New Delhi, March 26 India's health insurance sector continues to experience robust growth, growing at a rate of around 9 per cent, with total health insurance premium volume exceeding ₹1.2 lakh crore in 2024-25.
This growth reflects increasing awareness, improved access to healthcare financing, and a rising demand for financial protection against medical expenses, a finance ministry statement said.
To enhance efficiency and ensure timely support to policyholders, the Insurance Regulatory and Development Authority of India (IRDAI) has prescribed specific timelines for the processing of cashless health insurance claims, it said.
A timeline has been prescribed for cashless settlement, including cashless pre-authorization, to be approved within one hour and final authorization within three hours.
These timelines are aimed at minimizing delays and ensuring that patients receive timely access to medical care, it said.
The increase in health insurance premiums is driven by factors such as ageing policyholders, higher coverage, enhanced features, among others, it said.
IRDAI's 2024 regulations specify that insurance products are priced fairly, based on all relevant risk factors, and remain viable and value-driven, with periodic review by the appointed actuary using credible data and customer feedback, it said.
Furthermore, according to the IRDAI's Bima Bharosa portal, during 2024-25, 1,37,361 general and health insurance grievances were reported, of which 1,27,755 (93 per cent) were disposed of during the year itself.
Instances of claims disallowance or repudiation are largely attributable to specific policy conditions and limitations, it said.
Some of the reasons for claims disallowance or repudiation include exceeding the sum insured, co-payment clause, sub-limits in policies, deductible in top-up policies, room rent capping, proportionate charges, non-medical expenses, etc, it said.
Additionally, IRDAI has taken several measures to enhance clarity, streamline claims processing, and strengthen policyholder trust, it said.
In essence, a balanced, informed approach from all stakeholders will be crucial in fostering a transparent and trustworthy health insurance ecosystem, it added.