Assessment of Satisfaction Levels of Health Insurance Policy Holders with Claims Settlement Process in Pune, Maharashtra

Abstract

Introduction: Customer satisfaction is an important determinant of health insurance penetration. It is
not only indicative of customer loyalty but is also helpful in identifying the needs of the customer and
further necessity of product innovation. As compared to other verticals of insurance, health insurance is
more complex as for the administration and implementation of the policy various stakeholders are involved.
Theses take holders are namely hospitals, Third Party Administrators and health insurance agents and
advisors. Equally important is the satisfaction with the claim settlement process, which significantly impact
overall satisfaction with health insurance policies.
Aim and Objectives: To assess of customer satisfaction levels with the claim settlement process amongst
health insurance policyholders in Pune, Maharashtra. Further, the study is aimed to identify the potential
areas of dissatisfaction and weaknesses in the claim management system.
Materials and Method: The study design is and exploratory and descriptive. Sequential random sampling
used to select participants from the data of health insurance policyholders who have availed the benefit of
health insurance through hospitalisation. 5-point Likert scale was used to assess the responses on claim
settlement process.
Results: Health insurance claims administration involves coordinated efforts of stakeholders viz insurance
companies, TPA services, Hospitals and agents and advisors. The study shows scope of improvement in
the claims settlement process. The policyholders experience depends on the coordination, timeliness and
transparency in the process.