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PUBLIC DISCLOSURES ON QUANTITATIVE AND QUALITATIVE PARAMETERS OF HEALTH SERVICES RENDERED AS ON MARCH 31, 2020

Name of Insurance Company: Future Generali India Insurance Company Limited

  1. Specify in-house claim settlement (if, data is in respect of in-house claim settlement)/ specify the name of TPA with whom insurer entered into service level agreement (if data relates to health services rendered by TPA) as may be the case: In-house claim settlement

  1. Number of policies and lives serviced in respect of which public disclosures are made:

Description

Individual

Group

Government

Number of policies serviced 748389 2266 0
Number of lives serviced 862966 3500497 0
  1. Information with regard to the geographical area in which services are rendered by TPA/Insurer (State names-District names shall be provided) in respect of which public disclosures are made: Not Applicable

  1. Data of number of claims processed:

    1. Outstanding number of claims at the beginning of the year: 5406

    2. Number of claims received during the year: 98461

    3. Number of claims paid during the year: 84832 (89%)

    4. Number of Claims repudiated during the year: 10915(11%)

    5. Number of claims outstanding at the end of the year: 8120

  1. Turn Around Time (TAT) for cashless claims (in respect of number of claims):

Sr. No

Description

Individual policies (in %)

Group policies (in %)

TAT for preauth**

TAT for discharge***

TAT for preauth**

TAT for discharge***

1 Within 1 hour 48.31% 71.90% 49.87% 72.25%
2 Within 1-2 hours 47.57% 25.13% 44.97% 26.84%
3 Within 2-6 hours 3.32% 2.87% 3.25% 0.91%
4 Within 6-12 hours 0.48% 0.10% 1.06% 0.00%
5 Within 12-24 hours 0.32% 0.00% 0.84% 0.00%
6 Within 24 hours 0.00% 0.00% 0.00% 0.00%
Total        

*Percentage to be calculated on total of the respective column.

**reckoned from the time last necessary document is received by insurer /TPA (whichever is earlier) and till final pre-auth is issued to the hospitals

***reckoned as final discharge summary sent to hospital from the time discharge bill is received by TPA

  1. Turnaround time in case of payment/ repudiation of claims:

Description (to be reckoned from the date of receipt of last necessary document)

Individual

Group

Government

Total

  Number of Claims Percentage Number of Claims Percentage Number of Claims Percentage No of claims Percentage
Within 1 Months 15561 92% 76450 97% 3 100% 92014 96%
Between 1 – 3 Months 959 6% 1973 3% 0 0% 2932 3%
Between 3 to 6 Months 256 2% 297 0% 0 0% 553

 

1%
More than 6 Months 87 1% 161 0% 0 0% 248 0%
Total 16863 100% 78881 100% 3 100% 95747 100%

 

  1. Data of grievances received against TPA

Sr. No

Description

Number of Grievances

1 Grievance outstanding at the beginning of year 0
2 Grievances received during the year 46