94% Of Health Insurance Claims Gets Approval, Policyholders Report Satisfaction: Study

Health insurance claims in India consistently meet consumers' expectations, achieving an impressive approval rate of 94 per cent, according to a Policybazaar report released on Wednesday. This high approval rate reflects successful claim processing for the majority of policyholders. 

Additionally, the process is accompanied by high satisfaction, with 86 per cent of policyholders expressing contentment with their claims experience. Regarding the remaining 6 per cent of rejected claims, the report suggests that involving both online and offline intermediaries could potentially enhance approval rates and improve overall claim outcomes.

“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 and the industry,” the report reads.

It added: “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. Cashless Everywhere clearly paves the way forward for the industry.

The report indicates that 86 per cent of customers are satisfied with their health insurance claim experience, with 40 per cent expressing extreme satisfaction. Cashless claims, online channels, and reduced paperwork are identified as the primary factors contributing to customer satisfaction. 

Speaking on the findings, Sarbvir Singh, Joint Group CEO, Policybazaar, said, “Claim is the defining moment for any consumer in insurance and therefore, improving claims experience has been a key focus area for us through different initiatives like Claim Samadhan and Claims Assurance Program. This study is an extension of our efforts to further enhance the claims experience for consumers. The report offers a nuanced perspective of the customer in every aspect of claims experience which provides us with valuable insights to further improve their experience. It also brings out the need for better transparency, awareness and digital adoption.”

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