“The collaboration between payers and providers is essential for a sustainable healthcare ecosystem.These Working Groups represent a coordinated effort to put the patient at the centre of our care journey while ensuring operational efficiency and data-backed policy making”,”Ajay Seth, chairman, IRDAI

New Delhi: Ajay Seth,chairman, on March 17, held a high-level industry interaction with all the stake holders of the healthcare industry.

The IRDAI in bid to address critical challenges in the healthcare and insurance sectors, has formed five Working Groups aiming to improve insurance penetration, transparency, and the overall patient experience by addressing long-standing operational gaps and coordination issues between insurers and healthcare providers.

Each working group will be co-chaired by leaders from hospitals and insurance industry.

“The collaboration between payers and providers is essential for a sustainable healthcare ecosystem.These Working Groups represent a coordinated effort to put the patient at the centre of our care journey while ensuring operational efficiency and data-backed policy making”.,” stated Seth during his initial remarks.

Most Working Groups are scheduled to begin their activities in April 2026, with durations ranging from two to four months. The findings and recommendations from these groups will serve as a reference model for future industry standards and regulatory frameworks.

Hosted by the trade industry lobby body Confederation of Indian Industry (CII), the event brought together top executives from major hospitals, representatives of the Association of Health Providers India (AHPI), NatHealth, the Private Hospitals & Nursing Homes Association (PHANA), various state level health providers associations along with insurance companies to formalize a roadmap for systemic reforms through five specialised Working Groups.

Key Working Group Initiatives:
Joint Code of Conduct: Working Group will work towards developing a practical framework to strengthen trust and transparency. This group will focus on streamlining the discharge process, standardizing empanelment, and ensuring amicable dispute resolution.

Categorization of Providers: Working Group will aim to establish a data-driven methodology for classifying healthcare providers. By identifying relevant parameters like accreditation and geography, the group aims to bring consistency to empanelment and operational processes across the industry.

Scale-up of NHCX: To accelerate the adoption of the National Health Claims Exchange (NHCX), Working Group will identify and resolve process bottlenecks.

Focused Analytical Studies: Working Group will conduct structured studies on claim trends, the dynamics of cashless versus reimbursement claims, and the drivers of
medical inflation. These studies are intended to provide a shared analytical base for future policy reforms.

Simplified Products and Wellness: Working Group will work towards designing a scalable, “no-frill” health insurance framework. The objective is to increase penetration by integrating wellness components, such as OPD-to-IPD conversion pathways and proactive health engagement models.