The General Insurance Council (GI Council), guided by the Insurance Regulatory and Development
Authority of India (IRDAI), strives to ensure that health insurance serves as a crucial aspect of
financial security for individuals and families across India. Through initiatives promoting accessibility,
affordability, and quality of health insurance products and services, alongside regulations advocating
for consumer rights, the GI Council aims to alleviate the financial strain of healthcare expenses,
thereby nurturing societal well-being and prosperity nationwide with empathy and care.

The GI Council is deeply committed to promoting societal well-being through its activities and
efforts. With health insurance comprising 38% of the insurance market, it serves as a vital pillar of
national health security, reflecting our dedication to safeguarding community well-being.

Here are some activities and efforts that have led to positive outcomes or set the groundwork for

  1. Robust Financial Performance: The health insurance sector recorded a premium of close to INR
    1,00,000 Crores in FY2024, reflecting a robust compound annual growth rate (CAGR) of 20%.
  2. Expansive Coverage: More than 50 Crore citizens are now covered, with a clear target in mind of
    “Insurance for All by 2047”, set out by the IRDAI chairman.
  3. Cashless Access Expansion: The innovative ‘Cashless Everywhere’ initiative, spearheaded and
    announced by the GI Council, allows customers access to any hospital across the country, enhancing
    the convenience and reach of health insurance for all citizens. Currently, policyholders can avail
    themselves of cashless treatment at over 40,000 hospitals across various insurance networks.
  4. Efficiency in Claim Settlements: In 2022-23, the industry settled claims close to worth INR 75,000
    Crores for more than 2.5 crore claims. This figure is expected to rise significantly in 2023-24 as
    efforts to streamline processes continue even further. Today more than 60% of claims are settled on
    a cashless basis, with this only expected to go up over time, especially with Cashless Everywhere.
    The GI Council has constantly engaged with providers (hospitals), as well as TPA over the issue of streamlining experience for customers and making claims a friction-free process, through joint dialogue and collaborative solutions. Innovative Customer-Centric Initiatives: The council is spearheading various initiatives to make
    health insurance more accessible and user-friendly, with initiatives like,
  • Customized products for senior citizens
  • Simplification of policy wordings
  • Expansion of cashless access
  • Collaboration with hospitals and other stakeholders
  • Partnership with the National Health Authority (NHA) to develop a digital healthcare ecosystem,
    including the National Health Claims Exchange (NHCX) to standardize data and ease information
    exchange using ABHA ID. Through the exchange, the endeavor is to get all the ecosystem players on
    one platform to ensure customer claims are handled at a very fast pace, with a high level of
    transparency. In addition, with the Customer Information Sheet (CIS) as mandated by the IRDAI,
    policyholders can have an overview of their policy’s coverage and any exclusions in a clear and
    concise manner, thus bringing in more transparency for the consumers.
  1. Regulatory Enhancements: The Insurance Regulatory and Development Authority of India (IRDAI)
    has facilitated significant industry growth through various initiatives, regulations, and improving
    clarity of coverage as boosting consumer confidence. These include simplified definitions of pre-
    existing conditions, reduced waiting periods, assurance of policy renewal, and expansions in
    coverage. Through the use and file regulation, IRDAI has opened a lot of room for innovation in the
    health insurance space and has actively encouraged insurers to come out with new products,
    especially when it comes to senior citizens, children, people with disabilities, and citizens with
    chronic ailments. Even today, many innovative products have hit the market that doesn’t just cover
    hospitalisation but also outpatient expenses.
    In a major boost for consumer confidence, the Insurance Regulatory and Development Authority of
    India (IRDAI) has implemented a series of reforms that significantly improve health insurance
    coverage and clarity. These reforms include simplifying the definition of pre-existing conditions to
    only two specific situations: diagnosis and treatment within a specific timeframe. Additionally, the
    waiting period for pre-existing conditions has been reduced to 36 months, and the moratorium
    period for new policyholders with pre-existing conditions has been shortened to five years.
    Furthermore, policy renewals are now guaranteed, and individual premium loading based on health
    status is no longer permitted.

The IRDAI has also brought more clarity to coverage details and
expanded coverage to include modern medical treatments, mental illness, physical disabilities, and

other previously excluded pre-existing conditions. These
changes provide greater transparency and accessibility for policyholders, making health insurance a
more attractive and reliable option for all citizens.

  1. Market Penetration Initiatives: Efforts are underway to increase market penetration in
    underserved regions, with a specific focus on reducing the protection gap and enhancing insurance
    access through rural and social targets to insurers. Through the Bima trinity of Bima Vistaar, Bima
    Vaahaks, and Bima Sugam, the regulator wants insurance to reach every stratum and every corner of
    the country. The Bima Vistaar product which will be announced soon, will have not just coverage for
    life and property but will also be a health insurance cover at an affordable price.
  2. Eliminating Frauds: The industry is focused on identifying and removing roadblocks to ensure
    speedy claim settlements. The ‘Cashless Everywhere’ initiative is expected to set new standards for
    quick, hassle-free settlements and reduce incidents of fraud. The industry has come together
    through the aegis of the council and is aggressively looking to tackle, reduce, and ultimately
    eliminate fraud. This will bring in greater trust in the system, augment claim settlement, and
    encourage more citizens to go for insurance.

Quote from Mr. Tapan Singhel, Chairman of the General Insurance Council: “Our collective efforts
are focused on making health insurance a key enabler of not just our citizen’s health but societal
health at large. We aim to make quality treatment accessible to everybody, irrespective of where
they are from, and ensure we can take away their worries so that they can live a life of dignity. By
fostering collaboration among insurers, the council, regulators, ministries, and fintech, we are
dedicated to making health care affordable, accessible, and comprehensible to every citizen.

A lot has already been achieved and we firmly believe we are on the right path to completely
revolutionize the way health insurance is perceived. The aim is to alleviate concerns and simplify the
lives of people, ensuring that they have the confidence and support they need to secure their health
Looking Forward:
The GIC remains committed to advancing health insurance to create a more informed, healthy, and
secure society. Initiatives such as state-specific cashless utilization data collection and pilot projects to enhance cashless services are set to further elevate service standards and customer satisfaction across the board.