Health Claims Rejections: Dis-Trust, Mis-Trust, No-Trust & Mis-Selling
Have you ever noticed that the Claim Settlement Ratio (CSR) of nearly any Insurer in India always happens to be over 90%!
The Government, with its goal of Insurance for all by 2047 intends to ensure that every Indian citizen has appropriate life, health and property insurance.
Proud yet? Then consider the following:
- The issue of high claim rejections by the health insurers has become a cause for great concern. According to IRDAI data, health insurers have rejected, on average, claims worth Rs.22/- for every Rs.100/- premium received.
- The value of health claim denials in FY2024 grew by 19%. In other words, insurers denied claims worth around Rs.15,000 Crores.
- These rejections and denials are always as per “Terms and Conditions of the policy contract”, often for reasons like non-disclosure of specific ailments or the existence of diseases excluded under the policy. Individual policy holders in the age group of 45 years and above are taken for a grand ride by hiding policy conditions within heavily jargonized policy documents.
The government’s own insurance schemes are limited to certain section of people. Corporate India offers very limited health coverage to its employees. Hence, most Indians depend on individual health insurance policies.
It may be noted that around 50% of the health care expenses in India are born through out-of-pocket costs.
Now consider this: As we pen down this piece, 368 hospitals across Telangana State have resorted to calling off Aarogyasri health insurance services for beneficiaries demanding the government release dues amounting to over Rs 1,200 crore, which have been pending for more than a year. Many similar protests are raging across other Indian states.
All is not well.
It must also be noted that Niti Aayog had proposed a health Insurance scheme to cover 30% of the population which are neither protected by the government schemes or traditional health insurance.
Insurance is an industry that is knowledge intensive. All we intend is for you not to become a victim of misselling i.e., selling products that are not suitable for an individual or family.
The growing lack of trust of the policyholders in insurance products has worsened the already bad situation. The solution lies in appointing a qualified and experienced insurance intermediary to take care of your insurance needs, in Utmost Good Faith.
This blog post is brought to you by the minds at insurancepe!
Got questions or doubts about anyone insurance?
Need advice or help understanding your insurance needs?
Want the best bang for your buck when buying insurance?
We got you!
Reach out to us at:
Whatsapp/Phone: 89779 18030
E-mail: contact@insurancepe.com
Visit us at www.insurancepe.com
