A nationwide study on health insurance claims experience, in which nearly 2,300 people participated, shows while the system is functional the complexity of the process and the gaps across claim mode, region and hospitalisation frequency call for meaningful improvements.
Cashless claim route, compared to reimbursement, remains the easier route for customers. Reduced upfront burden, simpler paperwork, nearby network hospitals and faster approvals are some of the advantages of the cashless mode.
Reimbursement mode is “far more effort heavy journey” and require the responsibility that fall on such customers in terms of payments, documentation, follows ups and settlement.
76% borrowed for treatment
As many as 76% of the reimbursement claimants, as opposed to 68% of those who participated in the study last year, said they borrowed funds during treatments. Many claimants who opt for reimbursement when cashless mode is unavailable were delayed when waiting for discharge after the hospitalisation. “This becomes even more stressful when customers must arrange funds upfront,” the findings of the study conducted as part of the Health Claims Experience (HCX) Index launched by Policybazaar showed.
Sharing the report, the insurance aggregator said India’s positive health insurance claims experience is being driven by those who opted for cashless. Such customers cited ease of paperwork, faster approvals and access to network hospitals as key drivers of satisfaction, Policybazaar said on the ‘Is India Happy with Health Insurance Claims? 2.0.’ consumer study findings.
Seven in ten respondents underwent cashless treatment, with such claims recording an HCX score of 86.7, higher than reimbursement claims at 73.7. The study covered 2,228 Indians across metros and tier-II and III cities who had filed a health insurance claim, post hospitalisation, either for themselves or those close to them, between August 2024 and September 2025.
The HCX score for India stands at 82.8 out of 100, placing the country’s health insurance claims experience in the ‘moderate’ category.
Call for greater transparency
Policybazaar said the findings call for greater transparency in claim communication, claim-specific rejection explanations, stronger verification at policy purchase, real-time claim tracking, deeper hospital-insurer integration and reduced paperwork to make health insurance claims faster, simpler and more dependable for customers.
Joint Group CEO Sarbvir Singh said as “the industry evolves, the next frontier is not just settling claims, but ensuring customers clearly understand claim decisions and have confidence in the process.”
Introduce universal claims form
Among recommendations, of the study, to the insurers are introduction of a single, universal claims form and shifting the responsibility of submitting bills and discharge summaries from patient to the provider.
