Average health insurance claim low in India but a ₹5 lakh cover may still not be enough

• The average size of health insurance claim in India is ₹42,000
• The average hospitalisation period in India is two days
• Almost one in five claims are maternity related.
• Though cancer claims stand at 1%, their per case cost is high.

The average size of health insurance claims in India stands at ₹42,000, with 15% of these claims over ₹1 lakh, as per a research report by SecureNow, an insurance broker. The report offers insights into various aspects of health insurance in India.

The analysis is based on 3,846 health claims filed through the reimbursement process, encompassing diverse geographical locations, insurers, family members, and both external, and internal Third-Party Administrators (TPAs).

A ₹5 lakhs coverage may not be enough

The findings highlight the need for policyholders, and insurance providers to consider potential high-cost scenarios, such as hospitalisations exceeding five days, and costing over ₹5 lakhs, when designing coverage options.

“The report highlights the importance of hospitalisation duration as a key factor in health insurance claims,” says Kapil Mehta, co-founder, SecureNow.

What is important to note is that the report highlights that though the average hospitalisation period is two days, more than 21% of hospitalisations, i.e. one in five approximately, extend beyond three days.

Cancer account for approximately 1% claims

Day care procedures make up 29% of all claims, so it is important to include coverage for such procedures in health insurance policies. A hospitalisation of 24 hours is required to get health insurance coverage, however, common day care procedures are covered under most policies.

Maternity claims constitute a significant portion at 20% of total claims. Other notable contributions to the overall claim volume include fever (5%), eye surgeries (5%), and accidents (3%).

Although cancer claims account only for approximately one percent of total claims, their per case cost is relatively high. On the other hand, accidents, despite being common, have an average cost of ₹33,000, which is lower than the overall average cost of claims.

Importance of proper documents

Submitting accurate, and complete documents is crucial when filing health insurance claims. Essential documents include medical bills, prescriptions, diagnostic reports, discharge summary, claim form, policy documents, and any other supporting documents requested by the insurance provider. These documents provide necessary evidence for the claim, and ensure a smoother and faster claim settlement process.

According to the report, the claim process is efficient with more than 82% of required documents being submitted at the time of claim intimation, and deficiencies in documents being present in only 24% of cases.