What the policy is claimed for most often

The claims that arrive most often are not necessarily the ones that account for the most money. General health services leads this book by frequency, yet represents only 1.1% of incurred cost. Musculoskeletal injury and fractures ranks seventh by frequency and first by money. The first view describes the claims a service must handle; the second describes where recorded costs concentrate.

This page starts with frequency, then compares it with the same book ranked by incurred-cost share. It covers 74,339 claim records with admission dates from 26 December 2024 to 26 December 2025. The categories group the wording on claims; they are not verified diagnoses, and claim shares are not disease rates. Methodology explains how incurred amounts differ from claimed and deducted amounts.

General health services leads claim frequency; infection and fever is the largest named medical category#

The row at the top of this table is not a disease. "General health services" is a broad category assigned when the claim text matches health-services terms and none of the earlier category rules. At ₹2,910 a claim, its average is less than a tenth of the book-wide ₹43,129 average. It carries 15.7% of claims but about one rupee in every hundred incurred. The broad category label does not identify the condition treated or the procedure performed. That is a reason to inspect the underlying descriptions before treating these claims as one type of care.

Read past it and the ranking of named medical categories starts with infection and fever at 11.7%, then maternity and delivery at 10.6%, kidney and urinary complaints at 6.9%, gastrointestinal at 5.7% and eye and cataract at 5.4%. These eleven groups are every category that reaches 3% of claims, and no group outside them reaches 2%. Below them the book scatters across many smaller labels.

Categories are keyword matches in claim text, not confirmed diagnoses. Missing text can produce “Unclassified”; related conditions can retain separate labels. Methodology.

Musculoskeletal injury ranks seventh by claim frequency and first by incurred-cost share#

The five most frequent categories account for 50.6% of every claim filed and 37.0% of incurred cost. Half the volume, a bit over a third of the cost share. That gap is what the second ranking is for.

These are the ten largest categories by incurred-cost share, and they are exactly the frequency ranks 2 to 11. The same categories appear in both rankings and only the order changes. The one member of the frequency top eleven missing here is General health services, which ranks first by claim frequency and sixteenth by incurred-cost share, a drop of fifteen places between the two rankings.

A category's incurred-cost share reflects both the number of claims and the average amount per claim, so neither explains a rank on its own. Musculoskeletal injury and fractures takes a larger share of incurred cost than of claims, 10.7% against 5.2%, alongside an average of ₹89,455 — about twice the book's ₹43,129. Cardiac and circulatory reaches fourth by incurred-cost share on 3.3% of claims for the same reason and more so, with the highest average of the eleven groups here. Infection, maternity and gastrointestinal hold the same rank in both columns, while the higher averages for musculoskeletal and cardiac claims give those categories a larger share of incurred cost than of claim volume.

Maternity leads spouse claims, infection leads child claims, and eye and cataract leads parent claims#

The leading category differs across the four main relationship groups shown here. The book-wide ranking also includes claims recorded under sibling and other-relationship labels; this table shows the leading categories for employees, spouses, children and parents or parents-in-law.

Claims filed for employees lead with the general-services group at 19.1%, then infection and fever at 12.7%. More than one in three claims filed for spouses, 35.8%, is in the maternity and delivery category. That is the largest single share in this table, and the maternity page takes it apart in full. For children, infection and fever accounts for 23.7% of claims and respiratory conditions for 13.4%. Claims filed for parents lead with Eye and cataract at 14.0%, ahead of kidney and urinary complaints at 11.1%.

The parent group shows the same difference between frequency and cost. Its most frequent category is Eye and cataract, at ₹30,620 a claim, but its three largest categories by money are cardiac, musculoskeletal injury and cancer, and Eye and cataract is not among those three. Cataract is one condition within that broader eye category. The employee and family split sets out how the layers carry the book between them.

Each share shows the makeup of that group's claims.

Maternity is 14.3% of SME claims and 8.8% of Enterprise claims#

The mix differs again by account tier, Loop's account bands, with Enterprise accounts at one end and small and medium enterprises at the other. Maternity is 8.8% of claims on Enterprise accounts and 14.3% on SME accounts, and infection 10.7% against 15.7%. General health services runs the other way, 22.4% of Enterprise claims against 6.2% of SME claims, which is the largest single difference in the table. Claims without an account-tier label are not shown in this table.

That is a difference in claim mix, and nothing here makes it a difference in health. These claim records do not establish the covered population or the benefit terms behind any tier, and nothing in them defines where one tier ends and the next begins. An employer comparing its own mix against this table has to compare those things first, from its own coverage records.

Recorded female share is similar across four common medical claim categories#

Infection, respiratory, gastrointestinal, and kidney and urinary claims have similar recorded female shares, from 38.5% to 40.5%. Maternity and delivery is different, at 90.9%. These figures describe the gender recorded on claims within each category. They do not establish the gender mix of everyone covered by the policy or a difference in illness risk.

Claims with blank or unknown sex remain in the total.

A frequency table is not a budget#

Among the eleven categories shown, cardiac and circulatory rises seven places from frequency rank to incurred rank, musculoskeletal injury six and cancer two. These are the three largest upward moves within that group. Infection and maternity hold second and third place in both rankings. The frequency and severity matrix shows claim frequency and average incurred amount together.

The other thing this table is not is a measure of illness. A category is what a claim was documented as, and a claim is an event that someone filed. Neither is a diagnosis, and neither is a rate of disease in the covered population.