As per Bima Bharosa portal of IRDAI, during FY 2024-25, 1,37,361 general and health insurance grievances were reported, out of which 1,27,755 (93%) were disposed of during FY 2024-25 itself.
New Delhi: What is is forcing the insurers to jack up the health insurance premium and making them unaffordable?
The insurance regulator IRDAI and insurers differ on the answers.
While insurers say the hike in health insurance is primarily due to medical inflation, the government has said the increase in health insurance premiums in recent times is driven by factors such as ageing policyholders, higher coverage, enhanced features, among others.
Last week, Minister of State in the Ministry of Finance, Pankaj Chaudhary in a written reply in Lok Sabha also said,“ IRDAI has informed that no specific study has been conducted by it on the rate of medical inflation and its correlation with health insurance premium.Since multiple reasons contribute to increase in individual premiums, the increase attributable to only medical inflation cannot be identified.”
Chaudhary in his speech also attributed health inssurance premium hikes to multiple factors including the rising average age of policyholders, higher sum insured, and modified policy features,
“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,” said a government statement on Thursday.
India’s health insurance sector continues to witness robust growth, growing at a rate of around 9%, with total health insurance premiums 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.
Further, as per Bima Bharosa portal of IRDAI, during FY 2024-25, 1,37,361 general and health insurance grievances were reported, out of which 1,27,755 (93%) were disposed of during FY 2024-25 itself.
Instances of claims disallowance or repudiation are largely attributable to specific policy conditions and limitations. Some of the reasons for claims disallowance or repudiation include exceeding sum insured, co-payment clause, sub-limits in policies, deductible in top-up policies, room rent capping, proportionate charges, non-medical expenses etc.
Additionally, several measures have been taken by the IRDAI to enhance clarity, streamline claims processing, and strengthen policyholder trust. In essence, a balanced, informed approach from all stakeholders would be crucial in fostering a transparent and trustworthy health insurance ecosystem,said the government.
The claims paid ratio (by number of claims) stood at 85.66 per cent in 2022-23, which declined slightly to 82.46 per cent in 2023-24, before rising to 87.50 per cent in 2024-25.
In order 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.
As per the regulator, cashless pre-authorisation requests must be processed within one hour, while final authorization is required to be completed within three hours.
These timelines are aimed at minimising delays and ensuring that patients receive timely access to medical care.