Key Points
- 25-35 age group leads insurance claims with significant maternity coverage
The claims under this age group are mainly dominated by maternity coverage.
The report adds that policy claims from women have surged and account for 60 per cent of the total claims while claims from men account for 40 per cent.
Male employees aged 35-45 make the highest claims, reflecting a rise in lifestyle-related illnesses such as diabetes, cardiovascular diseases, and stress-related disorders.The company said that the corporates are increasingly customising age-specific health benefits, such as higher maternity coverage for female employees and wellness benefits for their workforce.
As per the report which is based on its internal data, healthcare costs have been rising due to the high cost of healthcare services in private hospitals and expensive medical procedures.Observing the trends, Sajja Praveen Chowdary, Director at Policybazaar for Business, said, "The evolving trends in group health insurance claims highlight the rising cost of medical care and the need for efficient claim processing."
Companies with operations in Tier 1 cities are opting for higher sum insured policies to protect employees from out-of-pocket expenses. Tier 2 and Tier 3 cities employers are exploring co-payment and deductible models to keep insurance premiums manageable while maintaining adequate coverage. Employees of Industries involved in physically difficult roles like manufacturing, construction, transport and logistics stand on top for group insurance claims. Industries with rising group health insurance (GHI) adoption highlight a shift in employee benefits strategy, especially in sectors with young, health-conscious workforces. New-age startups, e-commerce and online retail, fintech and IT are attracting top talent with comprehensive healthcare benefits.Customised, flexible health insurance plans are gaining traction, offering telehealth, mental wellness support, and stress management programs. Companies in technology sectors are bundling wellness incentives such as gym memberships and health-tracking apps into their policies to encourage proactive health management. In terms of employee claim frequency, 5-7 per cent of employees file multiple claims annually, highlighting the impact of chronic illnesses and recurrent medical conditions. Cardiovascular diseases, respiratory disorders, and joint problems are among the leading causes of repeat claims under the employee's claim categories. Companies in non-metro areas are encouraging employees to use insurer-partnered hospitals to maximise cashless benefits. Insurers are also expanding their cashless hospital networks in Tier 2 and Tier 3 cities to increase adoption rates.
