Unsure Payout – India’s health insurers get away with denying too many claims. Regulator must step in

Source: The post is based on an article “Unsure Payout – India’s health insurers get away with denying too many claims. Regulator must step in” published in The Times of India on 29^th November 2022.

Syllabus: GS 2 – Social Justice

Relevance: problems with health insurance in India

News: India’s out-of-pocket expenditure is around 55% of total health expenditure which is more than the global average of 18%.

However, the experience of individual with health policies has been unsatisfactory even though it has been over two decades since the insurance market opened up.

What are the problems with health insurance in India?

Health insurance in India has three main problems – it covers only hospitalisation, exclusions as many people are excluded from getting the insurance, and limits on covering the hospital bills.

Many times, people are excluded from getting the insurance benefit due to different reasons and people bear the cost of paying medical expenses even though they have insurance for it.

For example, during the pandemic, many insured found that a significant amount of their hospital bills fell outside the purview of insurance.

Some fear of being cheated as the claims process is often handled by third party administrators. 

The largest buyer of health insurance is GoI and the state government for their different schemes.

Even though, a good number of people are not covered under their schemes and they remain vulnerable to health emergencies in the absence of a first-rate insurance system.

Therefore, IRDAI needs to find a way to enhance the quality of insurance policies by providing individual satisfaction.