Health Insurers Reject Rs 15,100 Crore In Claims; Settle 71.29% Of Total Claims In FY24

Health insurers rejected claims worth Rs 15,100 crore, or 12.9% of the total claims filed during fiscal year 2023-24, according to data released by the Insurance Regulatory and Development Authority of India.

Out of the total Rs 1.17 lakh crore in health insurance claims made to general and standalone health insurers, only Rs 83,493.17 crore (71.29%) was paid out during the year ending March 2024. Additionally, insurers repudiated claims totalling Rs 10,937.18 crore (9.34%), while outstanding claims amounted to Rs 7,584.57 crore (6.48%), as per Irdai's annual report for 2023-24.

The report also revealed that approximately 3.26 crore health insurance claims were filed during the year, with insurers settling 2.69 crore claims, or 82.46%. The average amount paid per claim was Rs 31,086, Irdai said.

In terms of the number of claims settled, 72% of the claims were settled through TPAs, and the balance of 28% of the claims were settled through in-house mechanisms.

In terms of mode of settlement of claims, 66.16% of the total number of claims were settled through cashless mode and another 39% through reimbursement mode.

During the year 2023-24, general and health insurance companies collected Rs 1,07,681 crore as health insurance premiums, excluding personal accident and travel insurance, registering a growth of about 20.32% over the previous year.

The general and health insurance companies had covered 57 crore lives under 2.68 crore health insurance policies, excluding policies issued under personal accident and travel insurance.

At the end of March 2024, there were 25 general insurers and 8 standalone health insurers.

Public sector general insurers—New India, National, and Oriental Insurance—are doing health insurance business in foreign countries.

During the year 2023-24, they procured a gross premium of Rs 154 crore from health, personal accident, and travel insurance and covered 10.17 lakh lives.

The insurance industry covered a total of 165.05 crore lives under personal accident insurance during the last fiscal.

It includes 90.10 crore lives covered under government flagship schemes—Pradhan Mantri Suraksha Bima Yojana, Pradhan Mantri Jan Dhan Yojana, and IRCTC travel insurance for e-ticket passengers.

(With Inputs From PTI.)