What the policy actually carries

The largest single category by incurred cost share on Loop's broker book over the latest twelve months is musculoskeletal injury and fracture, at 10.7%. It is only the seventh most-filed category. Cardiac and circulatory disease does not appear among the ten most-filed categories at all, and it ranks fourth by incurred cost share. Five of these eight categories sit at a different place on the two rankings, and three sit at the same place.

This page ranks categories by their share of incurred cost. The claim-count ranking ranks on number of claims.

This page ranks recorded incurred cost, not cash paid: open claims remain included. Figures count claims, not people or verified admissions, and cannot establish household spending. Methodology.

Eight categories absorb two-thirds of the bill#

The incurred bill is not spread evenly across the recorded categories. It concentrates in a handful.

The top three categories have almost identical shares of incurred cost. Below them the line falls away. By the eighth category, the list accounts for two rupees in every three of incurred cost, and the remaining third is spread across everything else the policy covers.

The source classification splits musculoskeletal disease across two labels. The ranking keeps these separate, as the source does.

Injury ranks first by incurred-cost share and seventh by claim count#

Put the two rankings side by side. Where a category sits far apart on them, the distance is about cost per claim rather than about how often the policy is used.

Cardiac and circulatory disease is the clearest case. It sits outside the ten most-filed categories, at 3.3% of claims, and fourth by money, at 8.4% of incurred. Its average incurred cost is ₹1,09,946 a claim, 2.8 times the average infection claim and 2.6 times the average maternity claim. Cancer behaves similarly, climbing from tenth by claim count to eighth by rupees. Three of the eight do not move at all: infection is second on both rankings, maternity third on both, gastrointestinal fifth on both. The two rankings are neither the same document nor opposites of one another.

A high average alone does not give a category the largest cost share. Cardiac has the highest average of the eight and is still only fourth by incurred-cost share. Musculoskeletal injury leads the table with a lower average and a higher volume. An average and a relative cost share answer different questions.

The inverse case is starker. General health services is the single most-filed category, at 15.7% of all claims. It does not appear among the ten largest categories by rupees at all: 1.1% of incurred, at an average of ₹2,910 a claim. It tops the count ranking and all but vanishes from this one.

Claims for parents account for two-thirds of cardiac cost#

Each of the four categories below has a dominant relationship layer, and they are not all the same layer.

Claims for parents and parents-in-law account for two-thirds of cardiac incurred cost and well over half of cancer incurred cost. Musculoskeletal injury does not follow them: 46% of it is the employee layer's, against 36% on the parent layer. Maternity sits mostly on the spouse layer, at 76% of the category's incurred against 23% for employees.

In two of these four categories the parent layer also carries the higher average claim: parent cardiac ₹1,16,050 against ₹1,00,870 for employees, parent musculoskeletal ₹1,08,861 against ₹83,660. That is not a rule. On cancer the employee average is the higher of the two, ₹80,590 against ₹62,113. What does hold across the whole book is the parent layer's size: it is the largest single share of incurred, 36.9% against 29.4% of claims, which the parent claims page works through in full.

These are shares of incurred cost across all relationships. Child and other groups are not displayed, so the columns do not total 100%. A share of claims cannot be used as a share of cost.

Maternity has the widest billed-to-incurred gap of the eight#

How much of a bill becomes incurred cost varies by category. Two different measures describe that, both as a share of the amount claimed, and they must not be merged.

Maternity leads both columns among these eight, the categories that between them carry two-thirds of the bill. More than a third of everything billed on maternity does not become incurred cost, and the recorded deduction field comes to about three-quarters of that gap. What accounts for the remainder is not recorded in a way this extract can attribute, so this page cannot say what separates the two figures.

Across the whole book the recorded deduction rate is 20.9% of the amount claimed and the claimed-to-incurred gap is 31.8%. The two measures do not order the categories the same way. Cancer's gap is above the book's, at 32.3%, while its recorded deduction rate is below it, at 20.3%; respiratory runs the other way, 30.7% against 22.3%. Maternity and cardiac are first and second on both.

Categories use the first matching keyword rule, not confirmed diagnoses. Average cost can be pulled up by a small number of expensive claims; it is not a typical bill.

Where the money lands is measured; whether it was avoidable is not#

Eight named categories account for two-thirds of incurred cost, and parents and parents-in-law account for most of the incurred-cost share in cardiac and cancer. These are distributions in the claims record. Neither tells you whether any of the cost could have been avoided.