The Insurance Regulatory and Development Authority of India (IRDAI) has formed a new subcommittee under its Insurance Advisory Committee to carry out a broad review of the private health insurance market, as premiums rise and product offerings evolve. The subcommittee has been asked to examine the current structure and performance of private health insurance in India, including coverage levels, penetration, claims experience, product design, and grievance redressal.
The committee will also look at overall policyholder experience and identify regulatory, policy, and operational changes that may affect coverage, risk pooling, and financial protection provided through health insurance. IRDAI has indicated that the exercise is part of its wider work on policyholder outcomes and confidence in health insurance as a risk management tool. The regulator is expected to consider the subcommittee’s findings when assessing future rules and supervisory expectations for the health segment.
One of the core areas of the subcommittee’s work will be the relationship between insurers and health care providers. This will include a review of how provider networks are structured, how hospital tariffs are set and applied, and how these arrangements affect policyholder costs, claims behaviour, and dispute levels. The group will also examine fraud, waste, and abuse in the health insurance ecosystem. It is expected to look at current fraud control practices, gaps in detection and prevention, and the scope for more consistent approaches across insurers and intermediaries. The use of data analytics, common protocols, and shared information is likely to feature in these discussions, given their relevance to loss ratios and pricing assumptions. Digital infrastructure is another area under review. The subcommittee will assess the role of digital systems in reducing administrative friction, processing claims, and servicing both individual and group customers. This includes the use of electronic claims platforms, linkages with hospital information systems, and the digitisation of policy administration.
Beyond the private sector, IRDAI has asked the subcommittee to study how private health insurance interacts with public health insurance and assurance schemes. The review will look at areas of overlap and potential complementarity, as well as options for portability of cover and possible convergence of processes or benefits where appropriate. The committee will also draw on existing industry work. It has been mandated to review and incorporate recommendations from working groups convened by the Confederation of Indian Industry (CII) on health insurance ecosystem issues. Those groups have considered a joint code of conduct for insurers and providers, templates for commercial engagements and provider classification, adoption and scale-up of the National Health Claims Exchange (NHCX), research on claims trends and medical inflation, and the design of a basic health insurance product. By linking regulatory discussions with these initiatives, the process brings together supervisory, market conduct, and operational perspectives on how the health insurance system functions.
The formation of the subcommittee comes as India’s health insurance segment records double-digit premium growth. Industry data cited by Angel One show that health insurance premiums in India increased 27.17% year on year in January 2026 to ₹5,414.54 crore. The increase has been associated with the recent change in goods and services tax (GST) treatment for individual retail health policies and higher volumes from government health schemes.
General insurers reported health premiums of ₹2,187.98 crore in January, up 20.4% from the same month a year earlier. Standalone health insurers reported faster growth, with premiums rising 32.3% to ₹3,226.56 crore. The numbers indicate that specialist health insurers are accounting for a larger share of the health portfolio relative to multi-line general insurers. Market observers also note rising participation from non-resident Indians (NRIs), adding cross-border servicing and compliance considerations for health insurers writing this business.
Medium- to long-term forecasts point to continued expansion of India’s health insurance market. A study by SkyQuest projects that the market will grow from US$15.99 billion in 2024 to about US$38.2 billion by 2032, implying a compound annual growth rate of 11.5%. The projection is linked to higher medical costs, shifts in consumer expectations, and wider distribution of insurance through agency, bancassurance, corporate, and digital channels.
Group health insurance remains the largest segment, backed by employer-sponsored schemes and pooled risk arrangements. Individual retail policies, however, are gradually increasing their share as households purchase standalone covers with specific benefit structures and sums insured. Private-sector insurers hold a larger share of the market than public institutions, reflecting a broader range of products and distribution partnerships. Within product lines, hospitalisation cover continues to be the main offering, reimbursing inpatient and surgical expenses. Critical illness policies are increasingly used as supplementary covers, providing lump-sum benefits that can be used for medical or non-medical costs and for income replacement.
