As part of ongoing initiatives to improve policyholder experience and penetration of health insurance, the Insurance Regulatory and Development Authority of India (IRDAI) has constituted a sub-committee of the Insurance Advisory Committee to review the current landscape of private health insurance in India.
The scope of the review includes coverage, penetration, claims experience, product design, grievance redressal and consumer experience. It will recommend regulatory, policy, and operational measures to promote innovation, wider coverage, better risk pooling, and improved financial protection through health insurance.
“The emphasis will be on increasing trust and the overall consumer experience. The sub-committee will also examine the role of healthcare provider networks, hospital tariffs, fraud control, and digital systems in improving value to policyholders, reducing administrative inefficiencies,’’ the insurance regulator said in a release on Tuesday.
Implementing recommendations
A review of interaction between private health insurance and public health insurance/assurance schemes, including opportunities for complementarity, portability, and convergence where appropriate will also be done.
Further, the sub-committee will examine and incorporate the recommendations emerging from the working groups set up by the Confederation of Indian Industry (CII).
This will cover key issues relating to the health insurance ecosystem including a joint code of conduct for insurers and providers, methodology for commercial engagements and provider classification, adoption and scale-up of the National Health Claims Exchange (NHCX), analytical studies on claim trends and medical inflation, and a framework for a basic product, the release said.
Published on April 7, 2026