Financial Performance - Q1 FY27 (Consolidated)

  • Operating revenue growth: 24.1% Year-over-Year (YoY)
  • EBITDA margin: 20.3% (vs 22.0% in Q1FY26)
  • Reported PAT: ₹27.6 Crore
  • Adjusted PAT (excluding exceptional items): ₹24.5 Crore
  • Free cash position: ₹245.5 Crore (compared to ₹260.5 Crore in FY26)
  • Net worth: ₹884.1 Crore (compared to ₹852.4 Crore in FY26)
  • Contract liability: ₹337.4 Crore (compared to ₹280.2 Crore in FY26)
  • Debt position: Zero debt
  • Revenue per average headcount: ₹13.2 Lakhs (annualized)

Operational Highlights

  • Group + Retail premiums administered: ₹8,975 Crore (+26.8% YoY)
  • Overall market share: 24.3% (+120 basis points YoY)
  • Group market share: 37.6% (+440 basis points YoY)
  • Group PUM Retention: 90.2%
  • Total claims processed: 2.69 million (Group + Retail)
  • 813k Cashless IP (inpatient)
  • 352K Reimbursement IP
  • 582k Cashless OP (outpatient)
  • 945k Reimbursement OP

Segment Performance

Group Business:

  • Revenue: ₹166.0 Crore (+25.5% YoY)
  • Premiums managed: ₹8,454 Crore (+29.5% YoY)
  • Revenue contribution: 70.2%
  • Corporate portfolio: ~11,000 corporates across 25+ sectors
  • Integrations with corporates: 1,444

Retail Business (TPA Model):

  • Revenue: ₹23.4 Crore (+13.1% YoY)
  • Premiums managed: ₹521 Crore (-5.0% YoY)
  • Market share: 3.6% (-140 bps YoY)
  • Revenue contribution: 9.9%

Retail Business (Platform Model):

  • Premiums managed: ₹4,254 Crore
  • Market share: 29.5%
  • Claims managed: 467,000

Government Business:

  • Revenue: ₹28.5 Crore (+35.3% YoY)
  • Members serviced: ~31 Crore (+15% Quarter-over-Quarter)
  • Revenue contribution: 12.0% (+99 bps)
  • Active headcount: 2,751 (-0.5% QoQ)
  • Geographic coverage: 12 states, 4 Union Territories

Technology Business:

  • Revenue: ₹7.8 Crore (+55.5% YoY)
  • Revenue contribution: 3.3% (+66 bps YoY)
  • Insurers contracted: 7
  • AI capabilities at scale:
  • ~32 Lakh claims processed on MAtrix (including ~45k global claims)
  • ~87k Raksha Prime discharges
  • ₹183 Crore in fraud savings

International Benefits Administration (Mayfair):

  • Revenue: ₹10.1 Crore (-5.2% YoY)
  • Revenue contribution: 4.3% (+131 bps YoY)
  • Retail lives: 106.7k (+79.1% YoY)
  • Stake raised to 91.75% post Q1
  • Global reach: 1Mn+ lives, 185 providers across multiple countries

Strategic Initiatives and Integration

  • Paramount integration: 95%+ (Group) and 80%+ (Retail) of PHS claims volume migration to MAtrix completed
  • 100% migration targeted by Q2FY27
  • Margin recovery moving along expected lines
  • AI stack moved from investment to early monetization with seven contracts in place
  • First international technology deployment in Thailand went live on July 1, 2026
  • Contracts with multiple Indian insurers accessing >50% of travel premiums placed in India

Technology Platform Performance

  • MAtrix: End-to-end claims platform live at Star Health and SBI General
  • MAven Guard: Fraud, Waste & Abuse decisioning; first gain-share model signed; prevented ~₹183 Cr health insurance fraud
  • MAven IDP: AI that reads & validates claim documents, eliminating manual data entry
  • NaaS: Access to hospital network & discounted pricing as a plug-in; now live
  • Raksha Prime: ~87k (+29.9% YoY) patients experienced bill-free discharge across ~6k hospitals
  • Pre-authorizations: Over 186k processed within five minutes on the platform

Claims Processing Efficiency

  • Inpatient Cashless: ~64% (+40 bps YoY) by volume cashless
  • Discharges: 260k discharges within 30 minutes
  • Fraud prevention: ₹47 Crore of fraud prevented in cashless; cautioned/acted against 20+ hospitals
  • Inpatient Reimbursement: ~51% reimbursements (+441 bps YoY) submitted electronically
  • Reimbursement fraud prevention: ₹136 Crore of fraud prevented
  • Member consent feature moving reimbursement NPS to 69%+
  • End-to-end TAT for payments: 6.76 days (from 7.31 days); 88.3% of reimbursements processed within 1 day

NPS Swasthya Initiative

  • Core Technology Partner & HBA/TPA to PFRDA
  • 2 PFMs Live: Tata & Axis integrations active
  • MAven App: e-cards, claims, hospitals, fund authorization
  • CRA-integrated real-time balance checks; PFRDA-PFM transfers including top up insurance
  • Cashless claims across IPD and OPD

Exceptional Items

Reported PAT of ₹27.6 Cr includes the benefit of a derivative gain on account of acquisition of NCI in Mayfair that led to a one time ₹3.1 Cr accretion to PAT.