The Insurance Regulatory and Development Authority of India (IRDAI) has constituted a health insurance sub-committee under the Insurance Advisory Committee to review India’s private health insurance landscape as part of efforts to improve policyholder experience and penetration. The sub-committee is tasked with proposing regulatory, policy and operational measures aimed at fostering innovation, wider coverage, better risk pooling and improved financial protection through health insurance. Its review will cover coverage and penetration levels, claims experience, product design, grievance redressal and consumer experience, with an emphasis on increasing trust and improving overall consumer outcomes. The work programme also includes examining provider networks, hospital tariffs, fraud control and digital systems to improve value for policyholders and reduce administrative inefficiencies, as well as assessing how private health insurance interacts with public health insurance and assurance schemes, including scope for complementarity, portability and convergence. The sub-committee will also consider recommendations from Confederation of Indian Industry working groups, including proposals for a joint code of conduct for insurers and providers, approaches to commercial engagements and provider classification, adoption and scale-up of the National Health Claims Exchange, analytical studies on claim trends and medical inflation, and a framework for a basic product.
Insurance Regulatory and Development Authority of India2026-04-07
Insurance Regulatory and Development Authority of India establishes an Insurance Advisory Committee sub-committee to review private health insurance and recommend reforms
The Insurance Regulatory and Development Authority of India has formed a health insurance sub-committee under the Insurance Advisory Committee to review the private health insurance landscape and recommend regulatory, policy and operational measures to improve policyholder experience and penetration. Its work will cover coverage and penetration, claims experience, product design, grievance redressal, provider networks, hospital tariffs, fraud control, digital systems and interaction with public schemes. The sub-committee will also assess industry recommendations on a joint insurer–provider code of conduct, commercial engagement and provider classification, adoption of the National Health Claims Exchange, analytical studies on claim trends and medical inflation, and a framework for a basic product.