Most medical insurance companies are very reluctant to reveal claims figures. Insurers of income protection and critical illness started a slow avalanche of claims information that caused more claims to be paid, and forced companies to behave better to claimants.
Universal Provident hopes to do the same for private medical insurance by becoming the first insurer to release details of its paid claims.
It paid 85.6% of claims submitted between January 2010 and the end of April 2011 with a further 2.6% being paid in part. 44% of declined claims were for failing to follow the claims administration process or pursue the matter after initial notification, and failure to follow medical advice.
Other reasons for rejection:
- 17.7% chronic conditions
- 7.6% a pre-existing condition or moratorium
- 7.6% routine examination
- 6.3 within the excess amount
- 5.1%, treatment not insured
- 2.5% GP service
- 2.5% arising from a hazardous pursuit
- 2.5% cosmetic treatment
- 2.5% fertility or infertility treatment
- 1.3% normal pregnancy or childbirth