Top view of doctor's stethoscope, pen and health insurance claim form on table
Credit: iStock
Bengaluru: The average size of health claims have increased by 30 per cent between financial year 2022-23 (FY23) and FY25, according to a study by Policybazaar released on Friday.
From the average claim payout of Rs 62,014, it has now risen to Rs 81,025 in FY25.
Heart diseases, at 25-30 per cent, and natural causes, at 25-30 per cent, remain the most prevalent reasons for term insurance claims. Accidents are third at 15-20 per cent.
Covid-19 claims also reflect the ongoing impact of the pandemic on life insurance needs.
“This suggests that healthcare costs are rising, and policyholders are claiming higher amounts for medical treatments. This trend also indicates that insurance is becoming a more essential tool for managing medical expenses as medical inflation outpaces general inflation,” the study pointed out.
Health insurance claims are primarily driven by both seasonal and chronic conditions. The most common health conditions leading to claims include fever, gastritis, heart disease, diabetes and cancer.
The frequency of claims has also increased over the last three years.
The majority of term insurance claims are made by male policyholders (90-92 per cent).
The top regions for term insurance claims include Maharashtra, Uttar Pradesh, Delhi, Karnataka, and Gujarat. Regions with higher urban populations and greater access to financial services see more claims.
In October 2024, the non-life insurance industry reported a premium of Rs 30,378.0 crore, breaching the Rs 30,000-crore mark for the first time in the last 79 months rising by 27.5 per cent, according to CareEdge Ratings data put out on Friday. This is following a decline in September 2024.
Health insurance premiums continue to be the largest segment of the non-life insurance industry. This growth has increased the segment’s market share from 35.1 per cent for year-to-date (YTD) FY23 to 38.8 per cent for YTD FY25.
The public sector health insurance business has lagged their private peers. Standalone health insurance had outperformed industry growth, growing by 24.8 per cent, versus 13.9 per cent growth in the aggregate health segment growth.