The maximum health insurance payouts in the country are related to diseases of the circulatory system, according to a new study. The major expenses are for angioplasties, bypass surgeries and treatment of circulatory diseases of the brain such as transient ischemic attacks or mini-strokes.
In terms of number of claims, infections topped the list with 2.19 lakh claims, according to the data collected from the 28 third party administrators (TPAs) on the top 15 diseases that resulted in high claims during 2007-08.
TPAs were introduced in 2002 to provide cashless hospitalisation to health insurance policyholders. TPAs are intermediaries between insurers and policyholders and service the claims made by the insured. Non-life insurance companies have paid Rs 468 crore as claims for various circulatory diseases. The average claim paid for circulatory diseases is the highest at Rs 40,231.
Second in the list is digestive diseases where insurers have paid Rs 314 crore as claims followed by Rs 258 crore claim paid due to urological diseases and Rs 255 crore claim settled due to injuries. The average claim paid for infections was the lowest at Rs 10,712.
Another interesting finding was that the average claim paid in Delhi was the highest at Rs 31,283, followed by Maharashtra at Rs 27,367, West Bengal at Rs 25,070, Karnataka at Rs 24,419. The average claim was the lowest in Kerala at Rs 10,671.
The data is not comprehensive as it does not include the premium and claims details of the business done by non-life insurers directly.