PUBLIC DISCLOSURES ON QUANTITATIVE AND QUALITATIVE PARAMETERS OF HEALTH SERVICES RENDERED AS ON MARCH 31, 2023
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 | 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
| Details | Count |
| 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% |
| 6 | >24 hours | 0% | 0% | 0% | 0% |
| Total | 100% | 100% | 100% | 100% | |
*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 | 7% | 0 | 0% | 12279 | 9% |
| 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% |
| Total | 32549 | 100% | 102235 | 100% | 0 | 0% | 134784 | 100% |
*Percentage shall be calculated on total of the respective column
Data of grievances received against the TPA: Not applicable
