IRDAI Health Insurance Sub-Committee Charts Next Steps for Customer-Centric Reforms

The Insurance Regulatory and Development Authority of India (IRDAI) has continued its consultative push to reshape the health insurance ecosystem with a strong policyholder focus. On 28 August 2026, IRDAI convened the 3rd Meeting of the Insurance Advisory Committee (IAC) Sub-Committee on Health Insurance, following up on its 2nd Meeting held on 17 July 2026.

At this latest sitting, the Sub-Committee concentrated on:

  • Enhancing trust in health insurance products
  • Improving the perceived and actual economic value of health insurance
  • Expanding health insurance penetration across segments
  • Simplifying health insurance contracts and claims experiences
  • Promoting adoption of the National Health Claims Exchange (NHCX)

The discussions form part of an ongoing policy dialogue. As per the press release, the ideas recorded at this meeting represent deliberations and possible directions; they are not yet binding regulatory norms, and no specific implementation timelines have been prescribed in the release.

Core Objectives of the 3rd Sub-Committee Meeting

Strengthening the Health Insurance Ecosystem

The Sub-Committee examined multiple dimensions of the current health insurance framework, aiming to:

  • Make policies more intelligible for lay policyholders
  • Cut down friction and disputes at the claim stage
  • Encourage more individuals and families to opt for health insurance cover
  • Support more efficient coordination between insurers, hospitals, intermediaries and Third Party Administrators (TPAs)

The overall theme was to shift from a product-centric to a more customer-centric design, while ensuring operational efficiency and improved health outcomes.

Building Customer Trust and Economic Value

The members repeatedly returned to the question of customer trust in health insurance contracts. They stressed that health insurance must not only offer risk protection in theory, but must translate into:

  • Predictable and understandable coverage
  • Reduced instances of claim repudiation linked to disclosure or documentation gaps
  • Faster and more transparent claim settlements

The committee also discussed how to enhance the economic value of health insurance by:

  • Promoting efficiency in claim processing
  • Encouraging collaboration among all participants in the value chain
  • Harnessing data to shape better product architecture and pricing

Making Health Insurance Simpler and More Transparent

Policy Wording and Product Clarity

A key concern was that many policyholders still find policy terms difficult to decode. The Sub-Committee therefore focused on ways to:

  • Simplify policy wording, especially for exclusions, waiting periods, sub-limits and co-payments
  • Use clearer, plainer language in policy documents and related materials
  • Ensure that the benefits and limitations of a policy are evident at the point of sale

The intent is to reduce policyholder confusion and mitigate later disputes, particularly at the claim stage, where misunderstanding of terms often leads to dissatisfaction.

Stronger Underwriting at the Point of Sale

Another central discussion area was the improvement of underwriting practices at the time of purchase. The Sub-Committee emphasised:

  • Collecting complete and accurate medical and lifestyle disclosures from prospective policyholders
  • Training agents, intermediaries and other distribution channels to explain the importance of full disclosure
  • Using better underwriting tools and risk assessment processes to ensure that policies are correctly priced and structured

The deliberations linked better upfront underwriting to fewer claim rejections and disputes caused by inadequate or incorrect disclosures.

Hassle-Free Claim Settlements

To enhance the claims experience, the Sub-Committee examined how all stakeholders can contribute to more seamless processing. Suggestions focused on:

  • Clarity of documentation requirements at the outset
  • Effective coordination between hospitals, TPAs and insurers
  • Ensuring that policyholders receive timely support during hospitalisation and claim filing