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Health insurers disallow claims worth Rs 15,100 crore in FY24: IRDAI

As per the data, of the total Rs 1.17 trillion claims under health insurance of general as well as standalone health insurers, only Rs 83,493.17 crore or 71.29 per cent were paid during the year ending March 2024.

Health insurers disallow claims worth Rs 15,100 crore in FY24: IRDAI

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During the financial year 2023-24, health insurers disallowed claims worth Rs 15,100 crore or 12.9% of the total claims filed, data released by Insurance Regulatory and Development Authority of India (Irdai) said.

As per the data, of the total Rs 1.17 trillion claims under health insurance of general as well as standalone health insurers, only Rs 83,493.17 crore or 71.29 per cent were paid during the year ending March 2024.

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Irdai said there were about 3.26 crore health insurance claims during 2023-24 with insurers, of which 2.69 crore (82.46%) claims were settled. The average amount paid per claim was Rs 31,086.

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Insurers repudiated claims amounting to Rs 10,937.18 crore (9.34%) while outstanding claims totalled Rs 7,584.57 crore (6.48%).

General and health insurance companies collected Rs 1,07,681 crore as health, excluding personal accident and travel, insurance premium registering a growth of about 20.32% over the previous year.

The general and health insurance companies had covered 57 crore lives under 2.68 crore health insurance policies, excluding policies issued under personal accident and travel insurance.

During the year 2023-24, public sector general insurers procured gross premiums of Rs 154 crore from health, personal accident and travel insurance and covered 10.17 lakh lives.

In terms of the number of claims settled, 72% of the claims were settled through TPAs and the balance 28% of the claims were settled through in-house mechanisms.

In terms of mode of settlement of claims, 66.16% of the total number of claims were settled through cashless mode and another 39% through reimbursement mode.

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