🚨11/15 private insurers paid less than 75% of the amount claimed.
It also seems to suggest that PSU insurers have paid more than 98% of the claim amount.
Let's deep dive into this data and see what is happening.👇
First of all
I stand for retail investors I will always speak for them.
Next,
Let's clear the market share of these insurers in the retail space
New India-16.85%
Star Health-13.85%
National-6.48%
Care Health-6.07%
Bajaj Allianz-6.05%
ICICI Lombard-5.72%
HDFC Ergo-5.51%
However, when you look at the below-said data:-
Claims considered for various insurers
New India-90,56,011
Oriental-25,49,779
United-45,24,241
Star health-19,55,549
HDFC Egro-9,07,914
United which has a market share less than Star Health has 2x higher claims than Star
New India which has a similar market like Star has 4x more claims than Star.
The above completely makes no sense,
But the above does make sense,
When you consider both corporate+retail claims,
PSU insurers the preferred corporate health insurance partners to big companies like TCS, Wipro and all other big MNCs.
It is obvious that corporate claims will be settled 100%.
The point here is that the below clipping does not specify,
If these is corporate+retail claims or not,
Looking at the sheer quantum of claims for PSU claims,
Highly likely that this includes the corporate claims as well as retail claims,
PSU insurers are no saints in retail health insurance space either,
Almost all old PSU policies with a Sum insured of less than 5L
comes with a room rent limit and proportionate deduction,
So highly unlikely they will even pay 95% of the sum insured,
PSU policies above 5L and up to 10L are the policies where there are no restrictions as such.
PSU insurers are no saints either,
Once you separate the retail claims you will tend to realize this
Now let's come to the bigger questions,
So why do Private life insurers have such a low claims payout ratio?
Private insurers are no saints either,
The whole health insurance industry is very very opaque
Claims get rejected left right and centre,
Sometimes for no reason at all,
There is a real pain for customers,
And there is no question that this is the reality.
To solve these problems
1. Insurance companies need to really improve
2. New-age advisors are needed to explain terms in detail
3. IRDAI needs strict laws against mis-selling of policies
4. Many agents hide pre-existing conditions to buy a health insurance policy for no reason at all.
PSU or private insurer....none of them are saints in this country,
But health insurance is not a luxury,
it is a necessity.
@RamaniSumit@GabbbarSingh Met 2 IIT K pass outs last week - both left high paying finance jobs to go back to their home towns and do conventional business - burnt out by early 30s / tired of competing at every stage of life - very happy now ..don’t want their kids to ever go through this grill