Motor insurance is the bestselling insurance product in our country in terms of premium volume and number of policies sold, although health insurance has also gained fast pace in the last decade and now perceived as a necessity by common people in the wake of the global pandemic faced by the world in the last years.

The reason for motor insurance still being number one not merely goes to the mandatory nature of third party liability insurance but also to the increasing number of road accidents and mishaps taking place all around. Motor third party insurance is a no fault liability insurance which is mandatory for any form of vehicle whether it may be two wheeler, four wheeler and commercial vehicle plying on Indian roads.

With the huge development in the standard of city roads and national highways in our country and modern latest cars coming in we have also seen increasing number of accidents which have increased the importance of both third party and own damage motor insurance. To reiterate own damage section of the policy covers the vehicle from a wide range of natural and man-made perils which in absence of the policy make give a blow on your pocket and disturb your monthly budget.

As mentioned in the paragraph above with the increasing number of accidents and the resulting increment in dependence of motor insurance policies, insurers are seeing a surge in motor insurance claims as well. Although modern age insures have devised many innovative and high tech ways of registering the claim, some of them are uploading a video, calling the toll free number or use the internet portal of the insurer with different functionalities. These features are new age which almost goes well with tech savvy and digital friendly customers, the claimant in every case necessarily not is the same.

There may be cases where a farmer wants to register a claim for a commercial vehicle from rural part of country where he may not be well versed with the computer and also may not understand and speak common languages used by the toll free customer care executive. For this and many other similar cases writing a claim intimation letter in one’s preferred language is still a popular way to writing insurers giving information about the claim incident.

Considered as an old fashioned way by many, this is still an authentic way which in cases may prove helpful and ease a lot of to and fro communication from both sides. In this present article we will write a sample claim intimation letter informing the insurer about a bike accident. The reader may take this letter as a guide and endeavour to write similar intimation letters informing their particular case to insurance companies.

To,

The Manager

Claims department

NORA Insurance Company,

138 C, Corporate House, Fort, Mumbai 400001

Subject: Intimating the insurance claim for my two wheeler (Registration number MH04GH6655) which is covered under Motor insurance (Product UIN – AASG56XXVW and Policy Number 1884600741) with policy period 03-06-2021 to 02-06-2022, regarding accident on 02-12-2021 with a car (registration number MH01GH2582) as per details provided below.

Dear Sir,

This letter is to inform you and bring to your kind attention that I met with a serious accident on 02-12-2021, Thursday at 6:30 PM while returning from my office at Juhu when an uncontrolled car hit me from front. I was driving my Honda CBR bike at the time of incident with a pillion rider who is my office colleague. Both of us have sustained minor injuries for which we have already received treatment from a registered medical practitioner.

To elaborate the incident me and my friend who works in the same office with me was returning back to our hostel located in Andheri via XYZ road, we were crossing a single lane street named as ABC market when a Maruti Swift car who was trying to avoid a car parked at the side of the road got uncontrolled and hit us unknowingly that we are coming from front. Both the vehicle was luckily at normal speeds which helped in averting any serious damage to both vehicles and passengers therein. Even then my bike is not in a driving condition and I am unable to use it since that day.

As I was injured and not able to take the vehicle to repair it is still standing in the parking area of my hostel. I intend to lodge a cashless claim with your company and get the bike repaired at the authorised Honda service centre Andheri which is quite near to my place of residence. For this purpose I am attaching herewith all the necessary documents, so that I can get this cashless claim settled at the earliest.

It is a request that kindly go through the contents of this letter and the attached supporting documents and send your surveyor to the Honda service centre so that I can get the bike repaired. For your information I will get the bike towed to the service centre tomorrow morning so that you can directly survey it there. Request your quick response on this issue as without the bike it is considerably difficult for me to attend office. For this I shall remain highly obliged to you.

Yours Truly

Mr. Raj

ABC Tower, NA Road, Andheri West, Mumbai 400091

Mobile – 79977997000

Email – [email protected]

Documents attached:

1. Bike registration copy
2. Driving Licence copy
3. Policy copy
4. Aadhar card

India stands on the brink of a significant transformation regarding the tax implications of term life insurance premiums and health insurance premiums for senior citizens.

The GST Council is considering the possibility of exempting these essential categories from the Goods and Services Tax. This change could result in substantial savings for millions and encourage greater adoption of insurance, especially among the elderly and middle-income groups.

Currently, term life insurance premiums and all health insurance policies are subject to an 18% GST. However, this may soon be altered. A committee of ministers has proposed a total GST exemption for:

• Term life insurance premiums for all policyholders, regardless of age

• Health insurance premiums for senior citizens (defined as individuals over 60 years), with no cap on the sum insured

The financial benefit can be significant

For elderly individuals who spend ₹50,000 annually on health insurance, an 18% GST results in an additional ₹9,000. Lowering this tax reduces the cost of these policies. Furthermore, it represents a move towards perceiving insurance as a necessity rather than a luxury.

The projected annual impact on the government is approximately ₹2,600 crore—₹2,400 crore attributed to health insurance and ₹200 crore to term life insurance. The Council intends to counterbalance this through adjustments in GST categories.

What to anticipate?

Upon approval, the exemption will considerably lower the expenses associated with term life and senior health insurance. This long-anticipated action has the potential to encourage a greater number of individuals to obtain insurance and offer assistance to the growing elderly demographic in India.

In India, a large number of private health insurance policyholders are witnessing a concerning trend—rising premium costs coupled with an increasing number of claim rejections. 18% GST levied on premiums add to it, prompting many to forego policy renewals altogether.

Healthcare remains one of the most significant expenses for individuals in India. With medical inflation hovering around 14% and nearly 60% of the population depending on private healthcare services, the financial burden of a single illness can potentially push an entire family into debt.

This raises critical questions:

• What regulations govern India’s health insurance sector?
• Why are premiums increasing so rapidly?
• Will the regulator bring any relief?
• And more importantly, is health insurance the ideal path toward universal healthcare in India?

Underinsurance Remains a Major Concern

Despite rising healthcare costs, a vast majority of Indians remain underinsured. Reason for this could be a general underestimation of actual treatment costs. 51% of non-buyers believe the cost of treating critical illnesses—like cancer, kidney transplants, or cardiac surgeries—is under ₹5 lakh, a figure far from today’s medical realities.

Limited Awareness and Outdated Financial Mindsets

Awareness continues to be a barrier. Indians are still unaware of Health insurance and its benefits. This lack of knowledge often results in poor financial planning, with many still relying on selling ancestral assets or taking loans during medical emergencies instead of investing in accessible insurance products.

Interestingly, while traditional instruments like gold, fixed deposits, and real estate remain popular, health insurance is now being viewed as a smart investment choice.

Opening In Health Insurance Underwriting

Upon certification, candidates can pursue various roles in the insurance industry, including Assistant Administrative Officer, Insurance Surveyor, Risk Manager, Underwriter, Claims Adjuster, Actuary, Insurance Consultant, and more. Potential employers include numerous Life Insurance and Non-Life Insurance companies across the country.

The Insurance Institute of India (III) offers exams that certify and train candidates in different aspects of the insurance industry. These exams are divided into two main streams: Life Insurance and General Insurance, with each stream comprising three papers. These include Principles of Insurance (IC 01), Practice of Life Insurance (IC 02), and Regulation of Insurance Business (IC 14), among others. The Principles of Insurance and Regulation of Insurance Business papers are common across both streams.

III exams play a pivotal role for those aspiring to build a career in the insurance sector in India, as they assess an individual’s proficiency and understanding of the industry. The Licentiate exam, which is the foundational step, marks the beginning of a rewarding career at an insurance company. Individuals who have completed their S.S.C. or an equivalent examination and are at least 18 years old are eligible to register for this exam.

The Licentiate exam serves as an introductory course, while the Associate ship program is more specialized, involving five technical subjects and a common subject on Information Technology. The Fellowship level represents the highest level of qualification, focusing on advanced studies in the specified fields.

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Job description

A Health Insurance Claims Job typically involves processing, evaluating, and managing claims made by policyholders under their health insurance policies. People in this role work with healthcare providers, policyholders, and insurance companies to ensure that claims are accurately processed, payments are made, and services are covered according to policy terms.

Here’s a breakdown of the key responsibilities and skills associated with the job profile:

Key Responsibilities:

1. Claims Processing:
   • Reviewing health insurance claims for accuracy, completeness, and compliance with policy coverage.
   • Verifying patient information and medical procedures to ensure they align with policy terms.
   • Analyzing billing codes, diagnoses, and treatments to determine reimbursement levels.
2. Claims Adjudication:
   • Deciding whether claims should be paid or denied based on policy coverage.
   • Applying relevant laws, regulations, and guidelines to make informed decisions.
   • Communicating with healthcare providers or policyholders to clarify any discrepancies or missing information.
3. Customer Service:
   • Assisting policyholders with inquiries regarding their claims, coverage, and payments.
   • Explaining the claims process to customers and helping them resolve issues.
   • Handling escalations for complex claims or disputes.
4. Claims Investigation:
   • Conducting investigations to identify fraudulent claims or instances of abuse.
   • Reviewing medical records, treatment histories, and other supporting documents.
5. Documentation and Reporting:
   • Maintaining accurate records of claims submitted, processed, and paid.
   • Preparing reports on claims processing metrics and trends for management.
6. Collaboration:
   • Working closely with insurance agents, healthcare providers, and other departments (e.g., underwriting, fraud prevention).
   • Assisting in updating policy documents to reflect changes in coverage or procedure codes.
7. Compliance:
   • Ensuring claims processing is in compliance with government regulations (like HIPAA in the U.S.) and insurance policy requirements.

Required Skills:

• Attention to Detail: Ability to scrutinize claims for accuracy and completeness.
• Analytical Thinking: Evaluating medical codes, treatment plans, and insurance policies.
• Communication Skills: Clear communication, especially when explaining claim status to policyholders or healthcare providers.
• Knowledge of Healthcare and Insurance Terminology: Familiarity with medical codes (CPT, ICD), treatment plans, and insurance terms.
• Problem-Solving: Resolving discrepancies and claims disputes in a fair and timely manner.
• Technical Proficiency: Familiarity with claims management software and general office software (Excel, Word).

Education and Qualifications:

• Degree Requirements: Typically requires a high school diploma or equivalent. However, a bachelor’s degree in health administration, business, or a related field may be preferred

Work Environment:

• This role can be performed in various settings such as insurance companies, healthcare organizations, or third-party administrators (TPAs).
• Health insurance claims professionals may work in office environments or remotely, depending on the company.

Career Path:

• Starting as a claims processor, one can advance to roles like Claims Analyst, Claims Supervisor, or Claims Manager.
• With additional experience or certifications, there’s potential to transition into medical billing, fraud investigation, or underwriting roles within the health insurance industry.

If you’re thinking of pursuing a job in health insurance claims, the role can offer strong career stability and a good blend of administrative, customer service, and analytical responsibilities!

Navigate below link to apply for Jobs:

Jobs in Health Insurance Claims