Pune Media

Health Insurance Claims Worth Over Rs 26 Crore Denied In FY24; Is Your Policy At Risk?

Standalone health insurers rejected a total of Rs 7,75,08 crore (Rs 4,56.09 crore disallowed plus Rs 3,19.32 crore repudiated). For instance, ManipalCigna Health Insurance and Niva Bupa Health Insurance rejected claims amounting to (approx.) Rs 104.99 crore and Rs 94.99 crore respectively.

Every policyholder expects his/her claim to be honoured at the time of medical emergencies. However, these numbers highlight a growing concern – how easy is it for insurers to reject claims?

MPs Balashowry Vallabhaneni and Advocate Dean Kuriakose, in their queries, asked the government whether the terms and conditions of health insurance companies run into many pages with very small font sizes, which frustrates those who want to take policy.

They pointed out that many customers simply sign on the dotted line without going through the T&Cs, which makes them vulnerable to claim rejections.

Responding to this, Pankaj Chaudhary, Union minister of state for finance, said the Insurance Regulatory and Development Authority of India (Irdai) has introduced several consumer-friendly measures, including;

  • Customer Information Sheet (CIS): Last year, the insurance regulatory body released a circular asking insurers to present policies with CIS documents which would include details of coverage offered, exclusions, sub-limits/deductibles, capping, the waiting period(s), etc.

  • Moreover, the insurers must provide policy details in a mandatory minimum font size of 11 to improve readability.

  • A free look period of 30 days (from the date of receipt of the policy document) is given to the policyholder to review the terms and conditions of the policy



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