Maharashtra large on health cover claims

When it comes to health insurance, the people of Maharashtra all the time get their due. The state led the country in the number of medical insurance claims filed in 2009-2010, indicating, according to experts, higher levels of public knowledge about the issue.

More than 2.96 lakh policyholders in Maharashtra applied for cashless and reimbursement claims with general insurance companies providing health cover in the financial year 2009-2010, according to data compiled by the Insurance Information Bureau (IIB), a government agency. In comparison, Delhi boasted a figure of just 1.16 lakh claims. Only Gujarat and Tamil Nadu came close to Maharashtra with 1.62 lakh and 1.51 lakh claims, respectively.

An insurance analyst certified the noticeable difference in numbers to public awareness levels. "In Delhi and Maharashtra, mostly in cities like Mumbai and Pune, awareness about insurance products is reasonably higher than in rest of the country. A large number of people are buying health insurance policies. Obviously, with a sizeable number of people getting insured, the claims are also going to be high," he said.

The large number of insurance claims, however, did not mean large amounts of money. Even though Delhi had fewer claims filed, it had the highest average of reimbursement paid by insurance companies in the country—Rs 31,052. Policyholders in Maharashtra, in comparison, received an average of Rs 30,885. This, however, was significantly better than Gujarat, where, despite the 1.62 lakh claims, the average reimbursement was just Rs 19,004.

But the best numbers were scored by Rajasthan, which had only 20,134 insurance claims, but an average reimbursement of Rs 19,632.

Many attribute the high number of insurance claims in the country to fraudulent practices. Dr Mohammed Mukhtar, health strategies manager, MD India Health Care Services, said: "Insurance companies have suffered major losses because of the high number of claims, some of which are fixed in frauds perpetrated by hospitals. In many cases, policyholders participate in the frauds by showing excess billing and unnecessary or extended hospitalization."

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