Health insurance firms settle claims worth ₹75,000 crore, earns 25% profit

With Rs 1 lakh crore in the premium collection, the health insurance segment has become the largest vertical of the general insurance industry constituting 37 percent of the industry revenue. The sector has settled as much as 2.5 crore claims worth Rs 75,000 crore in FY24, making the industry financially healthy with a 25 per cent operating profit.

According to General Insurance Council chairman Tapan Singhel, the health insurance sector has collected close to Rs 1,00,000 crore in premium in FY 2024, reflecting a robust annualized growth of 20% in the past few years.

What is more salutary is that more than 50 crore people are covered now, which is to say that as much as 38% of the population is covered, up from 37% in FY23.

Singhel is confident that the Bima trinity of Bima Vistaar, Bima Vaahaks, and Bima Sugam, the national mission of achieving ‘insurance for all by 2047’, as set out by the Insurance Regulatory and Development Authority chairman Debasish Panda is closer to fruition.

Singhel, who is also the chief executive of Bajaj Allianz General Insurance, also said the recently launched ‘Cashless everywhere’ initiative being spearheaded by the GI Council, has seen as much as 60 percent of all the claims in FY24 were settled cashless.

Currently, policy holders can avail of cashless treatment at over 40,000 hospitals across insurance networks.

On the increased efficiency in claim settlements, the council said in FY24, the industry had settled claims worth around Rs 75,000 crore from over 2.5 crore claims. The number is expected to rise significantly in FY25 as efforts to streamline processes continue. Today over 60% of the claims are settled cashless, and this only expected to go up over time, especially with the cashless everywhere initiative.

The uptick in coverage and industry premiums is on the back of the Irdai implementing a series of reforms to significantly boost health insurance coverage in recent years. These reforms include simplifying the definition of pre-existing conditions to only two specific situations of diagnosis and treatment within a specific timeframe.

Additionally, the Irdai has also reduced the waiting period for pre-existing conditions to 36 months from the longer period earlier, and the moratorium period for new policyholders with pre-existing conditions has been shortened to five years.

In another customer friendly measure, policy renewals are now guaranteed and individual premium loading based on health status is no longer permitted.

The Irdai has also brought more clarity to coverage details and expanded coverage to include modern medical treatments, mental illness, physical disabilities, and other previously excluded pre-existing conditions.

These changes have provided greater transparency and accessibility for policyholders, making health insurance a more attractive and reliable option for all citizens, said the council, which has reiterated that they are committed to remain focused on identifying and removing roadblocks to ensure speedy claim settlements. New Indian Express