New Delhi: The Ministry of Finance has stated that Health insurance sector recorded strong growth momentum as premiums exceeded Rs 1.2 lakh crore in 2024-25. The prescribed timelines and regulatory measures were introduced to ensure efficiency and fairness in Health insurance claim settlements.
India’s health insurance sector is witnessing a robust growth, growing at a rate of around 9 per cent. The growth shows that awareness has increased, and people are having access to healthcare financing, and a rising demand for financial protection against medical expenses.
The Insurance Regulatory and Development Authority of India (IRDAI) has issued guidelines to ensure specific timelines for the processing of cashless health insurance claims. The steps were taken to enhance efficiency and ensure timely support to policyholders.
IRDAI timelines for cashless settlement are as follows:
Cashless pre-authorisation should be done within 1 hour.
Final authorisation has is mandated to be completed within three hours
The health insurance regulatory bodu issued the guidelines with an aim to minimise delays and ensuring that patients receive timely access to medical care.
The increase in health insurance premiums is a result of ageing policyholders, higher coverage, enhanced features, among others.
Health insurance claims settlement ratio
During 2024-25, 1,37,361 general and health insurance grievances were reported, out of which 1,27,755 (93%) were disposed of during the same financial year itself.
“Instances of claims disallowance or repudiation are largely attributable to specific policy conditions and limitations. Some of the reasons for claims disallowance or repudiation include exceeding sum insured, co-payment clause, sub-limits in policies, deductible in top-up policies, room rent capping, proportionate charges, non-medical expenses etc,” an official release stated.
IRDAI has taken several measures to enhance clarity, streamline claims processing, and strengthen policyholder trust. The ministry noted that all stakeholders should adopt an approach that would be crucial in fostering a transparent and trustworthy health insurance ecosystem.
With PIB inputs