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Are You Covered? Average Health Insurance Claims in India Raise Alarms

Public Health

A recent research report reveals that the average size of health insurance claims in India is approximately ₹42,000. However, a significant portion of these claims, around 15%, exceeds ₹1 lakh. 

The research underscores the urgent requirement for policyholders and insurance providers to carefully consider potential high-cost scenarios while formulating coverage options. Specifically, hospitalizations that extend beyond five days and cost over ₹5 lakhs require careful consideration. 

It is worth noting that while the average hospitalization period is two days, more than 21% of hospitalizations, or roughly one in five cases, extend beyond three days. Daycare procedures make up 29% of all claims, emphasizing the importance of including coverage for such procedures in health insurance policies. While a minimum hospitalization period of 24 hours is typically required for coverage, most policies do cover common daycare procedures.

Maternity claims constitute a significant portion, representing 20% of total claims. Fever (5%), eye surgeries (5%), and accidents (3%) remain the other noteworthy contributors. Although cancer claims make up only about 1% of total claims, their per-case cost is relatively high. On the contrary, despite being common, accidents have an average cost of ₹33,000, which is lower than the average cost of claims.

In light of these findings, it is evident that the average health insurance coverage of ₹5 lakhs may not be sufficient to meet the needs of policyholders, especially in cases of prolonged hospitalizations or high-cost treatments. To ensure comprehensive coverage, both policyholders and insurers must carefully evaluate and customize health insurance policies to address potential high-cost scenarios, providing individuals and families with adequate protection for their healthcare needs.