.
Key Findings from the Study:
Higher Approval Rates: An overwhelming 94 per cent of respondents reported having their health insurance claims approved. This number surged to 97 per cent for claims initiated through online channels, showcasing the efficiency of digital processes.
Customer Satisfaction: The study reveals that 86 per cent of customers were satisfied with their health insurance claim experience, with 40 per cent indicating they were extremely satisfied. Cashless claims, online channels, and minimal paperwork emerged as the biggest drivers of customer satisfaction. Initiatives by the IRDAI, such as Cashless Everywhere and the three-hour claim settlement timeline, reflect thoughtful regulatory moves in the interest of consumers.
Reasons for Claim Rejection: Nearly half of the 6 per cent rejected claims were due to non-disclosure of pre-existing or uncovered diseases. This highlights the need for increased awareness, transparency, and product simplification in the industry to ensure better understanding between consumers and insurers.
Cashless vs Reimbursement Claims: 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 per cent of reimbursement claimants seeking financial aid through loans or breaking their savings.
Sarbvir Singh, Joint Group CEO of Policybazaar, commented on the findings, saying, "Claim is the defining moment for any consumer in insurance, and improving claims experience has been a key focus area for us through initiatives like Claim Samadhan and Claims Assurance Program. This study extends our efforts to further enhance the claims experience for consumers. The report offers a nuanced perspective on the customer experience, providing us with valuable insights to further improve their experience. It also underscores the need for better transparency, awareness, and digital adoption."
