Fact |
Our Comment |
Claims lodged by
61-65 yrs age group – 8%
66-70 yrs age group – 7%
Below 61 years - 85% |
Claims paid to Senior citizen are 15% of the total claims. This is different from what we have been hearing in the recent years that majority of the claims are from senior citizens and they are responsible for the losses being incurred by the Indian Health Insurance sector. |
No. of days spent in hospital for less than a day – 30%
No. of days spent in hospital for more than 10 days. – 21%
No. of days spent in hospital for more than 1 to 9 days. – 49% |
Day surgeries have become common and most of the cases pertain to eye case infection, circulation ailment, neoplasm. Infection , urology issues |
Highest number of claims are from following states
Maharashtra, Tamilnadu,
Karnataka, Delhi, West Bengal |
These are the states where highest number of policies is being sold so it is reasonable to expect that claims will also be originating from these states.
With RSBY being introduced in many states we will see different data appearing in the years to come. |
Average claim paid in
Delhi - Rs 30,100
Maharashtra (including Mumbai ) Rs 30,000
Andhra - Rs 25000
Karnataka – Rs 25000
West Bengal – Rs 25000 |
It means that even today purchasing policy for sum assured of Rs 1 Lakh makes sense |
Indian Health Insurance Industry paid
Claims - Rs. 103
vs.
Premium earned – Rs 100 |
A newspaper interpreted loss of Rs 3 on premium earned of Rs 100.
The fact is, loss is much higher Out of Premium earned of Rs 100, Rs.15 to Rs. 17.5 is paid to Insurance Intermediary and additional sum of Rs. 6 to 10 is paid to TPA.
Insurance company is left with Rs 72.50 out of which it pays for overheads of Rs. 25.00 and then it is left with Rs 47.5, When claim being paid is Rs 103 then loss being incurred on health portfolio is Rs. 55.5 |
