IRDAI Sub-Committee on Health Insurance Reform Explained
Why in the news
The insurance regulator IRDAI created a senior sub-committee of its Insurance Advisory Committee to give private health insurance a thorough check-up. The step comes after record premium income in FY26, but amid public anger over steep premium rises and slow claim settlement.
Key facts
- Body: sub-committee under the Insurance Advisory Committee (IAC) of IRDAI.
- Premiums: record ₹1.24 lakh crore collected in FY26.
- Claim rejection: about 8% of health claims, or 1 in 12.
- One-hour rule: cashless pre-authorisation within an hour; 86.8% of cases now comply, cutting discharge waits.
- Larger goal: Insurance for All by 2047.
Areas under review
| Area | Concern |
|---|---|
| Product design and innovation | Whether products suit varied needs or are needlessly complex |
| Claims experience | High rejection rate |
| Grievance redressal | Stronger remedies so customers are not stuck in legal limbo during a medical crisis |
| Risk pooling | Spreading risk to keep premiums affordable for seniors and high-risk people |
| Hospital tariffs and fraud | Narrow the gap between hospital charges and amounts insurers approve; lack of standard pricing is a roadblock |
Digital infrastructure
- NHCX (National Health Claims Exchange) and Bima Sugam will be examined for scale.
- Bima Sugam is an online marketplace for zero-commission policies, called a UPI moment for insurance, meant to cut premiums by removing middlemen.
Expected inputs from CII
- Joint code of conduct for insurers and healthcare providers.
- Medical inflation indexing to track rising treatment costs with data.
- Portability and convergence so private cover complements public schemes like Ayushman Bharat.
Exam angle
- Regulator: IRDAI; panel sits under the Insurance Advisory Committee.
- Related terms: Bima Sugam, NHCX, risk pooling, medical inflation indexing.
- Numbers to recall: ₹1.24 lakh crore, 8%, 86.8%.