Key highlights

CASHLESS

86.7

REIMBURSEMENT

73.7

HCX Score with a 13-point gap, the sharpest performance divide in the study

~76%

of reimbursement claimants took a loan or broke investments to fund hospital costs, up from 68% in 2023

73%

of dissatisfied claimants were given no clear reason for rejection, up sharply from 53% in 2023

Executive summary

A score of 82.8: the gaps beneath it demand action.

India's health insurance industry scores 82.8 on the HCX, placing it in the 'Moderate' band. But sharp inequalities lie beneath: cashless claimants score 86.7 while reimbursement claimants trail at 73.7. When cashless is unavailable, 76% of claimants had to borrow or break investments, up from 68%. Meanwhile, 73% of dissatisfied claimants received no reason for their rejection, up from 53%, the study's most alarming transparency finding.

Key insights

Finding 1

Two Claims Modes, Two Very Different Worlds

India's overall HCX score of 82.8 is credible, but it masks a 13-point divide driven entirely by claims mode. Cashless claimants enjoy a largely frictionless experience compared to reimbursement claimants, who face upfront costs, paperwork loops and settlement delays that pull their score well below the industry average.

HCX Score by Claims Mode

Overall

82.8

Industry average

Cashless

86.7

Smoother process, fewer financial shocks

Reimbursement

73.7

Delays, paperwork & upfront costs drive the gap

0% 25% 50% 75% 100%

Finding 2

Borrowing to Pay for Claims Is Rising

When cashless is unavailable, the financial burden on families is rising sharply. The share of reimbursement claimants who took a loan or broke investments to fund hospitalisation has climbed year on year, a sign that upfront costs are outpacing household preparedness.

Reimbursement claimants who took a loan or broke investments to fund hospitalisation

2023

68% took a loan or broke investments

Took a loan or broke investments (68%)

Did not (32%)

+6 Pts.

RISE

2024 - 2025

74% took a loan or broke investments

Took a loan or broke investments (74%)

Did not (26%)

Finding 3

The "Why Not" Crisis: Rejections Without Explanation

When a claim is rejected, claimants want one thing: to know why. That expectation is going unmet at scale, and getting worse every year.

2023

53%

dissatisfied claimants received
no reason for rejection

+20 Pts.

RISE

2024 - 25

73%

dissatisfied claimants received
no reason for rejection

Methodology

This study assesses the health insurance claims experience across all zones and city tiers in India, interviewing policyholders who had made at least one hospitalisation claim in the prior 12 months.

Methodology

Face-to-face quantitative survey (CAPI) with a structured questionnaire in regional languages

Sample

2,228 respondents, ages under 22 to 65+, covering all policyholder life stages

Coverage

39 cities across Metro, Tier 2 and Tier 3 in all four zones

Zonal split

North 515 · East 522 · West 632 · South 559

Claim period

Hospitalisation claims made between August 2024 and September 2025. OPD and ineligible treatments excluded.

Is India Happy with Health Insurance Claims? 2.0

Key highlights

Executive summary

Key insights

Two Claims Modes, Two Very Different Worlds

HCX Score by Claims Mode

Borrowing to Pay for Claims Is Rising

Reimbursement claimants who took a loan or broke investments to fund hospitalisation

The "Why Not" Crisis: Rejections Without Explanation

Methodology

Methodology

Sample

Coverage

Zonal split

Claim period

Get the report on Email

Is India Happy with Health Insurance Claims? 2.0

How India Buys Insurance 2.0

Is India Happy With Health Insurance Claims?

India's Investment Readiness Report

How India Buys Insurance