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
|Number of policies serviced||127924||1607||0|
|Number of lives serviced||333796||2271375||0|
Guidelines on Public Disclosures by Insurers on the qualitative and quantitative parameters of the health services rendered to policyholders
|i. Outstanding number of claims at the beginning of the year: --||7675|
|ii. Number of claims received during the year ----||135277|
|iii. Number of claims paid during the year: ---- (also to specify % in brackets)||119839 (89%)|
|iv. Number of Claims repudiated during the year: --- (also to specify % in brackets)||14945 (11%)|
|v. Number of claims outstanding at the end of the year: ---||8168|
Turn Around Time (TAT) for cashless claims (in respect of number of claims):
|S. No||Description||Individual policies (in %)||Group policies (in %)|
|TAT for pre-auth**||TAT for discharge***||TAT for pre-auth**||TAT for discharge***|
|1||Within <1 hour||38%||33%||39%||30%|
|2||Within 1-2 hours||46%||51%||47%||53%|
|3||Within 2-6 hours||10%||15%||10%||16%|
|4||Within 6-12 hours||2%||0%||2%||0%|
|5||Within 12-24 hours||5%||0%||2%||0%|
*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
Turn Around 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||5395||17%||6884
|Between 1 – 3 Months||27154||83%||95351||93%||0||0%||122505||91%|
|Between 3 to 6 Months||0||0%||0||0%||0||0%||0||0%|
|More than 6 months||0||0%||0||0%||0||0%||0||0%|
*Percentage shall be calculated on total of the respective column
Data of grievances received against the TPA: Not applicable
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