New report reveals Indian health insurance claim success, showcasing claims approval rate at 94%, customer satisfaction at 86%

Celebrating Insurance Awareness Day, Policybazaar has released its latest report titled – ‘Is India Happy With Health Insurance Claims?’. Capturing the nature of health insurance claims experience across regions, tiers and demographics. With a sample size of over 2,100 surveyees across 39 cities, the report provides a deeply-studied narrative of the health insurance claims index in India.

As per the report, health insurance claims in India are increasingly hitting the mark, with 94 per cent approval rate, indicating that the vast majority of policyholders are successfully getting their claims approved. More important, the approval rate comes along with delivering a top-notch experience, with 86 per cent reporting satisfaction with their claims experience. Talking about the minuscule pie of 6 per cent rejected claims, research indicates that the involvement of both online and offline intermediaries can help turn over the tide and boost approval rates.

While an overwhelming 94 per cent of respondents reported having their health insurance claims approved, notably, this number surged to an impressive 97 per cent for claims initiated through online channels.

The study also reveals that 86 per cent of customers expressed satisfaction with their health insurance claim experience, with 40 per cent indicating they were extremely satisfied. In this regard, cashless claims, online channels and minimal paperwork emerge as the biggest drivers of customer satisfaction. The IRDAI’s recent slew of initiatives like Cashless Everywhere and the three-hour timeline of claim settlement reflect the regulatory body’s timely and thoughtful move in the interest of the consumer.

Understanding reasons behind the claim rejection, the study reveals that nearly half of the 6 per cent rejected claims were attributed to non-disclosure of pre-existing or uncovered diseases. This brings out the need for increased awareness and transparency in the industry along with product simplification so that there’s a better understanding between the consumer & the industry.

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 formal or informal loans or breaking their savings funds meant for other life goals.