In FY2024, health insurance companies collected Rs 1.1 lakh crore as premiums and paid Rs 83,493 crore in claims. They rejected 36 lakh claims, amounting to Rs 10,937 crore
In 2024, out of every 100 policyholders who claimed health insurance, only 82 received payouts from insurance companies. According to data from the insurance regulator IRDAI, 18% of the claims were rejected. The regulator’s report states that 3 crore claims, amounting to Rs 1.1 lakh crore, were registered. Additionally, there were 17.9 lakh pending claims worth Rs 6,290 crore from previous years.
Out of the total claims, insurers settled about 2.7 crore claims, disbursing Rs 83,493 crore to policyholders. This represents an 82% settlement rate in terms of the number of claims and 71.3% in terms of value. Of the unsettled claims, claims worth Rs 15,100 crore were deemed “invalid as per the terms and conditions of the policy contract”.
Insurance companies collected Rs 1.1 lakh crore as health insurance premiums in FY24, while claims paid amounted to Rs 83,493 crore. Public sector insurers collected the highest premiums, garnering Rs 40,993 crore. Private companies followed with Rs 34,503 crore, and standalone health insurers collected Rs 32,180 crore in premiums.
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The average claim payment amounted to Rs 31,086. In terms of claim settlement, TPAs (Third Party Administrators) processed 72% of claims, while insurance companies handled 28% internally. Regarding the mode of payment, 66.16% of claims were settled cashless, while 39% were reimbursed.
Insurance companies rejected or denied 36 lakh claims, totalling Rs 10,937 crore. A further 20 lakh claims, amounting to Rs 7,584 crore, are still pending. Rejected claims are those which are deemed invalid following document verification.
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The Insurance Ombudsman Office received 34,336 complaints related to health insurance this year, in addition to 2,846 pending complaints from previous years. Of the total complaints, 6,235 were decided in favour of the policyholder. Most complaints originated from Mumbai, Pune, Ahmedabad, and Chandigarh.
