What health insurance claims data tells us about Indians

health insurance Oct 28, 2019

There is an adage about insurance in general, and health insurance in particular - "everyone knows the price, only a few know the value". Those few are most likely ones who've seen a close relative/friend go through hospitalization.

It is a harsh reality that most people in India see insurance premium as an 'expense'. 'Health insurance' is a tough product to sell in a society where people seek instant gratification from a product/service they purchase. It is for this reason that customers need to be educated about the 'value' of health insurance and the best way to do that is by telling a story using data.

We believe that providing consumer insights using insurance claims data is a great way of educating customers on the 'value' of health insurance.

Insurance information Bureau (IIB), an initiative by IRDA, has done a great job putting together insights based on claims data submitted by various insurance companies. My only complaint with IIB is that this data is not available publicly and not updated frequently.

Let us look at some interesting insights based on IIB data that was published using claims data in 2013-14.

Region-wise claims: It is a fact that health insurance even today is largely an urban phenomena. It is no surprise that the top 5 regions where claims are made are the tier-1 cities. Mumbai stands out with the highest number of claims and claim value. A total of 225,000 claims worth ~900 crores in claim amount got settled in Mumbai alone.

Source: IIB report 2013-14

Average claim amount: Average claim size varies between 35,000-42,000 per claim. This gives you a rough sense of the 'value' of health insurance policy.

Source: IIB report 2013-14

Even if a person who pays an annual premium of 5,000 for a basic health cover claims once in 8 years, she will find that she is better off having a health insurance than having none.

You will notice that the claim size varies from city to city. This is usually because of the variation in hospitalization expenses (doctor fees, diagnostic expenses etc.) across Indian cities. Mumbai and Bangalore have the highest claim sizes.

Men v/s women: When we look at men v/s women data, we see that men make significantly higher number of claims than women. Out of every 100 claims paid, 30 are paid to women whereas 70 are paid to men. Average claims of both men and women are only marginally different.

Source: IIB report 2013-14

Men make 2.5 times more health claims than women. Either Indian women are superwomen or massively under-insured compared to men. Although we want to believe the former, we have to accept that truth is closer to the latter.


Age-wise distribution : This is the most interesting and counter-intuitive data-set we have. Conventional wisdom would have us believe that number of health claims filed by old people are much higher than those filed by younger ones. Data shows a different trend - maximum number of claims (in absolute numbers) are made in the age group of 26-35. Surprisingly, average claim made by a 26-40 year old is only 7% lower than a claim made by a 70 year old. Young Indians have a a 'casual attitude' towards health insurance and this data should come as a massive wake-up call .

Source: IIB report 2013-14

Youngsters have made more claims than older people and the average claim size of youngsters is only marginally lower than their older counterparts.

To summarize, Indians have an average claim size of 40,000 with an overwhelming portion of those claims made by men. Young Indians have made more number of claims with a marginally lower claim size than their older counterparts.

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Sushant Reddy

Sushant is a serial entrepreneur who is passionate about transforming senior heatlhcare in India