Nearly 4.5 crore Indians got Covid in the last two years since the pandemic struck while around 5.30 lakh of them lost their lives. However, just 27 lakh people availed insurance claims worth `24,000 crore, as per Government data.
It comes amid a recent survey that found that almost 50 per cent of patients feel that the long waiting time for approvals is the biggest pain point while filing for the insurance claim and nearly 60 per cent of patients are delaying treatments because of lack of health insurance.
Debashish Panda, Chairman, Insurance Regulatory and Development Authority of India (IRDAI), gave an insight into the status of the insurance sector at an event here where he called health insurance as a mitigation tool. But at the same time, he pointed out that a lot needed to be done to reach out to a common man.
“The pandemic taught us that health insurance is a risk mitigation tool. During Covid, health insurance played a very important role by catering to 27 lakh population with claims worth `24,000 crore.
As on date, we have 6 standalone health insurance companies and to facilitate seamless reimbursements there are 19 third party administrators,” he said at the “16th Health Insurance Summit 2022”, organized by the Confederation of Indian Industry (CII) and supported by the IRDAI.
However, he felt that more needs to be done given the size and diversity of the population. “The health insurance market has grown at a CAGR of 19 per cent in the last 5 years, however, given its potential it needs to grow at a CAGR of 30-35% CAGR .
With India commemorating 100 years of its independence in 2047 our goal should be Health Insurance for All,” Panda said. He stressed that, “parametric insurance products need to come up, OPD services need to be covered, treatments currently under exclusion should be included and distribution inefficiencies need to be addressed.” The National Family Health Survey-5 (NFHS-5) recently revealed that India has witnessed a marginal improvement in health insurance coverage, but even those who are insured face various challenges such as dealing with complex paperwork, delay in discharge, uncertainty about disease coverage etc, as has been found by the survey conducted recently by Pristyn Care Data Labs.
It found that “another big pain point for customers is that health insurance policies are too complex to understand. The study revealed that 67 per cent of respondents believe that their health insurance policies are difficult to understand and don’t give a holistic view of the benefits provided.
“Some of the other challenges faced by patients while claiming insurance were deduction of money at the time of claiming (24 per cent) and complex paperwork (17 per cent). To ease the process of claiming health insurance, more than 60 per cent Indians would opt for a third party end-to-end health insurance service provider who takes care of the hassle. With the rising costs of medical treatments in the country, as per the study which expressed its dismay that nearly 60% of the respondents are delaying treatment due to the lack of any health cover.
The IRDAI is already looking into the Covid-19 policy claims that were rejected by insurance companies. This followed after a public interest litigation was filed by Manav Seva Dham (petitioner), a social services’ trust against various insurance companies before the Bombay High Court.
According to reports, more than 80, 000 claims were received by the non-life insurance industry. However, despite having health insurance policies, the claims of the policyholders were blatantly rejected by these insurance companies citing frivolous reasons.