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India's health insurance sector continues to witness robust growth, growing at a rate of around 9 per cent, with total health insurance premiums volume exceeding Rs 1.2 lakh crore in 2024-25, according to a statement released by the Ministry of Finance.
This growth reflects increasing awareness, improved access to healthcare financing, and a rising demand for financial protection against medical expenses. To enhance efficiency and ensure timely support to policyholders, the Insurance Regulatory and Development Authority of India (IRDAI) has prescribed specific timelines for the processing of cashless health insurance claims, the statement noted. As per the regulator, cashless pre-authorisation requests must be processed within one hour, while final authorization is required to be completed within three hours. These timelines are aimed at minimising delays and ensuring that patients receive timely access to medical care. This increase in health insurance premiums is driven by factors such as ageing policyholders, higher coverage, and enhanced features, among others, the release noted. According to the release, IRDAI's 2024 regulations specify that insurance products are priced fairly, based on all relevant risk factors, and remain viable and value-driven, with periodic review by the Appointed Actuary using credible data and customer feedback. The data also showed an improvement in claims settlement ratios over the past three financial years. The claims paid ratio (by number of claims) stood at 85.66 per cent in 2022-23, which declined slightly to 82.46 per cent in 2023-24, before rising to 87.50 per cent in 2024-25. IRDAI's 2024 regulations specify that insurance products are priced fairly, based on all relevant risk factors, and remain viable and value-driven, with periodic review by the Appointed Actuary using credible data and customer feedback. Furthermore, as per the Bima Bharosa portal of IRDAI, during FY 2024-25, 1,37,361 general and health insurance grievances were reported, out of which 1,27,755 (93 per cent) were disposed of during FY 2024-25 itself. Instances of claims disallowance or repudiation are largely attributable to specific policy conditions and limitations. Some of the reasons for claims disallowance or repudiation include exceeding the sum insured, co-payment clause, sub-limits in policies, deductible in top-up policies, room rent capping, proportionate charges, non-medical expenses, etc. Additionally, several measures have been taken by the IRDAI to enhance clarity, streamline claims processing, and strengthen policyholder trust. In essence, a balanced, informed approach from all stakeholders would be crucial in fostering a transparent and trustworthy health insurance ecosystem. (ANI)
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