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Times of India
03 March 2011
By Manthan K Mehta
Mumbai, India

It is surprisingly not deadly maladies but everyday ailments for which policyholders knock the most on insurance companies’ door. In 2009–2010, these companies received 3.18 lakh health insurance claims for infectious illnesses like malaria, fever and the like, whereas the number for heart diseases was much lower at 1.7 lakh.

More than 32.63 lakh health claims were filed in India in the last fiscal, for which insurers paid out Rs 7,456 crore at an average of Rs 22,846 per claim, according to data recently released by the Insurance Information Bureau (IIB). The IIB figures for 2009–2010 say that of all illnesses, insurers paid the maximum claim for circulatory or heart diseases–Rs 758.04 crore. The average claim paid for these ailments too was the highest at Rs 44,429 per claim.

Go Figure
3.18 L | The maximum insurance claims in ’09–10 made for infectious diseases like malaria and meningitis
393.41cr | All that was paid out for them at an average of 12,333 per case

1.7 L | Claims for heart–related diseases
758.04cr | shelled out to settle them at an average of 44,429 per claim COMPANIES FIND DIGESTIVE DISORDERS A MAJOR PAIN

Mumbai: The Insurance Information Bureau (IIB), an independent body formed by the national Insurance Regulatory and Development Authority, collates data every year to make an assessment of the country’s insurance sector.
It surveys all medical claims, including for individual, group and corporate policies, and payments made through cashless refunds and cash reimbursements.

For the 3.18–lakh applications filed for infectious ailments (malaria, septicaemia, fever, meningitis), insurance companies shelled out only Rs 393 crore, the fifth highest across all divisions of diseases. The average payment, though, was the lowest of all at Rs 12,333 per claim.

"A few years ago, the maximum claims in individual policies were for cataract and hysterectomy," said Dr Aditi Kamath of Escalate Consultant Services, a health claim auditor. "The new IIB data shows that they have been replaced by circulatory and digestive disorders. This is mainly due to lifestyle changes like erratic food habits and high stress levels."

Dr Ajay Thakker, chairman and chief executive officer of Jupiter Hospital in Thane, had another answer. He said that the sizable claims in the infectious disease category can be explained by the large numbers falling ill every year to diseases like malaria, jaundice and dengue. "However, the claim amount is low because these disease have shorter hospitalization periods and the treatment cost is relatively low," Thakker said.

After infectious ailments, digestive disorders–like piles, hernia and appendicitis–was the next big category that affected the balance sheet of insurance firms. Around 2.44 claims were filed for these ailments in 2009–2010. And insurers reimbursed approximately Rs 501 crore at an average of Rs 20,584 per claim.

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