NEW DELHI, August 29, 2026 — The Insurance Regulatory and Development Authority of India (IRDAI) is pushing for simpler policy wording, stricter point-of-sale underwriting, and transparent treatment pricing to boost customer trust and health insurance penetration. These reform measures were the central focus of the 3rd meeting of the Insurance Advisory Committee (IAC) Sub-Committee on Health Insurance, convened on August 28, 2026.
Chaired by IRDAI Chairman Ajay Seth, the high-level panel emphasised that health insurance products must become easier for policyholders to understand and utilise. To minimize claim rejections connected with inadequate medical disclosures, the committee advocated for strengthening underwriting protocols directly at the point of sale. The regulatory body also highlighted the critical need for insurers, intermediaries, agents, and Third-Party Administrators (TPAs) to provide tangible, on-ground support to policyholders navigating hospital admissions.
Accelerating Digital Claims and Price Transparency
To improve the economic value and efficiency of health cover, regulators are evaluating strategies to accelerate the integration of both insurers and healthcare providers onto the National Health Claims Exchange (NHCX). The committee discussed introducing potential incentives linked to NHCX onboarding to facilitate faster, hassle-free claim settlements.
Addressing the unpredictability of medical billing, the sub-committee suggested that insurance providers publish Standard Treatment Guidelines (STGs) alongside treatment package rates, enabling policyholders to make more informed choices regarding their healthcare. During the session, NABH Chairperson Rizwan Koita presented on hospital certification frameworks and new Digital Health Standards aimed at standardizing healthcare outcomes and streamlining clinical processes.
Shifting Assessment Metrics and Preventive Care
Signaling a shift in how the regulator views consumer protection, the sub-committee noted that the assessment of claims and grievances should no longer rely solely on percentage-based settlement ratios but must also consider absolute values to present an accurate picture of industry performance.
The meeting also explored forward-looking structural changes, including:
- Incentivizing policyholders for maintaining healthy practices and undergoing periodic health check-ups.
- Examining the feasibility of dedicated Health Savings Accounts.
- Analyzing ported health policies as a separate cohort to better track customer mobility and satisfaction.
- Reviewing standard exclusions outlined in the Customer Information Sheet to ensure absolute clarity.
The four-member sub-committee includes IRDAI Member Deepak Sood, former National Health Authority CEO Dr. Indu Bhushan, and financial writer Monika Halan. The panel is further supported by chief executives from ICICI Lombard, Aditya Birla Health Insurance, and Niva Bupa, alongside global health financing experts drawn from the World Bank and the Asian Development Bank.