Four In Ten Health Insurance Policyholders Struggle During Claim Processing: Survey
The survey highlights challenges faced by health insurance holders, with 43% experiencing difficulties in claiming insurance.
Around 1.6 lakh cases, out of 5.5 lakh pending consumer complaints, received by the Department of Consumer Affairs is related to the insurance sector.
The Consumer Affairs Department wrote to the Ministry of Finance that the insurance agents should maintain an audio and visual record of their sales pitch, in order to keep the policy buyers aware of all the policy features, according to a survey by Local Circles.
The survey received over 39,000 responses, out of which 67% respondents were men, while 33% were women. 46% respondents were from tier-1 cities, while 32% were from tier-2, and 22% were from tier-3, 4 and rural districts.
The survey lists major issues faced by the policyholders. It includes:
Lack of full disclosure about exclusions and eligibility for claims in their policies.
Ambiguity in contracts due to use of technical jargon and complex words.
Claims rejected due to pre-existing disease.
Eligibility other than the pre-existing disease.
Crop insurance rules tied to the scheme.
Agents hardly take any interest to help policyholders after selling policies.
Out of the total people holding general insurance policies, health and motor insurance top the chart. 82% people hold motor insurance and 76% hold health insurance. The rest 22% possess home insurance.
The survey reported that consumers continue to face problems in getting their health claims from the insurance companies, despite interventions by the Insurance Regulatory and Development Authority of India. This includes rejection of health insurance claims and cancellation of policies by insurance companies.
43% of health insurance holders found it difficult to get their insurance claims, followed by 24% of motor insurance holders, and 10% of home insurance holders.
The majority of the people who commented on this subject mentioned that claiming a health insurance is very time-consuming as many policyholders and their family members waste their time running around, trying to get their claims processed. By the time, their insurance is approved, the patient has no energy to fight for expenses that are not approved by the insurance company.
The survey further highlighted that 93% of respondents want the IRDAI to make it compulsory for insurance companies to reveal details of claims received, rejected, policies approved and policies cancelled on their websites each month.
