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Representative Image

It's not just number of COVID health claims but the average size of claims that's worrying health insurers. Claims are even higher for non-COVID cases, say insurers.

The average claim size for COVID claims is nearly one lakh versus a pre-COVID average of Rs 50,000-Rs 55,000, said Rajagopal Rudraraju, Senior Vice President & Product Head - Health & Health Claims, Tata AIG. “The increase in average claim size for COVID is unprecedented in the industry and needs to be addressed, else these could be passed on to the customer by way of increase in premiums”, he said.

Average health claims double to Rs 1 lakh during pandemic, add to insurers' worries

The increase in COVID claims was compensated by a fall in claims for accidents and some infections. With reduction in COVID restrictions, the claim burden has increased significantly for all insurers. “Planned treatments like cataract, hernia and similar treatments which were postponed earlier are being conducted now, which is adding to this”, Rudraraju said.

Cashless priority

Meanwhile, Regulator IRDAI has directed insurers to decide on cashless COVID-19 treatment claims within 60 minutes of the receipt of final bill so that the hospital bed can be quickly made available to another waiting patient.

The Insurance Regulatory and Development Authority of India (IRDAI) also directed all general and health insurers to communicate their decision on authorisation for cashless treatment for COVID-19 claims to the hospital within 60 minutes from the time of receipt of request along with all necessary requirements from the hospital.

The regulator issued this direction in view of a Delhi High Court order asking the regulator to tell insurers to communicate their cashless approvals within a maximum time period of 30 to 60 minutes so that there is no delay in discharge of patients.

Rudraraju of Tata AIG said, cashless facility for COVID claims has become an issue because some hospitals are either refusing to provide cashless for COVID cases or asking for rates higher than the agreed rates in the SLA. The provider hospitals are justifying increase in their rates due to the higher cost of maintaining healthcare services in COVID times. There have been consultations between providers and insurers to resolve and reach a mid-point, but the issue is still persisting.

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