Irdai sets up panel to review private health insurers, signalling major overhaul

Irdai sets up a panel to review private health insurers, signalling a potential overhaul in claims, pricing, product design and grievance redressal.

Written by FE Bureau

April 7, 2026 20:25 IST

Health insurance reforms on the cards as Irdai panel examines coverage gaps, hospital tariffs and consumer experience amid rising premiums.

The Insurance Regulatory and Development Authority of India (Irdai) has set up a sub-committee to review private health insurers, in what could be a precursor to major overhaul across health insurance claims experience to product design and grievance redressal.

The health insurance sub-committee, to be formed under the Insurance Advisory Committee (IAC), is part of ongoing efforts to improve policyholder experience and expand coverage, the regulator said on Tuesday.

“IRDAI has constituted a sub-committee of the Insurance Advisory Committee to review the current landscape of private health insurance in India, including coverage, penetration, claims experience, product design, grievance redressal and consumer experience,” it said.

What will this panel do?

The panel will examine healthcare provider networks, hospital tariffs, fraud control and digital systems to improve value for policyholders and reduce administrative inefficiencies. It will also review the interaction between private insurers and public health schemes, including scope for complementarity, portability and convergence.

The move comes as the health insurance industry reported record premium collections of ₹1.24 lakh crore in FY26, aided by a GST cut.

Despite this, health insurers face mounting public criticism over claim settlement experience and steep increase premiums, making health insurance unaffordable. Irdai’s focus on hospital tariffs, through the proposed sub-committee, addresses a long-standing issue, with insurers and hospitals often at odds over pricing and claim approvals.

The sub-committee will also consider recommendations from Confederation of Indian Industry (CII) working groups on the health insurance ecosystem. These include a joint code of conduct for insurers and providers, frameworks for commercial engagement and provider classification, scaling up the National Health Claims Exchange, studies on claims trends and medical inflation, and a basic product framework.

Last month, Irdai reconstituted IAC, which includes representatives from industry bodies such as the Life and General Insurance Councils, Institute of Actuaries of India, Insurance Brokers’ Association of India, and trade bodies like CII and FICCI.

This article was first uploaded on April seven, twenty twenty-six, at twenty-five minutes past eight in the night.