The Insurance Regulatory and Development Authority of India (IRDAI) held a high-level industry interaction, led by Chairman Ajay Seth, to formalise a roadmap for systemic reforms in the health insurance ecosystem through five specialised working groups co-chaired by leaders from hospitals and the insurance industry. The initiative is positioned to address long-standing operational and coordination gaps between insurers and healthcare providers, with a stated focus on improving insurance penetration, transparency and the patient experience. The working groups will develop a joint code of conduct covering discharge process streamlining, empanelment standardisation and amicable dispute resolution; create a data-driven methodology to categorise healthcare providers using parameters such as accreditation and geography; and identify and resolve process bottlenecks to scale up adoption of the National Health Claims Exchange (NHCX). Additional workstreams include structured analytical studies on claim trends, cashless versus reimbursement claim dynamics and drivers of medical inflation, and the design of a scalable “no-frill” health insurance framework integrating wellness components such as OPD-to-IPD conversion pathways and proactive health engagement models. Most working groups are scheduled to start in April 2026 and run for two to four months. Their findings and recommendations are intended to serve as a reference model for future industry standards and regulatory frameworks.
Insurance Regulatory and Development Authority of India 2026-03-17
Insurance Regulatory and Development Authority of India convenes industry leaders to launch five working groups to reform health insurance operations and claims processes
The Insurance Regulatory and Development Authority of India held a high-level industry interaction to establish a roadmap for systemic reforms in the health insurance ecosystem via five specialised working groups co-chaired by hospital and insurance industry leaders. The groups will develop a joint code of conduct, standardise provider categorisation, address process bottlenecks in the National Health Claims Exchange, analyse claim and medical inflation trends, and design a scalable “no-frill” health insurance framework with wellness components to inform future industry standards and regulatory frameworks.