The IAC advises the Irdai on framing regulations, protecting policyholder interests, and fostering the orderly growth of the insurance sector. Comprised of industry experts, it reviews policies, ensures regulatory efficiency, and recommends measures to improve market standards and consumer understanding
Hyderabad:The insurance regulator Irdai on Monday has reconstitued Insurance Advisory Committee with professionals from across the industries.
The IAC is a body established by the IRDAI, consists of members representing various sectors like commerce, industry, and consumer groups, with a maximum of 25 members excluding ex-officio members.the tenure for the members is typically three years. The IAC advises the irdai on framing regulations, protecting policyholder interests, and fostering the orderly growth of the insurance sector. Comprised of industry experts, it reviews policies, ensures regulatory efficiency, and recommends measures to improve market standards and consumer understanding.
The appointed members of the reconstituted IAC are-Chairman of Executive Committee of Life Insurance Council,Chairman of Executive Committee of General Insurance Council,President, Institute of Actuaries of India,President, Insurance Brokers’ Association of India,President, Indian Institute of Insurance Surveyors & Loss Assessors,Director, National Insurance Academy,Chandrajit Banerjee, Director General,Confederation of Indian Industry (CII), Jyoti Vij, Director General, Federation of Indian Chambers of Commerce and Industry (FICCI),.Saurabh Sanyal, Secretary General, Associated Chambers of Commerce and Industry of India(ASSOCHAM),. Ajay Sahai, Director General & CEO, Federation of Indian Export Organisations (FIEO), Ashok Gulati, Professor, Indian Council for Research on International Economic Relations (ICRIER), Charan Singh, CEO, Foundation for Economic growth and Welfare (EGROW Foundation),Suresh Goyal, Director General, National Council of Applied Economic Research (NCAER),Indu Bhushan, Former CEO, National Health Authority (NHA),Monika Halan, financial writer and adjunct professor at Banasthali Vidyapeeth,
Rajasthan, Padmaja Chunduru, Former MD, National Securities Depository Limited (NSDL),, Partha Ray, Director, National Institute of Bank Management (NIBM),.Sahil Barua, MD & CEO, Delhivery
To,
Sri Ajay Seth. IAS
Chairman
Insurance Regulatory and Development Authority of India
Hyderabad .
Respect Sir,
I am Ramesh Gangashetty retired officer from State Bank. Myself and my wife are covered with SBI Life Insurance facility with CASHLESS Facility.
Recently my wife Smt Meera was admitted in a Corporate hospital for 7 days from 10-11- 2025 to 16-11-2025 .
The hospital submitted their final bill no BL12526 001579 dated 16-11-2025 for Rs1,29,454/- only to Insurance Co for their approval. The Insurance Co had given the final approval vide Claim no46919374 for Rs 91,009/- only . I am herewith forwarding the copies of the Hospital Bills and the copies of the Claim Approvals and submitting the following for your perusal and necessary action.
Hereunder I am referring the above hospital bill step by step.
Example 1
In the hospital bill under the Subhead “other Doctor Charges” the sub total amount is shown as Rs8000/- whereas in the Insurance Co’s CLAIM APPROVAL, the Consultant Charges is shown as Rs25250/-.
Example. 2
In case of Sub head the “Room Charges” the amount is shown as Rs36000/- by the Hospital, whereas in the Insurance Co’s Claim Approvals under the Subhead “Hospital Charges, it is shown as Rs30000/-
Example. 3
In case of Subhead “Diagnostic Charges” the amount is shown as Rs26760/- by the Hospital whereas in the Insurance Co’s Claim Approvals under the Subhead “Investigation & Lab Charges” it is shown as Rs32860/-
Example.4
In case of Subhead “Services & Procedures ” the amount of Rs20500/- shown by hospital, whereas in the Insurance Co’s Claim Approvals under the Subhead “Miscellaneous Charges” it is shown as Rs3900/-
Example. 5
Under the Subhead “Medicines & Consumables” the amount is Rs39578.37 by the Hospital, whereas in the Insurance Co’s Claim Approvals under the Subhead “Pharmacy & Medicine Charges” it is shown as Rs37445/-
From the above it can be seen that there is no uniform classification of Expenses under various “Sub-Heads” of the Bill submitted by the hospital and Insurance Co’s Claim Approvals . There is no uniform segregation of the Charges and Services provided by hospitals in their Bill and Insurance Co’s Claim Approvals.
The hospital include or classify various medical expenditure items , Service Charges under the various Sub-Heads as per their convenience or as per their practice. The Insurance Cos segregate the medical expenses and other expenses as per their convenience or their practice. Further it is observed that Insurance Cos do not maintain a definite or a well structured format maintaining the same order of Subheadings .
It is difficult to understand what Hospital has charged for what ? And what the Insurance Co has approved for what ?
There should be a uniform ” BILLING” System in the Hospitals with clear guidelines stating that which expenditure should be included under which Sub-Heads and a definite order under which the Sub-Heads as the should follow in the Bill. There should be a stipulated uniform and well “STRUCTURED PATTERN” of the Bills of the hospitals and also for the Approvals of the Insurance Cos . These should be uniform and common for all the Hospitals and Insurance Cos.
Bringing in a uniform and well defined Billing system and Claim Approval Advice by Insurance Co’s is a much needed task to bring transparency in the field of Insurance business and Hospital business in India.
It is not out of context to mention about the Commercial Concerns , where there is a common performa for preparing Balance Sheet and other Final Accounts Statements for all the Commercial & Industrial activities. There is common performa for all commercial activities throughout the country and it is mandatory for all to follow the same order and performa.
In the similar way , the Authorities from IRDAI and NABH & HP can seat together and design a common and uniform performa for the Bills of the Hospitals and also for the Claim Approvals Advice of Insurance Cos. The Hospital’s Bills and Insurance Co’s Approval Advices should have COMMON spread of Sub-Headings. These performa should be “Mandatory” throughout the country for all the hospitals and for all the Insurance Cos.
This exercise will definitely bring lots of Transparency in the Life Insurance Business and Hospital business in India. At present, there is lots of criticism about these two business activities. It is high time to do some ratification work.
Sir, I understand that you are going to meet the Insurance Industry CEOs for “Bima Sugam” and “Bima Manthan” on Feb 12-14. Sir, this will be good occasion to discuss to introduce the “UNIFORM” billing system by the Hospitals and “UNIFORM” and well “STRUCTURED” performa for Claim Approvals Advices for Insurance Cos.
Sir this will be a “LAND MARK” beginning in the history of Hospital and Insurance business in India.
Sir it is not a complaint, it is only a submission with a request to take up this initiative to reach much published IRDAI ‘s aim of achieving 100% CASHLESS INSURANCE and also to extend the benefit of Cashless Insurance to the Middle Class and Public & Private Sector Working Class employees who are the bulk consumers for Life Insurance facility .
This will be the great service and great financial help to the people who need it most .
Thanks for giving me opportunity to present this write up.
Ramesh Gangashetty
302 Surya Residency,
SBH Colony ,Domalguda, Hyderabad 500029
Telangana
Cell no :- 9052991100
Email ID :- rbgshetty@gmail.com
26-12-2025