Parent claims — the largest share of incurred cost

The parent and parent-in-law group filed 29.4% of the claims on Loop's broker book in the latest twelve months and accounted for 36.9% of incurred cost. Across 74,339 claim records, this is the largest share of incurred cost among the four relationship groups, ahead of the employee layer at 32.2%.

The group is not one population. The claims run from patients under 50 to patients past 80, and what they record changes across that span. The cost also differs between mothers, fathers and in-laws, across condition groups and across recorded account categories.

The share of cost runs ahead of the share of claims#

Employees file more claims than parents, 33.5% against 29.4%, and the parent group still carries more of the incurred cost. That inversion is the parent group's defining feature, and among these four it is the only one that shows it. For the employee, the spouse and the child, the share of cost sits below the share of claims. The four groups together cover 99.9% of claims in the window. The remainder is a small number of sibling and unlabelled records, not reported here in either direction.

The recorded deduction on parent claims is 20.8% of the amount claimed, close to the 20.9% recorded across the whole book, and between the employee's 19.2% and the spouse's 23.1%. The average parent claim records ₹53,981 against the employee's ₹41,432. The deduction rates are alike. The claim sizes are not.

Incurred here means the amount recorded against a claim. It includes amounts on claims that are still open, it is not cash paid out, and it is not what a household spent. Methodology explains the recorded money fields and how they differ. For the employee-and-dependent split this table opens onto, see Self vs Dependent.

Patients aged 60+ carry 65.2% of parent cost; the highest average is at 80+#

Patients aged 60 and over file 59.9% of parent claims and carry 65.2% of the group's incurred cost. Ages 60–69 is the largest single band on both measures, 37.6% of claims and 39.2% of the cost. The average climbs across every band shown. The average at 80+ is ₹80,870, more than twice the ₹37,836 average under 50.

Claim share and average incurred cost peak in different bands. Ages 60–69 file the largest share of parent claims. The highest average sits in the 80+ band, which is 2.5% of parent claims. These bands compare different claims filed inside the same twelve months rather than the same patients growing older.

Where an employer sets the upper age limit on parental cover decides which ages can claim at all. Pricing a change to that limit is a different question, and it needs covered lives by age band and the policy terms themselves, neither of which is in this data. Age and Generation describes age patterns in a separate laboratory sample. It does not identify the employees whose parents filed these claims.

Mothers and fathers file almost the same share, at different averages#

Mothers file 47.9% of parent claims and fathers 47.2%, almost the same share, at averages of ₹50,849 and ₹56,152. A further 0.1% of parent claims carry the label "parents" with nothing more specific and sit in none of the four rows.

Taken together, the employee's own mother and father are 95.1% of parent claims, at an average of ₹53,483. The two in-law groups are 4.8% of claims, at an average of ₹63,418. The parent group is, in claim terms, overwhelmingly the employee's own parents, and the smaller in-law group records the higher average. What stands behind that difference is an open question. The field records a relationship, not a plan design, an enrolment route or a health status at enrolment.

Total incurred cost also differs by condition and relationship. The table below counts fathers-in-law with fathers and mothers-in-law with mothers:

Cardiac and circulatory shows the largest difference between the two sides in the groups shown. Musculoskeletal, injury and fracture runs the other way. Cancer and eye and cataract are close to even. The remaining groups have higher incurred cost on the father side. These are recorded relationship labels, and what they measure is which relative the claim was filed against, not a diagnosis, a disease subtype or a cause.

Eye and cataract fills the count, cardiac and circulatory fills the cost#

The two highest-volume condition groups are the two cheapest of the nine named ones. Eye and cataract is 14.0% of parent claims and 8.0% of parent incurred cost, at ₹30,620 a claim. General health services is 12.6% of claims and 1.0% of the cost, at ₹4,143, the lowest average of the nine. It is a source-label group covering examinations and investigations, health checkups, and encounters recorded for specific procedures or for other circumstances.

The cost is made at the other end of the table. Cardiac and circulatory claims are 7.1% of parent claims and 15.2% of parent incurred cost, the largest of the nine named groups, at an average of ₹1,16,050. Musculoskeletal, injury and fracture is 5.2% of claims and 10.5% of cost. Together with cancer and oncology, those three groups are 20.2% of parent claims and 34.9% of parent incurred cost. About a fifth of the claims, over a third of the cost. The whole-book ranking those groups sit inside is set out on Top Categories by Incurred.

Each claim is assigned to the first matching keyword group in its combined ailment-group and illness text. The final row holds everything outside the nine named ones. It contains further named groups, neurological at 1.5% of parent claims, endocrine and metabolic at 1.7%, and skin, liver and maternity below that, as well as raw source labels the method left unmatched. One of those unmatched labels is large enough to matter on its own. "Disorders Of Lens" is 3.0% of parent claims and 1.4% of parent incurred cost, so the eye load is a little larger than its own row shows.

Parents carry most of the cost in five condition groups#

The parent group is 36.9% of the book's incurred cost overall. Across the nine condition groups below, that share runs from a quarter to more than seven-tenths.

Seven rupees in every ten the book records against eye and cataract care belong to a parent or a parent-in-law. So do two-thirds of cardiac and circulatory, and around three-fifths of endocrine and metabolic and of cancer. In five of these nine groups parents account for most of the cost. In the other four they do not, and musculoskeletal, respiratory and infectious groups all sit below 40%.

This is a different ranking from the table above it, and the two answer different questions. Which groups carry the most parent cost is one question: cardiac and circulatory leads it at 15.2% of parent incurred cost, and musculoskeletal is 10.5%. Which groups parents carry the most of is another: endocrine and metabolic is near the top here while being 2.0% of parent incurred cost, while endocrine and metabolic conditions account for a small part of total incurred cost.

Parent cost share ranges from 18.8% to 42.7% across account categories#

"Account category" is a label recorded on the account. In this data it carries no headcount, premium or cover meaning, and 9.7% of claims in the window sit on accounts with no category recorded at all, shown here as their own row rather than dropped.

The parent share of incurred cost runs ahead of the parent share of claims in every category. In Enterprise accounts 34.8% of claims are 42.7% of the cost. SME accounts sit at the other end, 14.0% of claims and 18.8% of cost.

The averages do not follow the same order. The highest average per parent claim is on unlabelled accounts at ₹59,849, and Enterprise, the category with much the largest parent share, has the lowest at ₹51,311. The category with the largest parent share of incurred cost does not have the highest average parent claim.

The policy is named for the employee, and of the four relationship groups on it, the one carrying the largest share of incurred cost is a generation above the workforce. Parents carry 36.9% of incurred cost, most of the parent share comes from patients aged sixty and over, and the parent share ranges from 18.8% to 42.7% across recorded account categories.