Name of Insurance Company: Future Generali India Insurance Company Limited
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
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 |
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
Data of number of claims processed:
Outstanding number of claims at the beginning of the year: 5406
Number of claims received during the year: 98461
Number of claims paid during the year: 84832 (89%)
Number of Claims repudiated during the year: 10915(11%)
Number of claims outstanding at the end of the year: 8120
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
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% |
Sr. No |
Description |
Number of Grievances |
| 1 | Grievance outstanding at the beginning of year | 0 |
| 2 | Grievances received during the year | 46 |
