Covid health claims surge amid pandemic

Mumbai: Indian medical insurers are swamped with coronavirus claims since April — so much so that Covid-19 has emerged as one of the leading ailment categories under which policyholders are filing reimbursement demands this fiscal.Between April and August, Covid could well be the fourth leading medical category under which policyholders have demanded settlement for expenses incurred at hospital. This is against various other common ailment categories typically registered with insurers such as digestive, infections, injuries and respiratory. 78030183This is according to the composite claims data shared by leading online aggregator Policybazaar with ET based on the claims registered by its customers. The data represents about 10% of all retail health claims made in India.Coronavirus claims made for approximately 11% of total health claims registered in this period, the data showed. Ailment categories leading to most registered claims were digestive-related constituting 15% of the total claims, infections about 13%, and toxin-related health hazards at 13%, as per the data. “Our data has shown that Covid-19 claims registered since the virus started surging across the country in March is more than that under common categories such as respiratory and genitourinary,” said Amit Chhabra business head – health, Policybazaar.Covid-19 as a category had more claims registered than other common ailments classifications such as injury and poisoning at 8%, genitourinary at 6% and respiratory at 5% in this period, the data showed.Meanwhile, Policybazaar data also highlighted another critical aspect of covid-19 treatments – the high costs incurred by patients. Despite most cases referred to home treatments or mildly symptomatic, the claim severity — also known as the average settlement size — at ₹82,000 for Covid-19 is 67% higher than ₹50,000 for non-Covid-19 claims. “Most Covid-19 hospitalisations are for elderly people with comorbidities, which generally triggers a high claim amount,” said Chhabra. “Most of the younger and healthier people getting the virus are not getting hospitalised.”As per insurers that ET spoke with, the reasons for higher claims was also because of increased expenses on overheads in the treatment of the virus where the risk of contagion is rather high.“When it started out in March and April, the PPE kits were high due to the demand, the treatment protocols and cost patterns were not clear which took a few weeks to settle down,” said Anuj Gulati, CEO, Care Health Insurance. “From a hospital perspective, there is also a pressure to improve capacity utilisation.”Separately, as per the latest industry-level data accessed by ET, the general insurers have registered 1.92 lakh claims worth ₹3,013 crore as on September 8, 2020. This is the monthly claims data monitored and compiled by the General Insurance Council. Of this, about 1.2 lakh claims were settled by industry amounting to ₹1,165 crore, the data further showed. Maharashtra led the country with 78,000 claims, followed by Tamil Nadu, Karnataka, Gujarat, and Delhi.

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