Health insurers reject claims worth Rs 15,100 cr during FY24

New Delhi: Health insurers disallowed claims worth Rs 15,100 crore, accounting for 12.9 per cent of the total claims filed during the fiscal year 2023-24, according to the annual report released by the Insurance Regulatory and Development Authority of India (IRDAI). Out of the Rs 1.17 lakh crore worth of claims filed under health insurance by general and standalone health insurers, only Rs 83,493.17 crore—71.29 per cent—was paid during the year ending March 2024. Claims amounting to Rs 10,937.18 crore (9.34 per cent) were repudiated, while Rs 7,584.57 crore (6.48 per cent) remained outstanding.

A total of 3.26 crore health insurance claims were filed in FY24, of which 2.69 crore (82.46 per cent) were settled. The average amount paid per claim stood at Rs 31,086.

The report highlighted that 72 per cent of claims were settled through third-party administrators (TPAs), while the remaining 28 per cent were handled in-house. Regarding the mode of settlement, 66.16 per cent of claims were settled via cashless mode, and 39 per cent through reimbursement.

In FY24, general and health insurance companies collected Rs 1,07,681 crore in health insurance premiums (excluding personal accident and travel insurance), reflecting a 20.32 per cent growth over the previous year. These insurers issued 2.68 crore policies, covering 57 crore lives.

At the fiscal year’s end, India had 25 general insurers and 8 standalone health insurers. Public sector insurers like New India, National, and Oriental Insurance also operated health insurance businesses overseas, procuring Rs 154 crore in gross premiums and covering 10.17 lakh lives.

Additionally, the insurance sector covered 165.05 crore lives under personal accident insurance during FY24. This included 90.10 crore lives under flagship government schemes such as the Pradhan Mantri Suraksha Bima Yojana (PMSBY), Pradhan Mantri Jan Dhan Yojana (PMJDY), and IRCTC travel insurance for e-ticket passengers.