In a significant revelation from India's insurance sector, health insurers rejected claims worth Rs15,100 crore during the FY233-24, representing 12.9% of all filed claims, according to the Insurance Regulatory and Development Authority of India (IRDAI).

 

The health insurance landscape saw total claims amounting to Rs1.17 lakh crore, of which Rs83,493.17 crore around 71.29% were successfully paid out. The sector also witnessed repudiation of claims worth Rs10,937.18 crore around 9.34%, while claims totaling Rs7,584.57 crore around 6.48% remained outstanding at year's end.

 

Out of approximately 3.26 crore health insurance claims processed during the fiscal year, insurers settled 2.69 crore claims, achieving an 82.46% settlement rate. The average claim settlement amount stood at Rs31,086.

 

The settlement process showed that third-party administrators (TPAs) handled 72% of claims, while the remaining 28% were processed through in-house mechanisms. In terms of settlement modes, cashless settlements dominated at 66.16%, with reimbursement claims accounting for 39% of the total.

 

The sector demonstrated robust growth, with general and health insurance companies collecting premiums worth Rs1,07,681 crore (excluding personal accident and travel insurance), marking a 20.32% increase from the previous year. These companies provided coverage to 57 crore individuals under 2.68 crore health insurance policies.

 

As of March 2024, India's insurance landscape comprised 25 general insurers and 8 standalone health insurers. Notable public sector insurers - New India, National, and Oriental Insurance - expanded their operations internationally, generating Rs154 crore in gross premiums from health, personal accident, and travel insurance, covering over 10.17 lakh lives abroad.

 

The industry's reach extended significantly in the personal accident insurance segment, covering 165.05 crore lives. This included 90.10 crore lives under government flagship schemes such as Pradhan Mantri Suraksha Bima Yojana (PMSBY), Pradhan Mantri Jan Dhan Yojana (PMJDY), and IRCTC travel insurance for e-ticket passengers, highlighting the government's commitment to expanding insurance coverage across India.