While reiterating that insurance companies process the claims as per the terms and conditions of the policy, the Union government says that, during FY23-24, insurers rejected claims worth Rs26,037.65 crore. It includes claims worth Rs15,100.14 crore disallowed as per terms and conditions (T&C) of policy and claims of Rs10,937.17 crore repudiated by health insurance companies.
Responding to a question in the Lok Sabha, Pankaj Chaudhary, Union minister of state for finance, says during FY23-24, public sector insurer The New India Assurance Co Ltd tops the list, rejecting claims worth Rs7,038.04 crore. It is followed by ICICI Lombard General Insurance Co Ltd, which, according to the data shared by the insurance regulatory and development authority of India (IRDAI), rejected health insurance claims worth Rs2,016.81 crore.
Balashowry Vallabhaneni and advocate Dean Kuriakose, the members of Parliament (MP) have asked for details of health insurance claims rejected during FY23-24.
According to the minister, IRDAI has mandated a few rules for insurers to ensure that customers are fully aware of the policy's T&C and prevent mis-selling. It includes providing a customer information sheet (CIS) to each policyholder, using a minimum 11-size font in the policy documents, put in place a framework to correctly inform features and benefits with T&C of insurance policy to the buyer, among others.
Data shared by the government shows that public sector insurers are paid Rs10,122 as a claim during FY23-24 for every Rs10,000 collected as a premium for the insurance policy. While private sector general insurers paid Rs7,077, stand-alone health insurers (SAHI) paid just Rs5,463 as claim amount against a premium of Rs10,000.
However, when it comes to settling claims, for every 10,000 claims received in FY23-24, private sector general insurers and SAHI have an edge. IRDAI's annual report shows that while public sector insurers paid Rs7,984 for claims of every Rs10,000. Private sector general insurers and SAHI paid Rs8,639 and Rs8,635 for the same.
The MPs also asked for information about state-wise health insurance paid by policyholders from across the country. This excludes premiums collected for travel and personal accident business.
As per information shared in the lower house, Maharashtra tops the list with Rs31,258 crore collected during FY23-24 as health insurance premiums. Karnataka is in a distant second position with a collection of Rs12,017 crore, followed by Tamil Nadu at Rs9,738 crore.
During the past three financial years, policyholders paid Rs73,052 crore, Rs89,432 crore and Rs1.07 lakh crore for FY21-22, FY22-23 and FY23-24, respectively, as health insurance premiums.
IRDAI has further advised the insurance companies to take various measures to improve the customer claim settlement experience, Mr Chaudhary says.
Here are some of the measures suggested by IRDAI...
1. No claim shall be repudiated without the approval of the insurer's product management committee (PMC) or a three-member sub-group of PMC called the claims review committee (CRC).
2. In case the claim is repudiated or rejected or disallowed partially, details shall be communicated to the claimant along with full details giving reference to the specific terms and conditions of the policy document.
3. If a customer is not satisfied with the decision of the insurer on the claim, he/she may lodge a complaint with the grievance redressal officer of the insurer. The policyholders have the right to approach the insurance ombudsman without any charges. Insurers must comply with the ombudsman's decision within 30 days, or they need to pay penal charges of Rs5,000 per day for each day of delay.
4. Shorter timelines for processing and settlement of claims have been introduced for reimbursement/ cashless claim settlement and for pre-authorisation.
5. Suo-moto payment of interest at bank rate plus 2% in the event of a delay beyond specified timelines.
Absolutely needed matter raised by MP.Insurers r looting and emotionally blackmailing.Only improve need in this dirty insurance system is
1. to cut in luxury facility attraction to insured and payment against medicine and medical labour only to be paid
2 A huge unnecessarily pay and perks to insurance companies staff to be cut latest honourable court shown eye to care health insurance false payment made to a female authority
3 five star facility advertisement air taxi ac room ac toilet tv sofa bed and bedsheets facility to be banned by irdai
Only medicine and medical labour should be covered by insurer
They r cheating looting robbingon the name of five star facility and 90 % of looted cheated amount is either westing on the luxury ugly purpose
At the last health insurance means insurance of body so exclussion and permanent exclussion words to be removed from terms and conditions of policy
Exclussion and permanent exclussions r hidden agenda of insurance companies for rejection of claim
You go to consumer court believe me you will get justice.
I got my money through consumer court. Care health insurance is a very big fraud company.always buy policy from public sector company.
I admitted in hospital on 14/11/2024 at that time i applied for cashless claim for only 30000/- they denied said apply for reimbursement..
After discharge from hospital i apply same in reimbursement process they again denied giving some bullshit reasons THAT DOCTOR HANDWRITING IS STEREOTYPE AND IN SINGLE STRETCH.
after that i registered my complaint with IRDA after 8 days i got response from insurer asking me to provide pre hospitalization reports... I suffered with some infection in my lower abdomen with serious pain in midnight of 13/11/2024 and on 14/11/2024 early around 1:30 AM i admitted.
HOW CAN I PROVIDE MY PRE HOSPITALIZATION REPORTS?
They are doing scam with patients
In their customer care all employes are uneducated they don't know how to talk with patients.
And communication of upper management is very slow. They tak 8-10 days for a single mail reply..
CARE HEALTH INSURANCE
SCAM COMPANY
#CAREHEALTHSCAM
You go to consumer court believe me you will get justice.
I got my money through consumer court. Care health insurance is a very big fraud company.always buy policy from public sector company.
;give us the